Talking to Teens About Substance Use: What Parents Should Know

A recap of Cartwheel’s family webinar with Amy McCarthy Baluch, LICSW, Director of Social Work for Adolescent Substance Use and Addiction at Boston Children’s Hospital

Talking with your child about substance use can feel uncertain — when to bring it up, what to say, how to keep the conversation going without shutting it down. Most parents and caregivers have thought about these questions at some point, even if nothing specific has prompted it.

In a recent Cartwheel family webinar, Amy McCarthy Baluch, a licensed clinical social worker who has spent more than 15 years working with adolescents and families navigating substance use, shared what the research shows, what parents can watch for, and how to approach these conversations in a way that builds trust rather than resistance.

Here are some of the key themes from that session:

Adolescents are developmentally primed for risk — and that's important context.

One of the first things Amy addressed is something many parents find reassuring: risk-taking in adolescence isn't a character flaw. It's biology.

The prefrontal cortex — the part of the brain responsible for planning, decision-making, and impulse control — doesn’t fully develop until around age 24 or 25. During that window, young people are wired to push boundaries and experiment. That doesn’t mean substance use should be expected or accepted, but it does mean that when it happens, meeting it with empathy alongside clear limits tends to be more effective than meeting it with anger alone.

Amy used a simple analogy: a toddler wants to walk up and down the stairs, but doesn't yet understand the danger. We don’t punish them for it — we put up gates, walk behind them, and teach them. The same principle applies with adolescents and substances, just at a different scale.

The substance landscape has changed — and parents may not realize how much.

Amy shared several data points that surprised many attendees.

Cannabis is significantly more potent than it was a generation ago. Parents who used cannabis as teenagers may underestimate the risk because their own experience turned out fine. But the THC content in today's cannabis is substantially higher than what was available in previous decades, and clinicians are seeing consequences that weren't common before — including cannabinoid hyperemesis syndrome (chronic vomiting requiring emergency care) and cannabis-induced psychosis.

Nicotine vaping has introduced levels of nicotine that are, in Amy's words, “almost unquantifiably higher” than what previous generations encountered. Vapes are designed to be discreet — shaped like pens, highlighters, or USB drives, often flavored to appeal to younger users.

Fentanyl is present in a significant portion of the drug supply. It is 50 to 100 times more potent than morphine, often undetectable, and frequently mixed into other substances without the user's knowledge. Amy shared that an estimated 7 out of 10 pills on the illicit market are now counterfeit, and that a lethal dose of fentanyl can fit on the tip of a pencil. Many young people who have died of opioid overdoses had no known substance use history.

This isn’t meant to create panic. It's context that helps parents understand why the conversations matter — and why accurate information is more effective than fear-based messaging.

The language we use shapes how young people think about substance use.

Amy opened the session with a note about language that's worth highlighting. Many of the terms commonly used around substance use — “addict,” “junkie,” “clean,” “dirty” — carry judgment and reinforce stigma. That stigma can make it harder for young people (and adults) to seek help.

Some of the shifts Amy recommended:

→ “Drug abuse” → substance use disorder, addiction, or misuse
→ “Addict” or “alcoholic” → person with a substance use disorder
→ “Clean” → abstinent, not currently using, or negative test
→ “Dirty” → actively using, or positive test

These aren't just clinical preferences. When families use non-stigmatizing language at home, it signals to young people that substance use is something that can be talked about — not something that has to be hidden.

Not as many teens are using substances as most people think.

One of the most useful pieces of information Amy shared was about norms. There’s a widespread perception — among both teens and adults — that “everyone” is using substances in high school. The data tells a different story.

According to the Monitoring the Future study, an annual national survey of young people, less than half of 12th graders report current regular alcohol use. For cannabis, less than half of seniors reported ever having tried it, and only about 20% reported current use.

This matters because perceived norms influence behavior. When teens believe everyone is doing it, it normalizes experimentation. Resetting those norms with accurate data — sharing with your child that most of their peers are not regularly using — can be a meaningful part of the conversation.

Parental involvement is one of the strongest protective factors.

The research is consistent on this point: young people whose parents are actively involved in their lives are less likely to use substances. Amy cited several specific behaviors associated with lower risk — families eating dinner together regularly, parents checking in on homework, frequent praise, and perhaps most significantly, teens perceiving that their parents strongly disapprove of substance use.

That last point is worth sitting with. It’s not about having a single dramatic conversation. It’s about consistently, clearly communicating that you care about their health and that you don’t approve of underage substance use — while also making it clear that your love for them isn’t conditional on their choices.

Talking to middle schoolers vs. high schoolers requires different approaches.

Amy offered age-specific guidance that parents can adapt to their own families.

For middle schoolers:

→ Connect substance use to things they care about — their goals, their friendships, their involvement in sports or activities
→ Get to know their friends, and when possible, their friends’ parents
→ Rehearse scenarios: what would you do if someone offered you something at a party?
→ Let them know they can always call you to leave a situation — no questions asked in the moment
→ Consider a code word they can text if they need you to come get them
→ Use what's around you — a scene in a movie, a lyric, a news story — as a natural way into the conversation

For high schoolers:

→ Involve them in setting expectations and consequences — young people are more likely to respect rules they helped shape
→ Be direct about what you're seeing and what concerns you
→ Stay informed about what's circulating in their school and community — and ask them what they're seeing
→ Emphasize the danger of buying pills or substances through social media
→ If they ask to drink at home because “it's safer,” Amy’s guidance was clear: research shows it sends a mixed message and reinforces the idea that there’s a safe way to use substances as an adolescent

The through-line across both age groups: listening matters as much as talking. Amy noted that many of the best conversations happen in the car, on a walk, or side by side — settings where the pressure of direct eye contact is reduced.

If you discover your child is using substances.

Amy described a cycle she sees often: a parent discovers substance use, reacts emotionally, the teen shuts down, the parent becomes more vigilant, the teen retreats further, and trust erodes on both sides.

Her guidance for breaking that cycle:

→ If your child is safe, you don’t have to address it in the moment. It’s okay to take a few hours or even a day to think about how you want to approach the conversation.
→ Be factual, not accusatory. “I found a vape in your room and I'd like to understand what’s going on” opens a conversation. “How could you do this?” closes one.
→ Ask open-ended questions. How long has this been happening? What does it look like? What's going on for them?
→ Separate the behavior from the relationship. “I disapprove of this, and I love you” can coexist in the same sentence.
→ Consider reaching out for guidance — to your child’s pediatrician, a school counselor, or a clinician who can help you assess whether additional support would be helpful.

Amy also recommended family meetings — short, structured check-ins (no more than 15 minutes, once or twice a week) that start with what's going well before getting into concerns. They can happen anywhere — at the kitchen table, at Dunkin’ Donuts, on a walk. The point is creating a predictable space where both the parent and the teen know hard topics will be discussed, so neither side has to bring everything up in the heat of the moment.

One thing every family can do: learn about naloxone.

Amy recommended that all families — not just those concerned about substance use — have naloxone (often known by the brand name Narcan) available at home. Naloxone reverses opioid overdoses and can be obtained without a prescription in many states.

Her reasoning: a significant number of young people who have died from opioid overdoses had no known history of substance use, and many of those overdoses happened at home. She framed naloxone as a public health tool — comparable to sunscreen or seatbelts — rather than something that signals a problem.

Resources Amy shared

→ justthinktwice.com — Evidence-based information about substances, designed for young people
→ SAMHSA Treatment Locator — Helps families find substance use treatment providers nationwide
→ Motivational Interviewing for Parents — A course that helps caregivers learn communication techniques used in substance use treatment (link available in the webinar recording)
→ Awkward Conversations Podcast — Co-hosted by Amy, covering real-world challenges facing teens and families, including substance use

Continuing the conversation

If this topic resonated with you, or if you're noticing something with your child that you'd like to talk through with someone, Cartwheel's clinicians are available to support families — whether that's through parent guidance sessions, individual therapy for your child, or family therapy.

You don't need to have a crisis to reach out. Sometimes a conversation with a clinician is the most helpful next step.

Learn more and request support →

Cartwheel’s family webinar series covers topics that matter to parents and caregivers — from managing anxiety and school avoidance to navigating social media and building healthy habits. 

Our next session focuses on parenting a child with ADHD. Register here →

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