How do I know if my teen or young adult has a substance use disorder?
Addiction can happen at any age, but it usually starts when a person is young. If your teen continues to use drugs despite harmful consequences, he or she may be addicted.
If an adolescent starts behaving differently for no apparent reason—such as acting withdrawn, frequently tired or depressed, or hostile—it could be a sign he or she is developing a drug-related problem. Parents and others may overlook such signs, believing them to be a normal part of puberty. Other signs include:
- a change in peer group
- carelessness with grooming
- decline in academic performance
- missing classes or skipping school
- loss of interest in favorite activities
- trouble in school or with the law
- changes in eating or sleeping habits
- deteriorating relationships with family members and friends
Through scientific advances, we know more than ever before about how drugs work in the brain. We also know that addiction can be successfully treated to help young people stop abusing drugs and lead productive lives. Intervening early when you first spot signs of drug use in your teen is critical; don’t wait for your teen to become addicted before you seek help. However, if a teen is addicted, treatment is the next step.
Why can't some teens stop using drugs on their own?
Repeated drug use changes the brain. Brain imaging studies of people with drug addictions show changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. Quitting is difficult, even for those who feel ready.
If I want help for my teen or young adult, where do I start?
Asking for help from professionals is the first important step.
You can start by bringing your child to a doctor who can screen for signs of drug use and other related health conditions. You might want to ask in advance if he or she is comfortable screening for drug use with standard assessment tools and making a referral to an appropriate treatment provider. If not, ask for a referral to another provider skilled in these issues.
You can also contact an addiction specialist directly. There are 3,500 board- certified physicians who specialize in addiction in the United States. The American Society of Addiction Medicine website, http://www.asam.org, has a Find a Physician feature on its home page, and the American Academy of Child & Adolescent Psychiatry has a Child and Adolescent Psychiatrist Finder on its website, http://www.aacap.org. You and the physician can decide if your teen or young adult should be referred to treatment.
It takes a lot of courage to seek help for a child with a possible drug problem because there is a lot of hard work ahead for both of you, and it interrupts academic, personal, and possibly athletic milestones expected during the teen years. However, treatment works, and teens can recover from addiction, although it may take time and patience. Treatment enables young people to counteract addiction's powerful disruptive effects on their brain and behavior so they can regain control of their lives. You want to be sure your teen is healthy before venturing into the world with more independence, and where drugs are more easily available.
What kind of screening will the doctor do?
The doctor will ask your child a series of questions about use of alcohol and drugs, and associated risk behaviors (such as driving under the influence or riding with other drivers who have been using drugs or alcohol). The doctor might also give a urine and/or blood test to identify drugs that are being abused. This assessment will help determine the extent of a teen's drug use (if any) and whether a referral to a treatment program is necessary.
If my child refuses to cooperate, should the family conduct an intervention?
Most teens, and many young adults still being supported by their family, only enter treatment when they are compelled to by the pressure of their family, the juvenile justice, or other court system. However, there is no evidence that confrontational "interventions" like those familiar from TV programs are effective. It is even possible for such confrontational encounters to escalate into violence or backfire in other ways. Instead, parents should focus on creating incentives to get the teen to a doctor. Oftentimes, young people will listen to professionals rather than family members, as the latter encounters can sometimes be driven by fear, accusations, and emotions.
People of all ages with substance use disorders live in fear of what will happen if their drugs are taken away. You can ensure your teen that professional treatment centers will keep him or her safe and as comfortable as possible if a detoxification process is needed. Be sure to let your teen know that family and loved ones will stand by and offer loving support.
How do I find the right treatment center?
If you or your medical specialist decides your teen can benefit from substance abuse treatment, there are many options available. You can start by contacting the government's Treatment Locator service at 1-800-662-HELP (4357) or go online at http://findtreatment.samhsa.gov. (This service is supported by the Substance Abuse and Mental Health Administration in the U.S. Department of Health and Human Services.) This Treatment Locator service lets you to search for a provider in your area; it will also tell you information about the treatment center and if it works with teens.
What do I look for in a treatment center for this age group?
Treatment approaches must be tailored to address each patient's unique substance abuse patterns and related medical, psychiatric, and social problems. Some treatment centers offer outpatient treatment programs, which would allow your teen to stay in school, at least part time. However, some adolescents do better in inpatient (residential) treatment. An addiction specialist can advise you about your best options.
Who will provide treatment to my child?
Different kinds of addiction specialists will work together in your teen’s care, including doctors, nurses, therapists, social workers, and others.
Is there medication that can help?
There are medications available to treat addictions to alcohol, nicotine, and opioids (heroin and pain relievers). These are generally prescribed for adults but, in some circumstances, doctors may prescribe them for younger patients. When medication is available, it can be combined with behavioral therapy to ensure success for most patients. In addition, nonaddictive medication is sometimes prescribed to help with withdrawal. Other medications are available to treat possible mental health conditions (such as depression) that might be contributing to your child's addiction.
Your treatment provider will advise you about what medications are available for your particular situation. Some treatment centers follow the philosophy that they should not treat a drug addiction with other drugs, but research shows that medication can help in many cases.
If my teen or young adult confides in his or her doctor, will I be able to find out what's going on?
If your child talks to a doctor or other medical expert, privacy laws might prevent that expert from sharing the information with you. However, you can speak to the doctor before your child's appointment and express your concerns, so the doctor knows the importance of a drug use screening in your child’s situation. In addition, most health care providers that specialize in addiction treatment can’t share your information with anyone (even other providers) without your written permission.
In certain cases when health professionals believe your child might be a danger to him- or herself or to others, the provider may be able to share relevant information with family members.
What if my teen or young adult has been in rehab before?
This means your child has already learned many of the skills needed to recover from addiction, and he or she will only benefit from further treatment. Relapse does not mean the first treatment failed.
Relapse rates with addiction are similar to rates for other chronic diseases, such as hypertension, diabetes, and asthma. Treatment of chronic diseases involves changing deeply imbedded behaviors, so setbacks are to be expected along the way. A return to substance abuse indicates that treatment needs to be reinstated or adjusted, or that a different treatment might be called for.
How will I pay for treatment?
If your child has health insurance, it may cover substance abuse treatment services. Many insurance plans offer inpatient stays. When setting up appointments with treatment centers, you can ask about payment options and what insurance plans they take. They can also advise you on low-cost options.
The Behavioral Health Treatment Services Locator provided by the Substance Abuse and Mental Health Services Administration at https://findtreatment.samhsa.gov provides payment information for each of the treatment services listed, including information on sliding fee scales and payment assistance. Its "Frequently Asked Questions" section addresses cost of treatment. In addition, you can also call the treatment helpline at 1-800-662-HELP (1-800-662-4357) or 1-800-487-4889 (TTY) to ask about treatment centers that offer low- or no-cost treatment. You can also contact your state substance abuse agency—many states offer help with payment for substance abuse treatment.
Note that the new The Mental Health Parity and Addiction Equity Act ensures that co-pays, deductibles, and visit limits are generally not more restrictive for mental health and substance abuse disorder benefits than they are for medical and surgical benefits. The Affordable Care Act builds on this law and requires coverage of mental health and substance use disorder services as one of ten essential health benefits categories. Under the essential health benefits rule, individual and small group health plans are required to comply with these parity regulations. When you research payment options, be sure you are speaking to people familiar with the new rules (old websites and pamphlets will not necessarily be accurate.)
What kind of counseling is best for a teen or young adult?
Your child's treatment provider will probably recommend counseling. Behavioral treatment (also known as "talk therapy") can help patients engage in the treatment process, change their attitudes and behaviors related to substance abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer.
Treatment for substance abuse and addiction can be delivered in many different settings using a variety of behavioral approaches. With adults, both individual therapy and group counseling settings with peers are used. However, studies suggest group therapy can be risky with a younger age group, as some participants in a group may have negative influence over the others, or even steer conversation toward stories about having fun with drugs. Some research suggests that the most effective treatments for teens are those that involve one or more family members present.
Will a support group help my teen?
While group counseling is sometimes discouraged for teens, peer support groups for teens can be a useful companion to treatment. Self-help groups and other support services can extend the effects of professional treatment for a teen recovering from an addiction. Such groups can be particularly helpful during recovery, offering an added layer of community-level social support to help teens maintain healthy lifestyle behaviors over the course of a lifetime. If your teen is in treatment, your treatment provider will likely be able to tell you about good support groups.
The most well-known self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA), and Teen-Anon. All of these are based on the 12-step model. Support groups for family members of people with addictions, like Alateen, can also be helpful. You can check the web sites of any of these groups for information about teen programs or meetings in your area. To find other meetings in your area, contact local hospitals, treatment centers, or faith-based organizations.
Other services available for teens include recovery high schools (where teens attend school with others in recovery and apart from potentially harmful peer influences) and peer recovery support services.
There are other groups in the private sector that can provide a lot of support.
How do we keep things stable in our home until my teen is in treatment?
First, talk to your teen. There are ways to have a conversation about drugs or other sensitive issues that will prevent escalation into an argument. Acknowledge your child's opinions but know that many people with substance abuse problems are afraid and ashamed and might not always tell the truth. This is why it is important to involve medical professionals who have experience working with people struggling with substance abuse issues.
Second, if your teen has a driver's license, and you suspect drug use, you should take away your child's driving privileges. This could cause an inconvenience for the family, but could prevent a tragic accident. This could also be used as an incentive to get your child to agree to be evaluated by a medical professional.
I have heard that teens and young adults who use drugs could be "self-medicating" because they feel depressed. How do we handle that problem as well?
It is very possible your child needs to find treatment for both depression and addiction. This is very common. It is called "comorbidity" or "co-ocurrence" when you have more than one health problem at the same time. Parents should encourage their children to tell all of their health care providers about all of their symptoms and behaviors. There are many nonaddictive drugs that can help with depression or other mental health issues. Sometimes health care providers do not communicate with each other as well as they should, so you can be your child's advocate and make sure all relevant health care providers know about all of your child's health issues. Your child should be treated for all health issues at the same time.
If your child ever feels so depressed that you think he or she will do self-harm, there is a hotline you or your child can call. The National Suicide Prevention Lifeline's number is 1-800-273-TALK (8255). You are also welcome to call it to discuss your child's symptoms and get advice on how to best handle the situation.
Where can I find more information on treatment and recovery?
More information on what to expect in treatment and recovery is in our publication on the science behind addiction, called Drugs, Brains, and Behavior: The Science of Addiction, written by NIDA scientists based on many years of research, available at https://www.drugabuse.gov/publications/science-addiction.
There is more information on the Substance Abuse and Mental Health Administration’s website, http://www.samhsa.gov.
You might also want to check out the websites of some other NIH Institutes:
- National Institute on Alcohol Abuse and Alcoholism, http://www.niaaa.nih.gov
- National Institute of Mental Health, http://www.nimh.nih.gov