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Experts say parents should deal with bullying behavior at an early age. Halfpoint/Getty Images

Compared to children who don’t bully others, those who do bully are more likely to use drugs, alcohol, and tobacco later in life, according to a study published Feb. 17 in Pediatrics.

The meta-analysis from 28 publications involved 28,477 participants and included 215 effects. Bullying was associated with all types of substance use.

In addition, children who bully had a higher risk of nonsubtyped substance use, such as general substance use dependence.

The researchers also found that childhood bullying had a stronger link to later alcohol and tobacco use than adolescent bullying. That was not true of drug use.

The study authors acknowledged a large variability in how bullying and substance use are measured. They say that bullying may be a risk factor for substance use.

However, they can’t make conclusions about causal risk factors that could be the basis for preventive interventions.

Also, though bullying is linked to depression and other negative life outcomes, the researchers caution against overestimating the societal relevance of the effects of bullying.

Joseph J. Palamar, PhD, MPH, is an associate professor in the Department of Population Health at New York University Langone Medical Center.

Palamar told Healthline that it’s important not to assume that substance use leads to addictions or substance use problems.

In the study, marijuana and illegal drugs were folded into one category.

“Is it really appropriate to categorize marijuana with heroin?” asked Palamar. “In addition, by young adulthood, more than half of young adults in the United States (52 percent) have used marijuana. So, ironically, what this study finds is that bullying is associated with young people later falling in the majority of young adults who have used an illegal drug.”

Palamar suggested that it may be more useful to study whether drug use increases the risk of bullying or being bullied.

Mayra Mendez, PhD, LMFT, is a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in California.

Mendez told Healthline that parents may not realize how family history plays into substance misuse.

“It doesn’t mean that everybody who has an alcoholic parent will be an alcoholic, but if there’s already a tendency toward substance use and misuse within the family, the risk is much higher,” she explained.

Adolescents tend to want to leap into adulthood, said Mendez.

“Little things, say struggling with self-image, or mild mood shifting going on, might make them more inclined to use alcohol if it’s available in the home, or something a friend offers, for the simple sake of feeling better,” she explained.

But feeling better is temporary, so they’ll do it again.

“Substances numb the pain and confusion in the moment. They don’t connect it to the drop after the high is gone and they feel worse. When someone gives or buys them substances, they feel connected to something. They may show less interest in home and family because they’re more connected to something outside,” said Mendez.

Signs that your child or teen might be using substances may be subtle at first, then more pronounced. These include slipping academic performance, truancy, and mood shifts.

Childhood pranks can get out of hand and kids can get hurt. But that’s not necessarily bullying behavior.

An important differentiation, according to Mendez, is that bullying is not a one-time or occasional thing. Another has to do with intent.

A childish prank can be hurtful or carry a bad message, but it’s without intent to cause harm and is followed by regret.

“Bullying is more long-standing. You have planning and plotting. They go after a target with the intent to cause harm or to make themselves feel superior, even though that’s an artificial perception. A bully tends to hold what they did as a badge of honor, and they get a thrill out of it,” said Mendez.

That kind of behavior is hard to keep under wraps all the time. There are usually identifiable signs at home.

Rachelle S. Theise, PsyD, is a licensed clinical psychologist and clinical assistant professor at NYU Child Study Center at NYU Langone.

Theise told Healthline that while we often think children who bully are angry, mean, or are bullied themselves, we should keep in mind that they can also be nice kids who are just seeing what it’s like to dominate.

“Bullies often feel powerful, funny, or cool when they realize the power they hold,” said Theise. “When kids don’t get these positive feelings from other activities or talents, they may keep hurting others to feel better about themselves.”

Early signs of bullying can include making fun of siblings more than usual or being purposely mean or sneaky toward others, she added.

“Kids who bully repeatedly may feel undermined and put down in other aspects of their lives, and if those feelings are not addressed, they could grow into long-standing patterns of anxiety and depression,” said Theise.

“Those early signs of bullying should be addressed immediately,” said Theise.

“Putting others down can become a habit for some kids who feel empowered or stronger by being mean. As a community, we’re all responsible for speaking up to someone who’s acting cruel. Kids need attention for the positive things they do so that helping and kind behaviors are then reinforced,” she added.

Parents can help by including empathy in everyday conversations.

“Ask kids what it might be like to live in other people’s shoes. Challenge your child to come up with reasons why someone may have acted a certain way. Parents should also focus on kids’ strengths in order to reinforce positive behaviors and decrease attention to their misbehaviors,” said Theise.

Mendez stressed the need to talk about the issue, not in a hostile manner, but in open discussion without the bullied person present, which can be threatening to both children.

“Invite an exchange about what’s going on. Express empathy to the bullying kid before you start to redirect to better behavior. Try to help with problem-solving. Make sure your bullying kid understands that everyone has the right to feel safe at home, at school, and in the community. There’s no allowance for bullying to continue,” said Mendez.

It’s not a one-time discussion but a process.

“You don’t drop it. You see it through,” said Mendez.

Mendez advised against the “wait and see” approach.

Discussions about substance use should be addressed, but in a non-accusatory, supportive way.

“Provide teens with credible sources such as the CDC, NIH, and SAMHSA, which deals specifically with substance use and mental health. Let them do some research on their own to help them understand what substances are and what they do to the brain and body. Empower them to inform themselves beyond what Mom or Dad says,” said Mendez.

You can also bring in a school counselor or psychologist. When seeking therapy, it’s important to find a specialist of your child’s age group.

Mendez wants parents to know that vigilance is important, but they don’t have to be in this alone. It’s OK to call in other family members or friends who have a good relationship with the child.

“It doesn’t mean you’re rejecting your kid, but that you have their best interests at heart,” said Mendez.