Which of the following is a hallmark sign of substance use disorder in adolescents?

• A. Secrecy
• B. Neglect of responsibilities
• C. Craving
• D. Improved physical fitness

Answer: (C)

Craving is the strong, persistent urge to use a substance. This intense motivation to seek and use reflects changes in the brain’s reward system that keep pulling a person back toward the substance, even when they want to stop or cut back. In adolescents, cravings can appear as intrusive thoughts or urges that resurface in response to cues, and they signal a loss of control over use—one of the core features clinicians look for when identifying a substance use problem. Because craving directly captures that compulsive pull to use, it serves as a clear indicator of substance use disorder.

Secrecy and neglect of responsibilities can occur with substance use, but they aren’t diagnostic on their own and can arise from many other issues. Improved physical fitness, on the other hand, does not fit the pattern of a substance use disorder and isn’t a hallmark of it.