Indiana’s youth are consuming less alcohol and tobacco than previous generations, but marijuana use has held steadier, according to recent surveys. At the same time, the potency of tetrahydrocannabinol (THC), the psychoactive part of cannabis, in products like vapes has intensified, while perceptions about the harmfulness of marijuana have downshifted.
These trends are especially troubling for the developing adolescent brain, said Zachary Adams, PhD, associate professor and associate vice chair of research in the Department of Psychiatry at the Indiana University School of Medicine. Drugs taken during adolescence increase risk for harmful outcomes because the teen brain is still developing, especially in areas that control decision making and self-control.
“When we think about the potential harms of cannabis use, in the short term, consequences may look like having a hard time thinking straight and having slowed reaction time, as well as getting in trouble at home or school. In the longer-term, harms include the risk for mental health concerns and substance use disorders,” Adams said.
Drug addiction changes the brain, making it difficult to stop using a substance despite a desire to do so. Experts believe genetics, environment and brain development all play a role in whether someone will develop a substance use disorder.
In recent years, IU has ramped up efforts to reach Indiana’s youth with new prevention and intervention strategies.
“When we think about adolescent substance use, it can be complicated — why they’re using, the ways in which they’re using and even what they’re using,” Adams said. “That landscape is ever-evolving, so sometimes straightforward messages that ignore that complexity may not resonate with everyone. What seems to be helpful is for us to have several options on the menu for how to respond when we learn that somebody is using substances.”
Those options range from a couple visits via telehealth, for those at relatively lower risk for addiction, all the way to inpatient and residential treatment programs for the most complex cases. Adams is leading a five-year study along with Tamika Zapolski, PhD, to compare the effectiveness of a brief intervention program called Teen Intervene, paired with varying types of caregiver involvement and support. The study, funded by the Patient-Centered Outcomes Research Institute, is enrolling approximately 600 adolescents from diverse sociodemographic backgrounds through primary care clinics across the state, including rural, urban and suburban communities.
“These interventions could help redefine the way pediatricians and other primary care providers prevent adolescent alcohol and other substance use in Indiana and across the country,” Adams said.
How Teen Intervene is helping
The 2024 Indiana Youth Survey, conducted by the IU School of Public Health, showed 62% of 12th graders think there is “no or slight risk” in smoking marijuana once or twice per week; 46% saw little risk in consuming one to two alcoholic drinks per day, and 38% thought the same about smoking a pack of cigarettes a day. Students in 12th grade estimated that half of their peers drank alcohol and used marijuana, but fewer than 16% actually reported using alcohol, and 10% reported using marijuana in the past month.
Although adolescent substance use has been trending down nationally, an ongoing study by Monitoring the Future showed one-fourth of 12th graders have used marijuana in the past year, and 5% use it daily. There’s also an uptick in the number of teens using nicotine pouches like Zyn.
Intervening early is key to avoiding a chronic substance use disorder, Adams said.
“Teen Intervene is a brief treatment model that’s proven to be effective that uses skills and strategies like motivational interviewing and cognitive behavioral therapy principles to help kids reduce their substance use over time,” he explained.
The program is one of the many tools employed by the Adolescent Dual Diagnosis Program at Riley Children’s Health, which reaches teens across the state through telehealth and in-person visits as a joint effort of IU School of Medicine, IU Health and the state of Indiana. IU is also leading an initiative to support primary care teams to identify adolescents at risk for substance use disorders and to implement Teen Intervene in their practices statewide through integrated behavioral health programming.
“We’ve also worked closely with other groups around the state to implement the Teen Intervene model, including working with folks in the juvenile justice context,” Adams said. “And we’ve had conversations with schools about using this model because it’s a time-limited treatment for kids who have mild substance use, which is the majority of adolescents who are using alcohol and other drugs.”
Several factors can help motivate teens to avoid or stop using drugs and alcohol. Those include involved parents or caregivers and opportunities to participate in activities like sports, clubs or jobs — “any structured, supervised and sober activities that teens enjoy and value,” Adams said.
For those with an existing substance use disorder, he recommends consistent participation in treatment using evidence-based practices to equip teens and their families with effective skills and strategies, along with integrated treatment for any co-occurring mental health disorders.
Adams’ enduring motivation to do this challenging work comes from seeing positive changes in the lives of struggling teens and their families as they create stronger support networks.
“Substance use disorders and addiction are major public health concerns that levy huge costs to individuals, families and communities,” Adams said. “I’m energized by knowing that we have treatments that work to promote healing and recovery, and I’m inspired by the teens and families we serve.”
Get support
If someone you love is struggling with substance abuse, there are resources to help:
- FindTreatment.gov — anonymous resource for persons seeking treatment for mental and substance use disorders. Call: (800)662-HELP (4357)
- Partnership to End Addiction — resources and guide for parents and caregivers. Helpline: (855)378-4373 or text CONNECT to 55753
- Adolescent Dual Diagnosis Program at Riley at IU Health — treatment for Indiana youth ages 10-17 who struggle with substance abuse and mental health disorders
- IU School of Medicine Department of Mental Health Services — reference materials on a range of mental health topics including substance abuse disorder
- IU Employee Assistance Program — free, confidential support for IU employees and their household members. Call (888)881-5462
