What substances do pre-teens and teenagers use most often?
Over the past decade, alcohol, cannabis and nicotine have become teens’ and pre-teens’ most frequently used substances. While nicotine use from tobacco (via cigarettes) has decreased significantly over the past decade, rates of vaping nicotine have increased. Teens may also seek to ‘get high’ with over-the-counter cold medications and prescription medications, including cough and cold medication, pain medications (e.g., opioids), attention deficit hyperactivity disorder (ADHD) medications and sedatives (e.g., benzodiazepines).
When do children and teens begin to try substances?
Research indicates that the average age of first use of alcohol is 13 years. For cannabis, the average age of first use is 14 years.
Binge drinking (having five or more drinks at one time) is common among teens and often takes place during drinking games. One-in-ten students (10%) in grades 7–12 report binge drinking at least once in the past month. For Grade 12 students, this number is one-in-five (20%).
Some children may try a small amount of alcohol or nicotine at a younger age as part of their family’s cultural or religious practices. There is little evidence to say that these practices either protector promote future problematic substance use.
At what point should I become concerned that my child has a substance use disorder?
Teens and pre-teens may engage in substance use on a spectrum, from use that has a lower risk of harm to substance use disorder and addiction. The more regularly a teen uses a substance, the more likely they are to experience related harms.
Regular substance use can be associated with a range of physical and mental health problems, difficulties at school and at home and legal issues. The health risks of substance use increase with frequency of use, and with use of more than one substance at a time, especially with alcohol.
Substance use can also lead to dependence. When someone is physically dependent on a substance, they build up a tolerance to it and need to use more of it over time to get the same effect. If they stop or try to use less of the substance, they experience physical symptoms (also known as withdrawal symptoms). The level of dependence is based on the substance, the amount the person takes and how frequently they use it.
While teens may not be using a substance in a way that results in physical dependence, ongoing regular use of one or more substances can lead to a substance use disorder. Teens who have a substance use disorder will often:
- miss school, work or other responsibilities due to substance use
- crave whatever substance(s) they are using
- be unable to quit using despite trying to.
Does anything make a substance use disorder more likely?
A substance use disorder is more likely to develop if:
- a child or teen has a mental health condition (see below)
- there is a family history of addiction
- there is a history of abuse or other adverse childhood experiences (also referred to as ACEs)
- a child or teen identifies as LGBTQ2S+
- a teen is street-involved (unhoused).
Do issues with substance use occur with other mental health conditions?
About one-third to one-half of young people with a mental health condition such as depression, anxiety or ADHD will also have or develop a substance use disorder. This is called a concurrent disorder. Of teens with a substance use disorder, one third to half will have or develop a concurrent mental health condition.
What should I do if I am concerned that my child or teen has a problem with substance use?
Monitor your child's behaviour and have an open conversation with them about anything you have observed and your concerns that they might be using alcohol or another substance. When addressing substance use with your child or teen, focus your concerns on their health and wellbeing.
When to see a health-care professional for specific help
If you have any concerns about problematic substance use, encourage your teen to see, or bring your teen for an assessment by, a health-care professional or another helping professional such as a guidance counsellor.
Let your teen know that you understand they may not want to share certain things with you as their parent or caregiver but that they can get information about their health and raise any concerns privately with their health-care provider.
As teens are generally healthy as a group, they may not see the need to see their health-care provider. It is a good idea to encourage your teen to have a check-up with their health-care provider to review their general physical, mental and social health. The check-up is an opportunity to identify the factors that might put your teen at risk for problematic substance use. It also allows a teen to talk to their health-care provider about any aspect of their health.
Resources
Please visit the AKH Teen Mental Health Learning Hub for information on substance use and substance use disorder.
References
Boak, A., & Hamilton, H. A. (2024). Drug use among Ontario students, 1977–2023: Findings from the Ontario Student Drug Use and Health Survey (OSDUHS). Toronto, ON: Centre for Addiction and Mental Health. Retrieved from https://www.camh.ca/-/media/research-files/osduhs-drug-use-report_2023.pdf
Canadian Centre on Substance Use and Addiction (n.d.). The Real Deal on Youth and Drugs. Retrieved from http://www.ccsa.ca/Eng/topics/Children-and-Youth/Real-Deal-on-Youth-and-Drugs/Pages/default.aspx
Canadian Centre on Substance Use and Addiction (2016). Marijuana: Fact and Fiction. Retrieved from http://www.ccdus.ca/Resource%20Library/CCSA-Marijuana-Fact-and-Fiction-Infographic-2016-en.pdf
Canadian Centre on Substance Use and Addiction (2017). Canadian Drug Summary: Alcohol. Retrieved from http://www.ccsa.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Alcohol-2017-en.pdf
Health Canada. Alcohol and Drug Use among Students in Canada, 2023–24: Key findings from the Canadian Student Alcohol and Drugs Survey [Internet]. Government of Canada: Ottawa (ON); 2025. Retrieved from: https://www.canada.ca/en/health-canada/services/canadian-student-tobaccoalcohol-drugs-survey/2023-2024-key-findings.html
