Alcohol and drugs in the teenage years: when it is time to worry

Saturday, ten past one in the morning. The key takes a long time to find the lock. When the door finally opens, your fifteen-year-old son steps over the threshold a little too carefully, like someone walking on ice. The hallway smells of alcohol and of something sweet that was meant to cover it up. “I’m just tired,” he says, and walks past you straight to his room.

You stay in the hallway with two opposite wishes at once. The first is to knock on his door right now and find out everything: where, with whom, how much, who sold it to them. The second is to pretend nothing happened, because at that age you also came home dizzy once or twice and “it’s all part of growing up”. Both wishes make sense. Neither of them helps on its own.

This piece is written mainly for parents. It will not give you a formula for calculating whether your teenager is “at risk”. What I will try to explain is how to tell curiosity from a problem, what makes sense to do that same night and what the next day, and when worry is justified to the point where you need help from someone outside the family.

Experimenting is not the same as a problem

Most young people come across alcohol during their teenage years. That is not an excuse, it is a starting point. If you treat every first drink as the beginning of addiction, you will react so strongly that your teenager mainly learns one thing: never to tell you about it again. If you wave every first drink away as harmless, you will miss the moment when curiosity turned into something else.

Between these two extremes lies a difference that cannot be measured in millilitres. What matters more than the amount is the purpose and the pattern. A teenager who drank too much at the school prom and felt sick the next day did something foolish. A teenager who drinks alone in his room because otherwise he cannot fall asleep, or who has a drink before every party just to be able to talk to people, is using a substance for something he does not yet know how to manage any other way. That is a different story, even if the amounts are similar.

I have written more about what repetition does to the reward system in Addiction is not weak will: what happens to the reward system. Here I will stay with what matters particularly in the teenage years.

Why the age of the first drink is not irrelevant

A teenage brain is not an unfinished adult brain, but a brain in a different balance. Laurence Steinberg described this as two systems that do not mature at the same pace: the part that seeks reward, novelty and excitement is very active in puberty, while the part that slows down, plans and weighs consequences matures more slowly, right into the mid-twenties. One of his experiments with a driving simulator is particularly telling: adolescents took considerably more risks when they knew their peers were watching, whereas for adults the presence of friends changed almost nothing.

This means two things. First, your child can sit at the kitchen table on his own and say, quite reasonably, that he is not going to drink, and mean it. At midnight on Saturday among friends, a different system is at work. It is not a lie; it is the difference between “cold” and “hot” decision-making. Second, an early start is not irrelevant. In a large American survey, Bridget Grant and Deborah Dawson found that among people who started drinking before the age of 15, roughly 40 per cent became dependent on alcohol, compared with roughly 10 per cent among those who started at 21 or later. The study does not prove that the first drink itself is to blame — early drinking is often tangled up with other factors, from family history to distress — but it shows clearly enough that delaying is not an empty moral demand.

When it is time to worry

One evening when he comes home drunk is a reason for a conversation. The reason for worry is a pattern. It often turns out that the signs were there earlier, but each on its own seemed too innocent to connect. So I list them here together:

• Drinking or smoking alone. Teenage drinking is mostly social. When it becomes private, it has a different job.
• The substance as medicine. “I can’t sleep without it.” “Just to calm down before the test.” When a substance becomes linked to managing anxiety, sadness or anger, that tells you more than the amount.
• Blackouts. A teenager who cannot remember how he got home drank enough to be in danger, however often it happens.
• Mixing. Alcohol together with cannabis, sedatives from the bathroom cabinet or unknown pills from a party.
• Changes that add up. Grades dropping without explanation, old friends disappearing, new ones you are not allowed to meet, lost interest in sport or hobbies, money or things going missing at home.
• Driving. If he got behind the wheel drunk, or into a car with someone who was, that is a red line, even if it happened once.

Similar logic applies to cannabis — I have written about when it becomes a problem and when it does not in Cannabis: when it becomes a problem and when it does not. For teenagers it is worth adding only that a developing brain is more sensitive, and that today’s products are often considerably stronger than the ones parents remember.

When he comes home drunk: safety first, the talk tomorrow

The night he comes home drunk is not the time for a talk about upbringing. Someone with alcohol in their blood will not remember what you said, and you will probably say something you do not mean. That night is for one thing only: making sure he is safe.

If he is sleepy but responsive, do not leave him lying alone on his back. Recovery position, water by the bed, the door left ajar, and check his breathing a few times. If you cannot communicate with him, cannot wake him, his breathing is irregular, he is vomiting while semi-conscious, he is cold and pale, or you suspect he has taken something else as well, call 112 (the emergency number in Slovenia). Better to call once too often. Alcohol poisoning is not rare, and a teenage body has no experience that would stop it in time.

Leave the conversation for the next day, when you are both sober and rested. If you can, say just one thing that night: “Good that you’re home. We’ll talk tomorrow.” That is not being soft. It is a message that home is still a place he can come back to even when he has messed up — and everything you try to tell him tomorrow will stand on that message.

What parents really know about their teenagers

For a long time it was believed that the best-protected teenagers were the ones whose parents monitored them most closely. Håkan Stattin and Margaret Kerr looked at this more carefully and found something unexpected: what parents know about where their children are and what they are doing comes mostly not from monitoring or questioning, but from what teenagers tell them of their own accord. And a teenager tells what he knows will be heard without the world falling on his head.

For parents this is both a relief and a demand. A relief, because you do not have to become a detective. A demand, because your reaction to the first confession decides whether there will be a second. A parent who explodes at the first truth guarantees that next time they will hear a lie. There is more about what lies behind teenage concealment in When a teenager lies: what lies beneath.

That does not mean you may not know where he is, or that you may not set rules. It means rules work better when they are known in advance, when the consequence is proportionate and when the relationship survives it. A teenager who knows that breaking a rule will cost him one weekend out, but not your affection, has more reason to tell you the truth than one who has no idea what awaits him.

How might the start of the conversation the next day sound? Like this (a composite, not a real person):

“You came home drunk last night. I’m not going to interrogate you, but I’d like to understand what happened.”
“Nothing happened. Everyone was drinking.”
“I believe they were. What was good about it for you?”
“I don’t know… I was more relaxed. I could talk to people normally.”
“And otherwise you can’t?”
“Otherwise it feels like everyone is watching how weird I am.”

Something important happened in this short exchange. The mother did not start with an accusation or a lecture about livers. She asked what alcohol had given him. And the answer was not “fun”, but relief from social anxiety. That changes the direction of the conversation: it is no longer only about rules on drinking, but also about how he feels among his peers when he is sober.

The conversation will not necessarily go this smoothly. Often the first question will be met with a roll of the eyes and “it’s nothing”. That is not failure. Teenagers often check whether an adult is really willing to listen before they say anything serious. Sometimes the real answer comes three days later, in the car, when he does not have to look you in the eye.

A glass at home so he learns to drink?

In Slovenia there is a deep-rooted belief that a child should “learn to drink” at home, under supervision, so that he will not overdo it outside. I have written about how drinking becomes normalised here in Alcohol in the Slovenian family: how it is normalised until it breaks.

Research does not support this belief. Richard Mattick’s Australian group followed a group of teenagers and their parents for several years. Teenagers who were given alcohol by their parents did not go on to drink any less riskily — on the contrary, they were more likely to get alcohol from other sources as well. The authors found no trace of the protective effect parents were counting on. Moreover, in Slovenia alcohol may not be sold or served to anyone under 18 — so society has already drawn the line, and a parent can either support it or undermine it.

Something else matters more than that glass: how the adults at home drink. A teenager learns more from watching his father “need” a beer after work to unwind than from every conversation about moderation. This is not a reproach; it is an invitation to look at yourself, too.

What lies underneath

In relational family therapy, which I am training in at the Franciscan Family Institute, we also see an individual’s symptom as a message about the relationships he lives in. That does not mean the parents are “to blame” for a teenager’s drinking. It means it is worth asking what drinking is doing in this family at this moment.

Sometimes it is simply belonging — being part of a group that matters to him. Sometimes it is a way out of a home where there is tension, where the parents argue or one of them is ill. Sometimes it is quiet self-help with anxiety, depression or loneliness that nobody at home notices because the teenager seems to be functioning. If you are also noticing withdrawal, loss of enjoyment and changes in sleep, read Teenage depression: telling it apart from ordinary mood swings. What looks like rebellion from the outside is often, from the inside, an attempt at emotion regulation with whatever is at hand.

Your own regulation matters too. A teenager does not calm down next to a frightened, shouting parent; he shuts down. Next to a parent who stays present and reasonably calm, his nervous system settles more easily — we call this co-regulation. It does not mean you may not be angry or scared. It means you wait with the talk about rules until you are on solid ground again yourself.

If you notice that your teenager talks about death, about how it would not matter if he were gone, or is harming himself, do not wait. Call his doctor, and in an emergency 112. In Slovenia, the mental health crisis line (Klic v duševni stiski) is available at night on 01 520 99 00 (7 pm to 7 am), the Samaritans helpline on 116 123 around the clock, and for children and young people the TOM helpline on 116 111. How to respond to self-harm is described in Self-harm: what it really means and how to respond.

Exercise: preparing for the conversation

This exercise is for you, not for your teenager. Do it before the conversation, ideally the day before, with someone you trust or on your own with a pencil in hand.

1. Write down what you are afraid of. Not what you will say to your child, but what goes round your head at three in the morning: “That he will end up like his uncle.” “That he will die on the road.” A fear you do not name turns into shouting during the conversation.
2. Separate facts from assumptions. In one column, write what you actually know (he came home drunk, two bottles are missing from the cellar). In the other, what you are inferring (“he probably drinks every weekend”). Start the conversation with the first column only.
3. Prepare one curious question. For example: “What was good about it for you?” or “How did you feel the next morning?” A question you do not know the answer to opens more than ten you do.
4. Decide on one limit and one consequence. Just one, and one you can actually follow through. For example: home at the agreed time; if not, he stays in next weekend. Threats you do not carry out teach him that your words do not count.
5. Offer a safe way home. Tell him: “If you’re ever somewhere you can’t get home from safely, call me. I’ll come and get you, no lecture that night.” The conversation about what happened comes the next day — but his life comes before the rules.

Where this approach is not enough

Everything I have written about curious questions and calm conversations applies to a teenager who is experimenting or occasionally drinks too much. It does not hold as the only response when the signs are more serious. If your teenager drinks or uses drugs almost every day, has blackouts, shows unusual perceptions, paranoia or severe mood changes, has been in a road accident or has been in hospital with poisoning, then a conversation at home is not enough. That calls for a professional assessment — first with his GP or paediatrician, who can refer him on.

Nor is parental calm a magic wand. A teenager who drinks because there is violence at home, or because one of the parents drinks, will not stop thanks to a well-handled conversation. In such families it is often not the teenager who needs “fixing”, but something in the system around him. How addiction affects every member of a family is described in When addiction reaches the whole family: the roles children take on.

And finally: even the most thoughtful parent cannot prevent everything. A teenager has his own will, his own friends and his own secrets. Parenting at this stage is not control over the outcome, but making sure there is an adult at home he can turn to when something goes wrong.

Where to find help

For the teenager himself, the first places to turn are his GP or paediatrician, the school counselling service and a therapist who works with children and adolescents. He can also contact the TOM helpline for young people in Slovenia, 116 111, on his own and anonymously. You can also go to the doctor yourself, even before your teenager agrees to talk — they can tell you how urgent it is and where to go next.

For parents and the family as a whole, family therapy can help. Such a session is not about putting the teenager “on trial”, but about the family looking together at what is going on between them: how they talk, who sides with whom, what is left unsaid. It often turns out that drinking is only the most visible part of something that has been in the air for a long time. If the problem has already grown into addiction, there is more on how parents can respond in When your child becomes addicted: parents between guilt and boundaries. What addiction actually is is briefly explained in the knowledge base under addiction.

If an approach that does not demand immediate, complete abstinence from a teenager feels foreign to you, also read Harm reduction: an approach that does not demand immediate abstinence. With minors it is no substitute for clear limits, but it can help keep safety alongside the limit.

What to remember

• One drunken evening is a reason for a conversation; a pattern is a reason for worry — purpose and repetition count, not just the amount.
• Teenage brains take more risks among peers; that is not lying but a feature of development, which is why limits need parents.
• The night he comes home drunk is for safety; the talk comes the next day, when you are both sober.
• Parents know most when a teenager tells them himself — your reaction to the first confession decides whether there will be a second.
• With daily use, blackouts, mixing substances or thoughts of death, do not wait: the doctor, crisis lines, 112.