Prevenția consumului de substanțe interzise începe acasă – educația timpurie

Introduction

The prevention of illicit substance use is an essential component of public health, with significant implications for children’s mental, physical and social development. The literature highlights that the onset of these harmful behaviors is closely correlated with environmental factors and early childhood education, with the family playing a decisive role in shaping self-control mechanisms and decision-making abilities.

With this in mind, early education – which must take place within the family – becomes a frontline preventive tool. Through this, interventions based on effective communication, safety and the development of healthy behaviors drastically reduce the likelihood of attempts to use illicit substances.

This article aims to translate medical data into concrete steps for families, provide age-appropriate language and a monitoring framework, and guide parents on how to intervene early – before a crisis caused by substance use arises.

Why prevention starts at home and why it’s a medical issue

The use of illicit substances at a young age is associated with an increased risk of injuries, academic difficulties, mental health problems and substance use disorders. In the context of a brain that is still developing, exposure to psychoactive substances has more intense effects on cognitive functions, impairing judgment, attention and self-control. These vulnerabilities underscore the need for early preventive interventions grounded in the principles of neurobiology and preventive medicine, not merely in moral considerations⁽¹⁾.

The family is the primary setting where habits are formed, risks are discussed, and behaviors for seeking help are established. Parental modeling, establishing clear rules and adequate monitoring constitute effective, low-cost interventions that have a significant impact on reducing the risk of initiating substance use. In addition, early prevention also involves the early recognition of psychological vulnerability factors, such as anxiety, depression, trauma or impulsivity⁽²⁾.

Once substance use behavior has taken hold, intervention becomes considerably more difficult, as the child may have already developed dysfunctional behavioral patterns, may be part of a high-risk group, and may exhibit tendencies toward denial. For this reason, the primary goals of prevention are to delay first exposure and reduce the likelihood of repeated experimentation, thereby contributing to long-term health protection.

Prevention of illicit substance use begins, essentially, within the family environment, where a child’s first behavioral patterns, coping mechanisms and value systems are formed. An open relationship between parent and child significantly helps reduce the time between exposure to a risky situation and the moment the child seeks help. In this context, prevention programs focused on the family environment prove to be particularly effective when they promote authentic communication, the establishment of clear rules, and consistent monitoring of the child’s behavior. These elements also form what is known as the “protective triad”, which is an essential factor in reducing the risk of early substance use initiation, even in the presence of vulnerabilities⁽³⁾.

At the same time, the family is also the primary setting in which children learn to manage stress, frustration and social pressures. These skills become particularly relevant during adolescence, a period characterized by increased reactivity in reward circuits and incomplete maturation of executive control. From a neurobiological perspective, adolescents do not have a fully mature brain, particularly between the ages of 13 and 15 years old, which explains the tendency to seek immediate rewards at the expense of self-control; thus, mere awareness of the risks is not sufficient to prevent risky behaviors. The impact of substance use is not limited to behavior alone, but significantly affects cognitive and emotional functions, including memory, sleep quality and emotional regulation. Furthermore, there is a directly proportional relationship between the age of onset, frequency of exposure and the severity of neuropsychological consequences^(3,4).

The effects of substance use extend beyond the child, influencing the entire child-family-school system. In the school setting, this can lead to absenteeism, declining academic performance, reduced motivation and, in more severe cases, the risk of dropping out of school. At the family level, relationship dynamics may deteriorate, often characterized by a loss of trust, poor communication, tendencies toward overcontrol, recurring conflicts, or avoidance of discussions related to mental health. It is important to emphasize that delaying intervention significantly hinders the process of recalibrating this complex system. 

In situations where parents observe significant behavioral changes, it is essential to adopt a perspective focused on identifying medical and psychological causes, while avoiding stigmatization or denial of the problem. Shame is not a solution, and schools should be viewed as active partners, not merely passive observers; collaboration between families and educational institutions is crucial for effective prevention and intervention⁽⁵⁾.

In 2024, ESPAD published data on the main European trends related to substance use among adolescents. Several key findings are highlighted for the 15-16 years old age group, where 13% of students reported having used cannabis at least once, approximately 5% reported using other illicit drugs, and 2.4% began using cannabis at the age of 13 or earlier. Furthermore, 30% of participants perceive cannabis as easy to obtain. These data indicate that, while the majority of adolescents do not use illicit drugs, there is a vulnerable segment characterized by early experimentation that clearly requires early preventive interventions^(6-8).

Adolescent brain

Adolescence is a period of particular vulnerability with regard to the risk of substance use, as neurodevelopment continues beyond the age of 20. The brain regions involved in planning, judgment and impulse control mature more slowly, while reward systems respond immediately to novelty, social validation and intense experiences. This imbalance explains why adolescents may know the rules but still make poor decisions in emotionally or socially intense situations^(4,9).

Early-onset substance use should not be viewed as a minor episode, but rather as a sign of vulnerability, since early exposure can train the brain to seek quick fixes for stress, boredom, or the need to belong, increasing the risk of associating it with other problematic behaviors. Factors such as sleep deprivation, excessive screen time and difficulties with attention or self-regulation can further reduce a child’s ability to make decisions. For this reason, prevention is essential, as is fostering healthy alternatives for emotional regulation, reward-seeking and establishing a stable daily structure with a consistent sleep routine and clear rules that are consistently enforced⁽²⁾.

At the same time, seeking out new experiences is a normal part of adolescence, but it becomes dangerous when combined with easy access to substances, peer pressure, or a lack of clear guidance from the family. For children with a history of trauma or a family predisposition to addiction or mental health disorders, prevention must begin earlier and be consistently supported. However, biological predisposition or family history does not represent a clear path toward risky behavior, as a protective, predictable environment can alter this trajectory. Therefore, prevention that begins at home must include not only rules but also dialogue, practice in saying “no”, and a safe space where the child can talk about stress, anxiety or sadness without fear of being judged, so that they can understand what they are feeling⁽⁴⁾.

Risk and protective factors in the family

Within the family environment, the prevention of illicit substance use should be understood as an ongoing relational and educational process, not as a one-time reaction to the emergence of risky behavior. When family dynamics are marked by poor communication, conflicts, unclear rules, chronic stress or inappropriate parenting styles, the child’s vulnerability increases. In contrast, protective factors include secure attachment, explicit and consistent rules, a warm and predictable relationship with parents, and the family’s willingness to recognize the importance of mental health^(2,3).

In this context, the parent-child relationship plays a central preventive role. The strongest form of protection does not stem from prohibitions, but from the existence of a relationship that allows the child to feel safe enough to tell the truth – and not just a socially acceptable version of it. In their relationship with the child, parents must be empathetic toward the child’s emotions but consistent regarding boundaries – not through excessive control, but in a manner that conveys safety, not suspicion.

The emotional climate of the family is a very important factor, as mentioned earlier. A parenting style that normalizes excessive use or makes jokes about substance use loses its credibility. Similarly, criticism, recurring conflicts or unpredictability increase tension within the family and can turn substance use into a means of relief, rebellion or avoidance. Equally important is the parent’s mental state, as exhaustion, anxiety or depression reduce their ability to monitor, regulate emotions or maintain consistency. Family routines serve as protective factors by promoting early detection of changes in behavior or mood, as they reduce chaos and support self-regulation.

Psychoactive substances and their effects

From a medical perspective, the message conveyed to the family must emphasize that illicit substances pose a real biological risk to a developing body – not merely a behavioral problem. The immaturity of the brain net­works involved in memory, judgment and impulse con­trol amplifies the vulnerability of an adolescent’s or child’s brain^(4,10).

Cannabis can impair memory, attention, reaction time and decision-making ability, and forms presented as edibles or vaping products can create a false sense of safety by masking the actual dose they contain^(11,12). Similarly, cocaine, amphetamines or their derivatives can cause an excessive increase in dopamine and adrenaline, with significant cardiovascular and neurological risks such as tachycardia, arrhythmias, hyperthermia, hypertension or seizures^(13,14). MDMA, frequently used in recreational settings, poses additional risks such as dehydration, hyponatremia or acute toxicity, especially since the composition of the product is often unknown on the illicit market⁽¹⁵⁾.

A distinct group of these dangerous substances consists of opioids, particularly synthetic ones such as fentanyl. From a clinical standpoint, the major life-threatening risk is respiratory depression, which can occur even at low concentrations of the substance – found in preparations such as powders, tablets or other mixtures sold under various names. The clear message for families in such cases is that the unpredictability of the illicit market can lead to severe emergencies or even death from the very first exposure^(16,17). Similarly, hallucinogens, inhalants or new psychoactive substances pose a risk that is difficult to anticipate and control due to a lack of knowledge regarding their composition and potency. Poly-substance use further increases toxicity, as combinations of substances can mask initial symptoms and complicate emergency intervention⁽¹⁸⁾.

The assessment of substance use in a child or adolescent must always be considered within a psychological or relational context. Psychiatric comorbidity is common, and anxiety, depression, trauma or insomnia may precede substance use or contribute to it. For this reason, the medical approach must also consider the child’s biopsychosocial context, rather than treating the substance alone, and family intervention must aim for the early recognition of emotional distress and the seeking of specialized help when signs of vulnerability appear.

Preventive education tailored
to the child’s age

The effectiveness of prevention efforts regarding the use of prohibited substances depends significantly on tailoring the language and message to the child’s level of cognitive and emotional development. This education cannot be conceived as a one-size-fits-all approach applicable to all ages, but must be adapted according to the child’s ability to understand key concepts such as risk, responsibility, decision-making and the influence of peers.

In the early years of life, the focus is on creating a protective environment and providing information about protecting one’s own body. Between the ages of 0 and 5 years old, children must learn that they should not insert, touch or ingest certain substances without the consent of a responsible adult. Later, between the ages of 6 and 9, discussions can become more concrete by introducing simple concepts about the body, the brain, safety, and the differences between substances used for medical purposes and others that, if misused, can cause harm. The main objective of this stage is to develop the child’s ability to ask for help, to refuse the unknown, and to recognize what is not age-appropriate^(2,10).

Pre-adolescence and adolescence require a higher level of foresight. Since curiosity and indirect exposure emerge between the ages of 10 and 12, the family must be the one to initiate these discussions before peer groups become the primary source of information. Likewise, between the ages of 13 and 15, discussions should be explicit and cover more significant topics such as cannabis, pills, vaping, social media and peer pressure. Adolescents should be able to ask their families questions without being silenced by shame or moralizing remarks^(10,19).

The 16-18 age range is dominated by the teenager’s desire for autonomy. Therefore, it is imperative to uphold the principle of safety, even when the adolescents request space to make their own decisions. Family rules do not disappear under these circumstances; rather, they must be partially negotiated so as to maintain responsibility for the adolescent’s physical and mental well-being⁽¹⁹⁾.

One of the key elements of age-appropriate preventive education is how to respond to the questions asked by children or adolescents. Their curiosity about specific substances should be acknowledged and interpreted as an opportunity for dialogue with educational and preventive goals, not as a sign of deviant behavior. Strengthening the family’s role as the primary source of guidance and protection is achieved by providing brief, calm and non-sarcastic answers that also include medical information presented as clearly as possible. This helps the child remain open to communication and reduces the likelihood that they will later seek answers from their peer group or unverified online sources. Furthermore, the tone used when providing information must be respectful and should not inhibit or embarrass the child, as there is a risk that a harsh approach could shut down communication^(10,19).

Warning signs, screening and early intervention

A key step in secondary prevention is the early identification of signs suggestive of illicit substance use, as this allows for intervention before emotional, psychological, academic or family deterioration sets in.

In practice, the first observable changes are behavioral in nature, such as avoiding simple questions, telling new or more frequent lies, sudden changes in schedule, unusual irritability, impulsivity, repeated boundary violations and a decline in responsibility. None of these signs, if occurring in isolation, can be interpreted as a risk indicator. Instead, an assessment is warranted when a change in behavior persists, along with an analysis of its frequency, duration, context of occurrence and progression over time⁽⁹⁾.

These changes may be accompanied by psychological and emotional signs, such as mood swings, unusual anxiety, social withdrawal, apathy, euphoria, paranoia, or confusion. Clinically, these manifestations must be interpreted with caution, as they may be signs of intoxication, withdrawal or an associated psychiatric disorder^(20,21).

Other physical signs that may raise suspicion include red eyes, changes in the pupils, sweating, tremors, changes in speech patterns, alterations in sleep or appetite, vomiting etc. Situations that signal an emergency and require special attention include the lack of response to stimuli, seizures, respiratory depression, extreme agitation or hyperthermia^(17,22).

Often, the first noticeable changes are academic or social in nature. A sudden decline in academic performance, truancy, repeated conflicts, loss of interest in usual activities or a change in one’s group of friends may suggest risky behavior that requires a calm and structured approach. The appropriate approach is not direct accusation, but rather observation, documentation and discussion of the changes that have occurred. In this regard, collaboration with the school can be particularly helpful, providing a more accurate overall perspective compared to the observation of a single adult⁽²¹⁾.

In situations where the signs are vague or disputed by the family, screening conducted in the family physician’s or pediatrician’s office plays an important role. A medical consultation can provide a structured assessment regarding substance use, mental health, sleep and family risk factors, as well as referrals to psychological, psychiatric or addiction services. Seeking professional help is necessary not only in cases of confirmed or repeated substance use, but also in cases of severe emotional symptoms such as self-harm, suicidal ideation, marked social withdrawal, or when the family’s ability to ensure safety or maintain daily functioning is overwhelmed. In an emergency or suspected overdose, saving a life is the absolute priority, and the necessary steps are as follows: assess the level of consciousness and breathing, call emergency services, administer naloxone if available, and monitor the child or adolescent until the emergency medical team arrives⁽²⁰⁾.

Practical application of prevention: two clinical scenarios and common myths

To ensure the effectiveness of family intervention, it is important to apply preventive principles to specific situations. In practice, prevention is not just about conveying information, but about how parents respond to their child’s curiosity and warning signs.

A relevant scenario involves a curious preteen who has not yet used substances, but is exposed to language, images or messages about substances online or through their peer group. In this situation, a common mistake is avoiding the conversation for fear of “piquing their curiosity”. What is recommended is a calm, direct and early approach, using brief explanations about the effects on judgment, the brain and memory, and explicitly stating family rules. It is worth noting that the effectiveness of the prevention process does not stem from a single discussion, but from revisiting the topic in brief, natural conversations^(4,19).

A second scenario involves an adolescent who exhibits sudden behavioral changes and warning signs such as irritability, a decline in academic performance, the presence of suggestive items on their person (vapes or unknown pill packs), or an acute episode of confusion. Such a situation requires an intervention focused on observation, expressing concern and restoring a sense of safety – not the imposition of immediate punishments or an explosive emotional reaction from parents. Additionally, other helpful measures include temporarily limiting high-risk situations, promptly requesting a medical and/or psychological evaluation, and simultaneously assessing the child’s mental health, especially in cases involving anxiety or sleep disorders. The message must be conveyed in a way that combines firmness with maintaining a supportive relationship, so that the adolescent understands that the situation is serious but will not be left to face the problem alone^(20,21).

Equally, the implementation of preventive measures within the family is hindered by a number of persistent myths. The idea that discussing drugs introduces the child to this “world” or piques their interest is contradicted by a fundamental principle of preventive measures, since the absence of communication allows the child to turn to the internet or peer groups as sources of information or education. Furthermore, interpreting early warning signs as a temporary phase increases the risk of missing an opportunity for an intervention that could prove simple and effective.

Another common myth is the association of a substance’s “natural” character, even though its risk depends on the molecule and the dose, not on its label or origin. Downplaying the risk and generalizing the idea that all adolescents experiment, or relying on strategies based on severe punishments – without taking into account that sanctions are effective only if the principles of safety, relationship-building and follow-up dialogue are upheld – increase the likelihood that prevention measures will fail^(2,3).

Conclusions

The effectiveness of measures to prevent the use of illicit substances depends on the implementation of early interventions tailored to age groups and individual risk levels. Active family involvement, ongoing and appropriate communication, along with correcting misinformation about substance use are essential for reducing vulnerability and promoting healthy behaviors.

Current evidence supports the importance of a family environment that provides emotional support, consistent monitoring and access to specialized services when needed. In contrast, avoiding dialogue, extreme approaches or punitive measures can reduce the effectiveness of preventive interventions and harm the parent-child relationship.

Therefore, prevention proves effective when it is initiated before the first signs appear and is sustained through the family’s consistent, informed and responsible involvement, in collaboration with health and education professionals.

Autor corespondent:   Bogdan A. Stana E-mail: aurelian.stana@umfiasi.ro

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.