My Teen Seems Off. What Should I Watch For?
Your teen used to tell you about their day. Now they go straight to their room. They’re sleeping differently. Snapping more. Maybe grades have slipped. Maybe they just don’t seem like themselves. Is this typical teen behavior, stress or something that needs more attention?
Pay attention to what has changed—and what they’re doing to cope with it. That matters because emotional distress and substance use can overlap. In Song for Charlie’s latest national research, 73% of teens said coping with stress and anxiety is a common reason people their age misuse prescription pills.¹
KEY TAKEAWAYS
Look for changes from your teen’s usual baseline, especially changes that last more than a day or two or that get in the way of what your teen wants or needs to do.
Pay attention to how your teen copes with uncomfortable emotions, not just the emotions themselves.
Using alcohol, cannabis or pills to sleep, calm down, focus or escape difficult feelings can signal that your teen needs more support.
A sudden unexplained change that looks positive—your teen suddenly seems unusually calm, energized or “fine”—can also be worth asking about.
A pill from a friend is not a safe pill. Any pill not prescribed to your teen and dispensed by a licensed pharmacy carries risk.
WHAT’S NORMAL? Moodiness, wanting more privacy,turning to friends for support, and testing limits are all common during adolescence.² What matters more is a meaningful change from what’s typical for your teen’s.
WHAT SHOULD I WATCH FOR?
Pay attention to your teen’s mood and behavior.. Are you seeing changes that have lasted for days? Are the changes becoming more intense? Are they affecting sleep, school, relationships or activities your teen normally enjoys? The National Institute of Mental Health recommends looking more closely when emotions or behaviors persist, cause significant distress or interfere with everyday life.³ Mental health struggles don’t always look like obvious sadness. You may see:
Irritability or anger that feels different from usual
Pulling away from friends or activities
Major changes in sleep or eating
Persistent worry or avoidance
Trouble getting through school or everyday responsibilities
Frequent headaches, stomachaches or other physical complaints
Alcohol or other drug use
And ask yourself one more question: What does my teen do when things get hard? This is where mental health and substance-use prevention intersect. 73% of teens say coping with stress and anxiety is a common reason people their age misuse prescription pills.¹ When teens are overwhelmed, anything that promises quick relief can be appealing. A teen may reach for a substance to sleep, calm anxiety, improve their mood, focus on school or simply stop feeling bad for a while.
And early substance use may not always look like a problem.. A teen who has been anxious or overwhelmed may temporarily seem calmer, happier, more social or simply “fine” after trying a substance that provides relief or reward.⁴ That doesn’t mean that all positive changes are evidence of substance use. But any sudden, unexplained shift from your teen’s usual baseline is worth noticing. Start with curiosity:
“You seem different lately. How are you doing?”
“I’ve noticed you haven’t been sleeping much. What’s been going on?”
“When things feel overwhelming, what helps?”
Listen before you solve. In a 2024 survey of 1,675 families, young people said that when they were upset, they were much more likely to want parents to listen or give them space than to give advice.⁵
WHEN SHOULD I SEEK OUT HELP?
You may want to bring in additional support when mood or behavioral changes:
Have lasted for days on end or keep getting worse
Are interfering with school, sleep, relationships or everyday functioning
Include significant anxiety, depression or withdrawal
Involve alcohol or other drugs as a way to cope
Leave you feeling that your teen is no longer coping with feelings in ways that are safe
Consider talking with a school counselor, mental health professional, pediatrician or someone with experience in adolescent substance use. If substances are involved, try to understand what the substance is doing for your teen, instead of starting with a disciplinary response
For example, if you find a vape, alcohol or pills, ask:
“How long has this been going on?”
“Where did this come from?”
“What does it do for you?”
“Are you using this when you’re stressed, anxious, trying to sleep or trying to focus?”
The answers can help you understand whether you’re looking at experimentation, self-medication or a pattern that needs more specialized support.
WHAT IF I LEARN THAT MY TEEN HAS TRIED UNPRESCRIBED PILLS OR POWDERS?
If you learn your teen is taking pills that were not prescribed to them or using powdered drugs, do not wait to see whether it becomes a pattern. For pills, Song for Charlie’s latest research shows that teens make significant errors when assessing risk: 88% consider a prescription pill from a stranger online highly dangerous, but only 33% say the same about a pill from a close friend.¹ Make a clear rule : Never take a pill or powder that wasn’t prescribed to you and dispensed by a licensed pharmacy—even if it came from a friend.
Fake prescription pills can be made to resemble medications such as Percocet, Xanax or Adderall and may contain fentanyl or other dangerous substances.⁶ But fentanyl risk isn’t limited to pills. Illegally made fentanyl is also sold as a powder and can be mixed into drugs such as cocaine and methamphetamine, sometimes without the person using them knowing it’s there.⁶ You can’t tell by looking whether a pill is legitimate or whether a powder contains fentanyl.
If you find an unknown pill or powder, or learn that your teen has used either, talk with them that day. Find out what they know about it, where it came from and what they were hoping it would do for them. Consider contacting a healthcare professional or substance-use specialist for guidance.This is also a good reason to keep naloxone at home and to know how to use it.
WHAT MAKES FOR AN EMERGENCY?
Some situations should not be watched and waited on.
If suicide or self-harm is involved: Get immediate help if your teen says they want to die, talks about hurting themselves or someone else, has seriously harmed themselves or is doing anything that makes you believe they aren’t safe. Call or text 988 for the Suicide & Crisis Lifeline. Parents can also contact 988 because they are worried about a teen.⁷ If you are unsure, do not hesitate to ask: “Have you had any thoughts of harming yourself or ending your life?”
If an overdose may be happening: Signs can include being unable to wake someone, very slow or shallow breathing or choking, gurgling or unusual snoring sounds from someone who cannot be awakened. Give naloxone if you have it and call 911 immediately.⁸
If your teen is in immediate physical danger or experiencing another medical emergency, call 911 or go to the nearest emergency department.
WHAT IF I’M UNSURE ABOUT HOW MY TEEN IS DOING?
You don’t need to diagnose your teen. You do need to pay close attention. Notice what has changed. Notice whether it lasts. Notice how they are sleeping and how they are doing at school in their relationships. And especially notice how your teen tries to feel better when uneasy. Sometimes they’ll need space. Sometimes they’ll need you to listen. Sometimes they’ll need more help. The important thing is that they know they can come to you before they turn to any form of coping that could readily come at a cost.
NEED HELP NOW?
Crisis support: Call or text 988
Crisis Text Line: Text HOME to 741741
Find treatment: findtreatment.gov
Parent support: drugfree.org | nami.org
REFERENCES
Scott Hadland, MD, Chief of Adolescent Medicine, Mass General for Children/Harvard Medical School
Lisa Damour, PhD, Teen Parenting Expert, Best-Selling Author, Host of Ask Lisa Podcast
Fred Muench, PhD, CEO, Clear 30
SOURCES
Song for Charlie and Breakwater Strategy. 2026 national survey of 2,505 teens ages 13–17, young adults ages 18–24 and parents. Fieldwork conducted June 24–July 21, 2026.
American Academy of Child & Adolescent Psychiatry. Adolescent Development Part 1. Facts for Families No. 57.
National Institute of Mental Health. Children and Mental Health: Is This Just a Stage? nimh.nih.gov.
Muench, Fred, PhD. Expert review and clinical guidance provided to Song for Charlie.
Gallup and Walton Family Foundation, in partnership with Lisa Damour, PhD. Gen Zers to Their Parents: When We Are Upset, Just Listen. Survey of 1,675 youth ages 10–18 and a parent or guardian, March 2024.
U.S. Drug Enforcement Administration. Fake Prescription Pills. Drug Fact Sheet.
Substance Abuse and Mental Health Services Administration. 988 Suicide & Crisis Lifeline. samhsa.gov.
Centers for Disease Control and Prevention. What to Do If You Think Someone Is Overdosing. cdc.gov.
