More than misbehavior: Children living in the shadow of substance abuse

A boy sits in a classroom by himself, not talking to anyone. Another student screams, running around the library. The girl who always had excellent grades fails her classes. And yet another student hasn't been in school in weeks. Shifts in behavior, declining academic performance, frequent absences or signs of neglect are often the first symptoms teachers notice when a student is exposed to drugs. Students in elementary school tend to show the effects through behavior, emotional regulation or unfulfilled essential needs. More internalized reactions like depression, withdrawal, or, in certain situations, substance experimentation may be seen in middle and high schoolers. The Tennessee Bureau of Investigation shows the most used drugs in Tennessee include methamphetamine, cannabis-marijuana, fentanyl, cocaine and heroin as well as alcohol and nicotine. "Students impacted by substance abuse, whether their own or within the home, often experience difficulty concentrating, increased anxiety, inconsistent attendance and lower academic performance," local educator Alice Ann Smith said. "These challenges can significantly hinder their ability to fully engage in learning." Washington County had 466 severe child abuse cases total over the period of one year in 2024-2025, Children's Advocacy Center 1st Judicial District Education Advocate McKenna Lewis said. Drug-exposed children under 18 accounted for 126 of those. Between Jan. 1 and April 9, 2026, there have been 247 severe cases of child abuse across Carter, Johnson, Washington and Unicoi counties; 75 of those have been drug-exposed children. Tennessee law defines child abuse as a person under 18 that has suffered or may be in immediate danger of suffering from brutality or neglect from a parent or guardian, including physical, verbal, emotional or sexual harm. As of 2024, 21.7% of Tennessee's population is under 18. Out of 66,497 child abuse cases reported in Tennessee in 2023 to the Department of Children's Services, Carter, Johnson, Washington and Unicoi counties made up the following number: Carter: 671 cases (6.9%) Johnson: 234 cases (8.0%) Washington: 1,263 cases (5.0%) Unicoi: 198 cases (6.4%) Accidental ingestion, unsecured substances, parental exposure and proximity to drug usage or exposure during pregnancy are common reasons children are subject to substances. "I've seen it in Skittles, and they're basically dipped in THC, and it comes in a Skittles wrapper," said Dr. Josh Henry, medical director of the pediatric intensive care unit at Niswonger Children's Hospital. "It looks just like Skittles except in the background it's got pot leaves." Substance use is a tangled web of ways children can be affected, said Andrea Clements, affiliated researcher with the ETSU/Ballad Health Strong BRAIN Institute. She noted that distinguishing between the physical effects of drug exposure and environmental factors that influence behavior is difficult. "Your brain is built around what you're experiencing," Clements said. She added that a nurturing environment where children get read to and are clothed and fed regularly will build a healthy brain that is familiar with routines and schedules. In contrast, when growing up around addiction or abuse, children's brains are often in a survival mode; their brains get built around a lack of care. "And so, it's just going to act differently. And so, the people will grow up, and they may be reacting to the world differently just because of the way their brain was built." Relationships modeled in the household but also beyond will affect children's understanding of themselves and if they fall into addiction. Smith said that early intervention as well as relationship building play an important role in taking care of students who deal with substance abuse. "When students feel safe and connected at school, they are far more likely to seek help and respond positively to support systems," Smith said. "Addressing substance abuse is not just about intervention. It's also about prevention, education, and creating a school environment where students feel seen, supported and valued."