5 Things Parents Need To Know For Addressing Teen Substance Use

"We're aware that our daughter's been using alcohol and marijuana—definitely more than we're comfortable with. But we're just not sure what to do about it." 

That's what the mother of a 15-year-old told me yesterday. And she's not alone. I hear some version of that statement from concerned parents almost every day. Addressing a substance use issue with a teen or young adult child can be one of the toughest challenges parents can face, especially these days with the changing landscape of attitudes about substance use, the legalization of cannabis products, and the availability of increasingly dangerous drugs.

But it's also one of the most important challenges parents need to face if the situation presents itself.

In some cases it can lead to preventing a potential problem. In other cases it can be the vital first step towards getting someone the kind of help that could literally save their life. 

But it's so easy to fall into a trap of not knowing what to do, or the right way to do it, or if it should even be done at all! "Are we overreacting?" "What if they get mad at us?" "Maybe it's just normal teenage behavior?" "They said they were just "holding it for a friend...."

I've specialized in adolescent substance use assessment, prevention, and treatment for over thirty years. In this article I'm going to share a few simple points I've learned over the years that can go a long way in removing some of the confusion and angst parents experience when addressing a potential substance use issue with a teen or young adult child. 

1. ASSESSMENT

When it comes to addressing a potential problem, one simple piece of advice I give to parents who find themselves in the position of trying to figure out what to do at the initial signs of substance misuse is a little phrase I came up with years ago:

"When in doubt, rule it out! Get an assessment!"

The first thing you want to do is get an assessment from a trained substance use professional. The objective of a substance use assessment is to determine a) the extent of the substance use, and b) the degree to which substance use may be contributing to problems in the substance user's life. 

This in effect allows you to have someone who's familiar with the world of young people and substance use put their eyeballs on your case and give you an informed view of your situation. It's not uncommon for parents to lack perspective when it comes to the world of substance use, especially with their own kids:

What's social use?

What's recreational use?

What's "normal" experimentation? 

How serious is this? 

What's the appropriate response? 

Having your situation evaluated by a professional is the first step in establishing a perspective that will allow you to make an informed decision about the next steps to take. 

Take Control of the Situation

It's not uncommon for parents to avoid taking action for fear of how their child will react. 

"He won't agree to an assessment."

The first thing I'll say on this one—especially if your child is a minor—is that if you can't get your own child to agree to an assessment, that's a whole other issue that needs to be discussed about boundaries and control in the family system. All I'll say on that here is:

a. Parents of minors are responsible for their child's welfare. Taking action to make sure a child doesn't have a substance use disorder is being responsible for their welfare. 

b. Parents of young adults can't force their child to address their substance use, so it becomes a matter of boundaries and what's acceptable to you. And you offer them a choice: "We're asking you to address your substance use." If they choose not to, you set your own boundary that lets them know how strongly you feel about them addressing the issue. Again, that's a bit more complex as far as learning how to set informed boundaries, but as you'll see in a moment, it all starts with becoming educated about substance use disorder. 

Rule it Out

With regard to assessment, the important thing to stress at this point is that we simply want to "rule it out." If it's not a problem, it's not problem! There's some pretty specific criteria that goes into determining what qualifies as a "problem" or not, and the counselor can't make up a problem if it doesn't exist. So you can present to the child who is adamantly denying that they have a problem, completing an assessment is simply their opportunity to prove it. 

We'll get to what it means to have a "problem" in moment. But for here, I just want to drive home the point that it's not an overreaction to obtain an assessment, even at the earliest sign or hint of substance use. If a trained substance use professional is able to examine the circumstances and concludes that that whatever's going on doesn't constitute problem—then you know. You've ruled it out, and you don't need to burn up a lot of mental energy stressing over whether it's an issue or not. On the other hand, if the results point to the fact that there is indeed an issue, it's not an overstatement to say that you could be saving a life, or at least avoiding a lot of heartache. 

2. EDUCATION

Technically, assessment is merely an information gathering process.

No counseling.

No education.

We're simply asking questions and plugging the obtained information into a framework that points us to what type of intervention is indicated. Technically, I can tell if a client has a "problem" and "needs to go to rehab" by simply completing an assessment. 

But let's think this one through for a moment. 

If I complete the assessment and tell the client "You've got a drug problem and you need to go to rehab," give the parents the name of three facilities to check out, and say "Good luck!," how do we think that's going to work out? 

Chances are, all we're doing is leaving the parents with a really angry kid on their hands. And they spend the first three weeks of rehab fighting with him about why he's there. (If they even get there at all!)

During the years that I ran my own adolescent outpatient treatment program, we would offer a free assessment as part of the intake process for admitting kids into the program. Over time, I became notorious with the rest of the staff for taking a really long time to do assessments. "Jim! You can't  be taking three hours for an assessment—especially when we're not charging for it!" But I did this because I happened to feel that if you're going to tell a client they have a problem, they deserve the respect to take the time and help them understand why you're saying that. 

And that requires education. 

Which is not technically part of an assessment. 

What I sort of naturally fell into was this process of trying to cram a ton of education into that assessment time to help them:

a) understand what it means to have a "problem", and

b) arrive at their own conclusion about what needs to happen based on their diagnosis.

At the end of the assessment it wouldn't be uncommon for me to bring stunned parents back into the room where they would hear their child—who just an hour earlier had been angry and in denial—inform them that their drug use was in fact a problem and that they needed to go to treatment. 

As a result of an objective, informed discussion on what it means to be diagnosed with substance use disorder, getting treatment becomes their own idea. And when it's their own idea, they're going to be more motivated and ready to take treatment seriously. On the other hand, for clients whose substance use does not rise to the level of being diagnosed with an actual substance use disorder, having a good understanding of what this all means goes to heart of prevention efforts. The goal here would be to help the client gain a clear understanding of the potential risks of continued substance use. 

As you can see, the common denominator for successful intervention at both ends of the spectrum is effective substance use education. 

3. INTERVENTION

Assessment is strictly an information gathering process. In theory, a clinician can make a treatment recommendation based on the results of an assessment. But in the the strictest sense of the term, "assessment" does nothing as far as helping the client understand the recommendation. What I was doing in those long assessments where I delivered education to help the client understand the nature of their condition was in effect transitioning into what would more accurately be identified as intervention, as opposed to assessment. 

"Intervention" is a broad term you'll see used in various ways throughout the mental health field, including the iconic surprise meeting where family and friends read letters to the substance user to let them know how concerned they are. Don't worry, that's not what we're talking about here. In this discussion we're going to use the term "intervention" to refer to the action of following through with a recommendation based on the information gathered through the assessment. 

You can see from my example of when I was cramming a lot of information into the really small window of one assessment session, the key to successful prevention or treatment efforts is the seamless transition from assessment to intervention. And the secret sauce for turning assessment into successful intervention is—you guessed it: education. This is the most effective way of helping the client understand and accept the recommendation for what needs to happen next.

• In early stages of substance use, this may lead into continued prevention efforts.
• In more advanced cases, this may include some form of intensive treatment.

Regardless of which direction the recommendation goes, helping the client apply effective substance use education to the specific details of their own case is the first step in creating motivation to follow a plan. 

This short article doesn't provide the time and space needed to present everything that would be included in a comprehensive discussion on what I keep referring to as effective substance use education. (I do that in my online course called Understanding Substance Use Disorder) However, to at least give you an idea of what I'm talking about, I'll take a moment here to provide an example of how substance use education ties in directly to effective intervention efforts.

The Problem with "Problem"

One of the first things that needs to be addressed when dealing with a substance use issue is making sure that everybody's on the same page as far as what we're even talking about! And that starts with identifying all the problems that the word "problem" can cause. 

Think about it. 

There are so many terms that get thrown around when referring to issues related to substance use:

• substance abuse
• substance misuse
• experimental use
• social use
• addiction
• alcoholism
• chemical dependency

And what ends up happening is we tend to lump all of this into one default term, which is: problem.

As in, "What does it mean to have a problem?"

And the problem is, everybody ends up with their own definition of what it means to have a "problem." 

Talk about a lightning rod for creating tension, conflict, and resistance! Just mention the word "problem" to your child in a conversation about their own substance use and be prepared for the nuclear blowback: "I DON'T HAVE A PROBLEM!!!" Or how about, "IT WOULDN'T BE A PROBLEM IF YOU DIDN'T THINK IT WAS A PROBLEM!!!"

This particular issue goes to heart of just how important substance use education can be when it comes to successful intervention. Because in this case—if we really want to call this for what it is—what we're talking about when we use the term "problem" is whether or not an individual has, or is at risk for developing, a diagnosable medical condition called Substance Use Disorder. 

Explaining exactly what we mean when we talk about having a  "problem" can go a long way in helping the resistant client become more open-minded and willing to address the issue. Ultimately, understanding what it means to be diagnosed with Substance Use Disorder is what's going create the motivation to follow the recommendation for the next step, which will be either prevention or treatment. 

4. PREVENTION

For clients in the early stages of substance use, some form of prevention activity may be recommended. Technically speaking, this would be for the client who does not meet the criteria for being diagnosed with a substance use disorder; we're trying to prevent that from happening. This could include drug awareness education, therapy, or some combination of both. 

Referring back to our discussion on what it means to have a problem, one of the first things we'll talk about with regard to "non-problematic" substance use is that either:

a. bad things don't happen as a result of the substance use, or

b. if bad things do happen, the user is able to change his or her behavior to prevent bad things from continuing to happen. This would imply the user has control over their substance use. 

Even at the earliest stages of substance use, I'll tell parents there's nothing wrong with making a big deal out of it and initiating some form of assessment and prevention effort. Getting in trouble related to substance use does not automatically mean there is a problem (substance use disorder). However, when discussing prevention with parents I tell them it's like we're going to shine a big spotlight on the issue with the goal being "If you didn't get it before, now you do. You're not supposed to be using." With the right combination of education and applying it to their own circumstances, it's not uncommon to get them to the point of saying, "Yes, I get it now. It's not a good idea for me to keep using at this time in my life." And they agree to abstain. And if they indeed have control, they will be able to stick to that. 

5. TREATMENT

The treatment stage is where being informed about what it means to be diagnosed with a substance use disorder really comes into play.

To begin with, it's important to reiterate that "Substance Use Disorder" is a medically diagnosable condition with categories of mild, moderate, and severe. If diagnosed, it needs to be treated.

However, it's important to clarify exactly what we mean when we use the term "treatment" in this discussion. It's understandable that many young people might immediately assume we're talking about "getting sent off to rehab" and totally dig their heels in when we say, "you have a substance use disorder, and it needs to be treated."

But here's another example of how taking the time to provide some specific education about what it means to have a "problem" can help to avoid this issue. 

For instance, Substance Use Disorder is identified as a chronic condition. That means it lasts a long time. There is no pill that makes it go away. Simply admitting it's a problem and agreeing to stop using doesn't mean the condition automatically goes away. Rather, the client needs to learn how to manage the condition, much like a diabetic learns to manage their condition to avoid bad things from happening related to the condition. Helping the substance user remain abstinent and develop tools to prevent relapse are the kinds of things that would fall under the umbrella of "treating" the condition. 

Another important reason for understanding Substance Use Disorder diagnosis has to do with the categories of mild, moderate, and severe. Again, if a substance use disorder is diagnosed, it needs to be treated. However, the treatment plan for someone in the mild range is likely to be different than for someone in the severe range. At the risk of oversimplifying this, the severe end is where you will see the "going to rehab" type of plans, whereas treatment plans for clients on the mild end of the spectrum may be much less intensive. Helping the client understand this can go a long way in removing resistance when we talk about needing to "treat" their condition. 

One more point I'll make here about treatment has to do with what we refer to as "level of care."

When Substance Use Disorder is diagnosed, the recommendation is typically going to be some form of what we refer to as intensive treatment. In this case, "intensive" basically refers to how many hours per week the client is engaged in treatment.

• Intensive Outpatient (IOP )   This is typically regarded as the minimum level of care for treating a substance use disorder. A typical IOP format consists of group and/or individual sessions 3-5 times per week, for a total of 10-12 hours per week.
• Residential Treatment Center (RTC)  This is where the client resides at the treatment center for anywhere from 1-3 months. Upon completion of RTC they typically step-down into IOP or Outpatient (OP) counseling to continue their treatment at a lower level of care.

Again, the point I want to make here is that IOP is typically regarded as the lowest level of care appropriate for the primary phase of substance use disorder treatment. The idea is to start at the least restrictive level of care; thus IOP is often the first consideration. However, it's not uncommon for circumstances to indicate the need to start at the RTC level of care. The important point to be aware of here is that seeing a therapist for a weekly individual counseling session (OP) is not typically regarded as an adequate level of care for comprehensive substance use disorder treatment.

(For parents who have a child in treatment, the RehabWorks Family Support Program is an online course that teaches families how to provide effective treatment support and give their loved one the best chance possible for treatment success. LEARN MORE HERE)

SUMMARY

Just Say No, War On Drugs, The D.A.R.E Program... Addressing teen substance use has been a major challenge since I began working in this field in 1984. While we've obviously made a lot of progress, it remains one of the biggest challenges parents face today: "What do we do when we discover our child has been using drugs or alcohol?"

What I've attempted to do in this article is present a simple guide for helping you take control of a situation where it's easy to feel intimidated, confused, and in some cases overwhelmed. Let's do a quick review of what we've talked about:

1. "When in doubt, rule it out." 

Whether it's the first sign of substance use, or it's something you've been concerned about for a while, but just haven't been sure about what to do: Get an assessment. A trained substance use professional can put things in perspective and give you an idea of what you're dealing with. 

2. Education, education, education!

The secret sauce for effectively addressing a substance use issue is being informed. The more you learn, the more confident you will be that you are taking the right steps, regardless of where the process leads. 

3. Assessment + Education = Successful Intervention

In the world of substance use intervention, a recommendation without an explanation is a set-up for resistance and power struggles. To the contrary, including specific substance use education at this point can go a long way in removing resistance, and in many cases it leads to acknowledgement of a problem and motivation to change. 

4. Prevention

An effective prevention program is like shining a spotlight on the behavior, applying drug awareness education, and helping the client weigh out the potential risks of continued use versus the benefits. (See my PREVENT! program below) 

5. Treatment

If Substance Use Disorder is diagnosed, it needs to be treated. Treatment plans may differ depending on the severity of the condition. The overall goal of treatment at any level of care is to help the client learn how to manage their condition and prevent relapse.

When considering what's at stake when it comes to addressing a substance use issue with a young person, it can't be overstated how important it is for parents to be informed and prepared to take action. The good news is that it isn't as hard as it may appear at first. Knowledge is power, and the material contained in this short discussion can serve as a crucial first step towards taking control of a situation that you don't want to let get out of control.

RESOURCES

PREVENTION /ASSESSMENT

Understanding Substance Use Disorder   An online course that takes all the confusion out of addressing a substance use issue with a loved one. You'll learn:

• the difference between social use and having a problem
• how to respond to resistance and denial
• how Substance Use Disorder is diagnosed 
• what causes addiction

GO NOW > >

PREVENT!   An intensive evaluation program for teen and young adult substance use clients.

• For clients in the early stages of substance use, it becomes a prevention program.
• For clients in more advanced stages of substance use, it becomes an intervention. It helps the client understand why more help is needed, and saves valuable treatment time by not having to argue with a resistant client. 

LEARN MORE > >

TREATMENT SUPPORT FOR PARENTS

The RehabWorks Family Support Program   An online learning platform for parents of substance use treatment clients.

Education: Learn what clients are learning in treatment

Boundaries: Tools for restoring healthy family balance

Measurement: Monitoring treatment progress and compliance

Included:

• Hours of fun and engaging videos
• Custom PDFs based on material from Jim Savage's book Rehab Works! A Parent's Guide To Drug Treatment
• Interactive worksheets
• Tools for measuring progress
• Coaching support

GO NOW > > 

RehabWorks Family Recovery Package (coaching program)   An intensive coaching program that allows you to be guided by Jim Savage through your loved one's entire treatment process, giving you the best chance possible for treatment success.

LEARN MORE > >