In the past, it was common to think of adolescent substance use as centered around peer acceptance or partying. Since the COVID-19 pandemic, the reasons teens are using substances are changing. While some data points are promising, such as high rates of substance abstinence, teens are also increasingly using substances alone, and to try to cope with mental health conditions and stress.
“Among adolescents being assessed for substance use disorder treatment, the most commonly reported reasons for substance use included seeking to feel mellow or calm, experimentation and other stress-related motivations. Most reported using substances with friends; however, approximately one half of respondents who reported past–30-day prescription drug misuse reported using alone.”
– Centers for Disease Control and Prevention (CDC), 2024
The risks of self-medicating
Self-medicating can be defined as using drugs (including alcohol, marijuana, tobacco or illicit drugs) to cope with physical or emotional pain. Self-medicating can also look like misusing prescription or OTC medications without a doctor’s guidance.
A teen brain is still wiring itself. The prefrontal cortex — the part of the brain responsible for making good decisions and controlling impulses — is not fully developed until the mid-20s. Meanwhile, the reward system is highly active. When a teen uses a substance to "fix" a problem, their brain learns that this is a shortcut to feeling good. This shortcut can lead to addiction.
Self-medicating can create a loop, where the brain needs more of the substance to get the same relief, or where the underlying issues are worse than before when the substance isn’t present. Frequent substance use can permanently change how a young person experiences joy, handles stress and manages their emotions.
“In the United States, more than 90% of adults who have a substance use disorder (SUD) began their substance use in adolescence. Additionally, youth who have SUDs have poorer health and functional outcomes and are at greater lifetime risk for experiencing various adverse consequences, including sexually transmitted infections, justice system involvement, school-related challenges, and increased mental health challenges.”
– SAMHSA, 2023
Substance use as a symptom
Common reasons teens have cited for self-medicating include dealing with undiagnosed mental health conditions, trauma or daily stress; trying to sleep; or “numbing” difficult thoughts and feelings.
“Studies show that ADHD, anxiety disorders, post-traumatic stress disorder and depression all increase risk of drug use and dependence in adolescents.” – Child Mind Institute, 2025
According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2024 National Survey, more than one in seven adolescents experienced a major depressive episode in the past year. Of those struggling with their mental health, those who did not receive treatment were twice as likely to start using illicit drugs.
Furthermore, the CDC notes that over 40% of high school students report feeling "persistently sad or hopeless." It isn’t hard to see how these challenges lead some youth to self-medicate.
Recent reports from the National Institute on Drug Abuse (NIDA) and CDC also show a troubling trend. While overall drug use has not skyrocketed, the potency of drugs has. Marijuana is 4X as potent as it was in the 1990s. Teens who take pills bought online are now at a high risk of accidental fentanyl poisoning. In fact, adolescent overdose deaths have stayed at record highs even as use rates for some drugs have leveled off.
Tips for providers
1. Prioritize integrated care
In the past, a teen might see one provider for help treating their anxiety, and another counselor or treatment provider for their marijuana use. For co-occurring conditions (simultaneous mental health conditions and substance use issues), treating both conditions at the same time improves outcomes. When you treat the underlying mental health concerns, you are helping treat the “need” to use substances — as opposed to treating substance use as an isolated behavioral issue.
2. Embrace harm reduction
Education about harm reduction practices — such as having access to and knowing how to use Narcan, and understanding the risks of fentanyl-laced “fake” pills — can save the lives of young people. Harm reduction is not in opposition to abstinence. Instead, abstinence is on the spectrum of harm reduction. Meeting teens where they are, even if they aren’t ready to abstain completely from substances today, can help keep them safe and improve their short- and long-term outcomes.
Learn more about working with non-abstinent clients →
3. Focus on "soft skills" and coping
It is widely known that replacing a behavior with a healthier alternative is often easier than simply stopping a behavior. If a teen is using drugs to handle stress, exploring other coping skills for stress management can help them gain confidence, increase their resilience and move away from self-medicating. Evidence-based programs that explore healthy coping skills like mindfulness, emotional regulation and seeking support can help. A teen with a toolbox of coping skills available to them may be less likely to reach for a substance.
4. Use digital tools
Digital tools can help lighten the load for staff while giving teens a way to engage that feels natural to them. Modern digital platforms like Atlas allow participants to work through programming in a self-reflective, interactive way. For a generation that has grown up with tablets and smartphones, a digital tool can feel less threatening than talking to a stranger in person. These tools can provide a safe place to explore their behaviors and learn new skills.
Learn more about working with youth in the digital age →
For providers, digital tools also offer something vital: data. They allow you to see where clients are making progress and where your resources are needed most. Integrated reporting and programming tools can streamline work for staff and improve outcomes for clients.
Are you ready to update your youth programs? Explore Atlas today to see how our digital tools can make a real difference for your staff and the teens you serve.
Evidence-based, behavioral health Interactive Journaling® curricula are available digitally on Atlas. Atlas can save staff time while supporting fidelity to evidence-based practices.
Ready to see what Atlas can do for your program? Visit our website to schedule a personalized demo today. Learn more about Atlas →
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