Limited Financial and Social Resources:

Adolescents with a lack of financial and social support systems have limited opportunities to build protective assets such as school engagement or social networks. 

Higher Rate of Mental Health Symptoms:

Mental health challenges, particularly for females experiencing depression or anxiety before age 21, are strongly associated with substance use disorders when transitioning into adulthood. 

Increased Exposure to Adversities:

Adolescents are more likely to engage in substance use disorders if they experience daily urban altercations, exposure to violence, and home-life instability. These adversities can be compounded.

Poor Caregiving Environments:

Weak parental attachment, inconsistent caregiving, and limited adult guidance reduce the development of internal assets, such as positive identity, values, and competencies) and contribute to higher rates of substance-related problems. 

(Min et al., 2022)

Social Participation 

Adolescents who often struggle with communication, social skills, and emotional regulation have difficulty forming and maintaining close relationships. They may display aggression and hostility, and frequently cope with stress by increasing their substance use. 

Self-Care

Adolescents with substance use disorders often experience disruptions in self-care, including poor hygiene,   irregular sleep, inadequate nutrition, and neglect of health routines. 

Leisure 

Leisure activities are often negatively impacted, as adolescents may limit their participation to activities that involve drinking, substance use, or engaging in risky and unsafe behaviors. 

Job and Education Participation

Adolescents with substance use disorders often experience disruptions in work and education, such as being late, having unexcused absences, and showing declines in overall productivity and performance.  

Cognitive and Sensory Processing

Substance use can lead to cognitive and sensory-motor problems such as rigid thinking, memory lapses, impaired motor and praxis skills, peripheral neuropathy, and reduced physical conditioning. Occupational therapists assess how substance use affects core cognitive abilities, including attention, memory, problem-solving, judgment, communication, and information processing. 

(Dogu & Ozkan, 2023)

"Occupational therapy aims to find purposeful and meaningful activities with adolescents with substance use or regain previously meaningful ones. In other words, they use the substance for building their self-esteem, feeling good, and defining their identity. Therefore, the aim of occupational therapy should be to reactivate the other occupational roles of the individuals, allowing them to be aware of their roles, and develop person-centered programs that include purposeful activities to meet the needs of the adolescents" (Dogu & Ozkan, 2023). 

Substance use recovery programs that incorporate occupational therapy life skills training have been shown to improve occupational performance, self-esteem, and overall quality of life for individuals with substance use disorders. A combination of practical experiences outside of rehabilitation centers combined with skill development, work training, life skills, and leisure exploration have been found to be the most useful forms of intervention (Dogu & Ozkan, 2023). 

The following is a list of techniques occupational therapy practitioners should implement when working with adolescents facing substance use disorders: 

• Practice empathy and effective communication strategies to build understanding and trust. 

• Assess the child's readiness for change and apply motivational techniques to support progress. Evaluate how substance use impacts daily occupations in self-care, productivity, and leisure.

• Support clients in developing healthier, more meaningful patterns of time use by replacing harmful activities with positive ones.

• Guide clients in setting both short-term and long-term goals to promote engagement in meaningful occupations.

• Collaborate with clients to assess relapse risks and create individualized relapse-prevention plans (Dogu & Ozkan, 2023). 

Below is a list of different intervention programs that may be effective when used together with occupation-based interventions. 

• Brief Interventions: 

  • Brief interventions are short, structured approaches (typically five or fewer sessions) that aim to identify substance use problems, motivate change, and support healthier behaviors. They follow a clear process of screening, evaluation, feedback, referral, and follow-up, and have been shown to reduce alcohol use. In occupational therapy, brief interventions are used to assess readiness for change, provide encouragement, and promote lifestyle adjustments that support participation in community life (Dogu & Ozkan, 2023).

• Motivational Interventions: 

  • Motivational approaches help understand an individual’s readiness to address substance use. Techniques such as motivational interviewing (MI) and motivational enhancement therapy (MET) emphasize empathy, client strengths, autonomy, and small steps toward recovery. Using strategies like the FRAMES model (feedback, responsibility, advice, menu of options, empathy, and self-efficacy), occupational therapists support clients in resolving ambivalence, motivating change, and planning further evaluation and interventions (Dogu & Ozkan, 2023). 

• Cognitive Behavioral Therapy:

  • Cognitive Behavioral Therapy (CBT) is an evidence-based, problem-focused approach grounded in learning theories. It helps individuals manage daily challenges by addressing unrealistic thoughts, beliefs, and negative self-perceptions related to substance use, replacing them with healthier perspectives. CBT also supports positive health behaviors, such as exercise, relaxation, and balanced activity, and can be applied across school, home, work, and leisure settings to strengthen coping skills (Dogu & Ozkan, 2023).

• 12-Step Recovery Program

  • Self-help groups, such as Alcoholics Anonymous (AA), provide long-term support alongside professional treatment through the 12-step approach. This model views addiction as a disease that can be managed but not eliminated, emphasizing spiritual growth, maturity, reduced self-centeredness, and helping others in recovery. Participation involves abstaining from substances, attending meetings, seeking and giving support, and engaging actively in a recovery-focused social network (Dogu & Ozkan, 2023).

Poverty and Socioeconomic Status

"Socioeconomic factors such as income, education, and occupation play a significant role in determining an individual's vulnerability to substance abuse" (LCDC, 2024). People with low income or unemployment face a higher risk of developing substance use disorders. Socioeconomic inequality heightens this vulnerability by limiting access to preventive health care and social support systems (LCDC, 2024). 

Additionally, socioeconomic disadvantage often leads to untreated mental health issues, contributing to substance abuse. The lack of access to mental health services can exacerbate the problem, creating cycles of addiction and poor mental health (LCDC, 2024). 

Parental Factors 

"Familial risk factors include childhood maltreatment (including abuse and neglect), parental or familial substance abuse, marital status of parents, level of parental education, parent-child relationships, familial socioeconomic status, and child perception that parents approve of their substance use." (Whitesell et al., 2013). 

Research consistently shows a significant link between experiences of physical or sexual abuse and adolescent use of substances such as nicotine, marijuana, and alcohol. Some studies also suggest higher rates of illicit drug use, including cocaine, heroin, and barbiturates, among those with such histories. Overall, adolescents who experience physical or sexual assault are two to four times more likely to engage in substance use (Whitesell et al., 2013). 

Studies also indicate that emotional abuse increases the risk of adolescent substance use, though its impact is less pronounced than that of physical or sexual abuse. Witnessing violence, particularly domestic violence, also raises the likelihood of developing substance use disorders with alcohol, tobacco, marijuana, or harder drugs by two to three times. This heightened risk is likely tied to the stress of exposure to violence, with substance use serving as a coping mechanism (Whitesell et al., 2013). 

Additionally, research consistently shows that adolescents who experience neglect face a higher risk of substance use. Studies also suggest that neglect during this critical developmental stage can have lasting effects on brain development. However, isolating the impact of neglect is challenging due to other contributing factors, such as domestic violence, low socioeconomic status, and prenatal substance exposure (Whitesell et al., 2013). 

Community and Social Environment 

Adolescent substance use is often influenced by social factors such as peer deviance, popularity pressures, bullying, and gang involvement. These social and family influences frequently overlap, creating a complex network of risk factors that must be carefully considered when addressing substance use (Whitesell et al., 2013). 

Peer influence also plays a significant role in adolescent substance use, often through deviant peer relationships (associating with peers who use substances) or through pressures tied to perceived popularity. Studies show a strong link between deviant peer groups and increased substance use. This may occur because adolescents with a tendency toward substance use are drawn to one another, or because individuals use substances as a means of gaining social acceptance and group membership. Similarly, peer pressure and the desire to be popular are strongly linked to adolescent substance use. Adolescents who believe substance use enhances their social status are more likely to use than those who do not (Whitesell et al., 2013). 

Trump team revokes $11 billion in funding for addiction, mental health care.

The Trump administration has proposed major cuts and restructuring to federal mental health and addiction programs, raising concerns from health experts and community providers. The plan would reduce funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) and fold it into a new entity called the Administration for a Healthy America. This restructuring would consolidate grant programs for opioid response, prevention, and community mental health, making them more competitive and potentially harder for local organizations to access (Mann, 2025).

Critics warn that these changes could roll back recent progress in addressing the opioid crisis and expanding access to community mental health services. Programs that provide naloxone, support crisis centers, and serve vulnerable groups such as youth, people experiencing homelessness, and minority populations could see reduced funding or delays. Opponents argue that the cuts risk worsening overdose deaths and straining local health systems, while supporters say the consolidation could streamline services (Mann, 2025).