It has been my experience as a pediatrician that parents of teenagers are becoming increasingly concerned about all the potential dangers that face their child through those turbulent adolescent years. The good news is that the great majority of teenagers navigate through successfully to become responsible, caring young adults. The bad news is that some do not, and substance abuse often is the reason.

Let me start off by stating that the occasional moderate use of alcohol, tobacco or marijuana by a teenager is not what I consider substance abuse and does not lead to dangerous "high-risk" behavior. Rather, it is normal for a teenager to experiment. Most teens go no further.

But, all teenagers are at some risk to become real substance abusers and so parents must remain alert and watch for any signs or symptoms of high-risk behavior. Weekend "binge drinking" or suspicion of marijuana smoking must be taken seriously. And we know drinking and driving can be tragic.

Sad to say, significant adolescent substance abuse is becoming an ever-growing large and difficult problem that parents must recognize. The facts are that cigarettes, alcohol and marijuana are frequently found in most U.S. high schools, and even in many middle schools. A number of studies have shown that drinking is common for many high school students and that "binge drinking" is not unusual. It is estimated that about 20% of our teenagers smoke cigarettes and have either tried or occasionally smoke cigarettes, and they have either tried or occasionally smoke marijuana.

It is imperative that the parents of an adolescent be aware of specific situations that place their teen at high risk for substance abuse and risky behavior.

There are three groups of teenagers that have been identified as being at particular "high risk" of becoming substance abusers with possible tragic consequences.

Athletes

This may surprise you but it is true, especially with superior athletes. The scenario often involves the young, great teenage athlete, age 14 or 15, who is good enough to join the high school varsity team while only in 9th grade. He spends more time with older students, and in an attempt to keep up with the juniors or seniors- but lacking the judgment of those older teammates-will be more vulnerable to serious substance abuse.

The peer pressure from his older teammates to experiment in highrisk behavior often is difficult for the young athlete to withstand. The message certainly is not to discourage your child from excelling in athletics but rather to remain alert to the possible problem.

Anxiety and Depression

Any teenager who suffers from severe anxiety or depression has been found to be at higher risk for substance abuse. A family history of anxiety or depression also puts your child at higher risk. The same holds true with a family history of alcoholism. Obviously, treating the depression must be a high priority, but recognizing the higher risk of substance abuse is also important.

Attention-Deficit/ Hyperactivity Disorder

A teenager with attention-deficit/ hyperactivity disorder (ADHD) falls into the "high-risk" category for substance abuse; she is more susceptible to getting hooked on cigarettes, alcohol and marijuana.

It is theorized that this is how these adolescents find relief from the stresses of living with ADHD symptoms. The good news is that ADHD teenagers who are well controlled with stimulant medication taken regularly and with strong support services have been shown to have much lower levels of substance abuse than those ADHD suffers who are not well controlled.

The bottom line is that parents can only do so much to protect their teenagers from engaging in high-risk behaviors. Between the amount of time they spend out of the house, on their cell phone, using social media and driving around, it is obvious that parents cannot always control or prevent serious substance abuse. But oarents can certainly lower the risk. Recognizing the high-risk groups described here will help. Open and honest communication with your teenager really is the key. It is a lot more effective than trying to control your child's behavior 24/7. Establishing a warm and positive relationship with your teenager is essential. The adolescent who feels protected and connected with a school, team or club- and above all is connected to a loving family- is less likely to indulge in dangerous substance abuse and risky behavior than a child who is not.

Let me reassure you that the odds are with you. Your teenager, despite some ups and downs, will usually turn out to be the adult you hope she will become. The best insurance policy against substance abuse is to keep the lines of communication open between you and your teen. Setting the right example is important, but there is also a small element of luck involved.

Finally, if you suspect a problem, don't ignore it and hope it goes away. Talk to your teenager about it and, if necessary, consult your pediatrician or family physician.

Author affiliation:

By Alvin N. Eden, MD

Author affiliation:

Dr. Eden is the chairman emeritus of the Department of Pediatrics, Wyckoff Heights Medical Center, Brooklyn, New York and a Clinical Professor of Pediatrics, Weill Cornell Medical Center, New York, NY. He practices in Forest Hills, NY. He is the past chairman of the Section on Pediatrics, New York Academy of Medicine. His latest book, Positive Parenting, is now available.