What Is Substance Use Disorder?
The term “substance use disorder” is applied to people with destructive and unmanageable substance problems. Over the years, the medical community has updated the terminology as the treatment and diagnosis for these cases has evolved. An individual may “abuse” substances — overindulging in drugs or alcohol from time to time — or develop an “addiction,” a chemical and/or psychological dependence towards a certain substance. In 2013, doctors began using the term “substance use disorder” to diagnose those patients who could most benefit from the different treatment options for substance abuse.
Substance use disorders (or SUDs) require patients who abuse or depend on a substance to also show some impairment or distress when under the effects. While any relationship with drugs or alcohol can be disastrous, some people are able to manage it and still function normally alongside everyone else. You may even know someone like this. A substance use disorder, on the other hand, becomes an obvious issue the moment it develops. If your teen has a substance use disorder, the consequences can spread like wildfire into all aspects of their life. Some people who experiment with substances believe it “won’t happen to them.” But thousands of kids develop an SUD each day. For many of them, treatment for the underlying substance abuse is often the only solution.
Symptoms of Substance Use Disorder
When a doctor diagnoses and provides patients with treatment options for a substance abuse disorder, they’ll typically address it using the particular substance at hand (e.g. “alcohol use disorder,” “marijuana use disorder”). Cases range from mild to severe. To meet the criteria for a mild substance use disorder, as defined by the American Psychiatric Association, patients must exhibit at least 2–3 of the following 11 symptoms. In the past year, he or she:
- Had times when they used more, or longer, than they intended
- Wanted or tried to cut down or stop on more than one occasion, but couldn’t
- Spent a lot of time using or being sick/recovering from the aftereffects
- Wanted to use so badly they couldn’t think of anything else
- Found that using (or the aftereffects of using) often interfered with taking care of home or family, caused job troubles or caused school problems
- Continued to use even though it was causing trouble with family or friends
- Gave up or missed out on activities that were important to them or gave them pleasure in order to use
- More than once got into situations while or after using that increased their chances of getting hurt (e.g. driving, unsafe sex, operating machinery)
- Continued to use even though it was making them feel depressed or anxious, worsened another health problem or caused a memory blackout
- Had to use much more than they once did to reach the desired effect
- Felt withdrawal symptoms when the substance was wearing off (e.g. trouble sleeping, nausea, racing heart), or sensed things that weren’t there
A moderate SUD is marked by 4–5 of these symptoms, and a severe case involves 6 or more. Any mild substance use disorder may demand professional help. Today, doctors may label mild cases of SUD as “abuse” and severe causes of SUD as “dependence.”
Teen Substance Problems
Adolescents have a reputation for partying and experimenting, and it’s a reputation well-deserved. Around 75% of high schoolers have used addictive substances at least once, and nearly half of them — more than 6 million kids in the US — currently use. More than 65% of young people in the US have used more than one substance. And a 2011 study revealed that 1.5 million American teens meet the criteria for an SUD.
There’s overwhelming evidence that teens who abuse drugs or alcohol are far more vulnerable to SUDs than adults. Approximately 90% of US adults with an addiction started using before age 18 — whether it be smoking, drinking or doing drugs. A quarter of people who started using addictive substances before age 18 are addicted. whereas only 1 in 25 who began at age 21 or older are addicted.
Educating your children and keeping your house safe from substances go a long way in preventing them from using. But there’s only so much you can do. If you face the reality of an SUD in your child, it’s time to consider the various treatment options for substance abuse.
Can Rehab Work?
In short, yes. Rehab for teenagers with substance problems can be highly effective, and in some cases, it’s a major turning point in their lives. Unfortunately, only 7% of addicted teens receive treatment for their disorder.
As of 2015, there are more than 14,500 substance abuse treatment centers in the United States alone. Thousands of these facilities offer treatment, with many specializing in treating only young people. In cases of child rehab, a full recovery is never completely guaranteed — and it’s important to know that even with treatment, 40–60% of addicts will relapse (i.e. they will use substances again after becoming sober). But in successful cases, rehab saves lives, plain and simple. And even if it doesn’t cure them completely, time spent at drug rehab centers is a wake-up call to countless young people who don’t realize the dangers of their substance abuse, as well as the impact it’s already had.
Even if your teen relapses after treatment, this does not mean their treatment has failed. This is a common fear among parents: that rehab will be all for naught if their teen uses again. But this usually only means that treatment should be reinstated, potentially with some slight adjustments. Abuse of drugs or alcohol can do serious damage to the teenage brain. Rehab not only keeps them off the streets (and away from temptation), but is a scientifically-proven approach to help get an addict’s brain back in shape — even if some trial and error is involved.
What’s the Treatment Process?
Each teen who is admitted to rehab undergoes a proper diagnosis, and their treatment plan is then custom built for their addiction. Their program will likely include some variation of these substance abuse treatment modalities.
At the time your child arrives for rehab, there’s a good chance that the offending substance (or substances) is still coursing through their system. Detox (or detoxification) is where their body finishes flushing the drugs or alcohol out so that the real healing can begin. The human body will do this naturally, and it can take a couple days or a couple weeks — depending on the patient’s situation. Detoxing under the care of professionals ensures that it’s done safely out of reach from harmful substances. Your teen may experience withdrawal symptoms as well — physical or mental anguish from not feeding their addiction. By undergoing detox with medical supervision, doctors can aid them through any withdrawal pains (potentially with the help of medication).
Teen drug rehab or alcohol rehab is often focused primarily around therapy. In teenagers with SUDs, biological factors play an immense role. Segments of the brain typically show underdevelopment or other abnormalities. This includes the prefrontal cortex, which is responsible for goal setting, impulsivity, reasoning and judgment. The nucleus accumbens is also still developing in teens, which explains their tendency for thrill seeking. These factors, when combined with genetic and environmental factors, can help doctors understand why a teen may be struggling with substance abuse. To fully understand an individual teen’s problem — and to then address it comprehensively — the first course of action in rehab is one or more types of therapy.
Whether your teen chooses inpatient or outpatient rehab — the former taking place at a residential facility full-time stay and the latter taking place part-time — the rehab program will choose may offer several forms of therapy. Therapy is offered in both one-on-one and group settings. Depending on the severity of your teen’s problem, along with the substance at hand, their doctor may prescribe one or more of the following types of therapy.
Cognitive-behavioral therapy (also known as psychotherapy, talk therapy or CBT) is a treatment option that seeks to uncover the thinking behind a teenager’s addiction and work towards reshaping these thought patterns. On a whole, CBT is based on the notion that thoughts cause behaviors and the way we perceive, interpret and assign meaning to our environment. During a teen’s rehab for substance abuse, sessions of CBT encourage them to:
- Develop self-regulation and coping skills by helping them identify stimulus cues that precede their substance use
- Use various strategies to avoid high-risk situations, people or places
- Develop skills for communication and problem-solving
Family-based therapy emphasizes the role of family (or lack thereof) in a young person’s substance abuse. Sessions of family therapy bring together those closest to an addicted teen and address issues such as poor family communication, cohesiveness and problem solving. This method of treatment is centered on the premise that family carries the most profound and long-lasting influence on development, and in modeling both good and bad behaviors and beliefs. For instance, in a case of alcohol abuse treatment, family therapy may bring up the role of alcohol in the household. If the parents are casual drinkers, or haven’t discussed the risks of alcohol use with their children, this may be a major influence in a teen’s drinking problem.
A relationship with drugs or alcohol can rewire certain functions of the brain, specifically the reward centers. When a teen smokes marijuana every time they accomplish something or feels they deserve a break, the brain can come to expect marijuana as a reward, and nothing else will suffice. Contingency management (or “motivational incentives”) is utilized in many substance abuse treatment models for adolescents. This form of therapy tracks each patient’s progress in rehab, including each day they succeed in staying sober, and rewards them with a prize. Prizes might include gift certificates, electronics, clothing or even cash. The more teens feel satisfied with their rewards, not only will they continue striving to stay sober, but their brain will relearn how to appreciate rewards that aren’t drugs or alcohol.
Motivational interviewing (or “brief intervention”) techniques use a person-centered, non-confrontational style in assisting the patient to explore various facets of their substance habit. During these sessions, the teen patient is encouraged to examine the pros and cons of their use, and with the help of their therapist, create goals to help them achieve a healthier lifestyle. While the patient’s freedom of choice regarding their substance use is respected, the therapist will provide personalized feedback with the goal of gradually helping them realize the consequences of their actions. This type of therapy has grown significantly more popular in recent years, especially in addressing teenage substance abuse.
Recreational therapy (also called Therapeutic Recreation or TR) engages teen rehab patients in active leisure activities (e.g. sports, arts and crafts, games). Healthy leisure can benefit a recovering addict in several ways, and TR has an emphasis on treating the “whole person,” not just the mind. In the worst of a substance addiction, a teenager can easily forget how to enjoy life outside of drugs or alcohol. Recreational therapy encourages them to loosen up throughout the treatment process and helps them rediscover the positive traits of their personality. It also allows them to bond with other recovering addicts, and relearn how to interact with others in a healthy way. Along the way they may learn new skills, improve their physical health and feel a boost to their self-esteem and self-worth.
Medications for Treatment
Prescribing medications during substance abuse treatment may help your teen reduce cravings, restore their normal health, or address any underlying psychiatric disorders (which is also known as a dual diagnosis). Pharmacotherapy, as it’s called, is far more common in adult treatment patients. But if your doctors determine that medication would be beneficial, it may be implemented into your teen’s treatment plan.
Medications prescribed in substance abuse treatment may include:
- Opioids – drugs like Vicodin and Percocet that help numb patients to pain
- Stimulants – drugs like Adderall and Ritalin that increase mental functions like alertness and energy
- Mood stabilizers – drugs like Lithium that reduce the appearance of emotional swings
Any medication recommended to your child should be researched at length before they start taking it. These drugs are extremely potent in their own right, have potential side effects, and many are considered “habit-forming” — capable of causing addiction. The right medication may help your teen work through a difficult phase of their recovery. Make sure that you trust the medical staff treating your teen, and that you talk it over with your teen before deciding if medication would be best for them.
How Long Does Treatment Take?
Treatment for teenage drug abuse varies in length based on each individual’s needs. Your teen’s substance abuse treatment plan may be mapped out for 30 days, 90 days or 6 months. But curing an addiction is not as simple as following a recipe. Substance use disorders are a complex mental health problem, and each of the 1.5 million young people who suffer from one in the US requires special attention. If your teen needs rehab for an SUD, don’t expect results in a matter of days. The most severe cases may take months of treatment — and for many of these teens, the path to recovery extends far past the treatment phase. Follow the doctor’s recommendations and have your teen’s progress evaluated each step of the way. The worst thing you can do is end a teen’s treatment abruptly or prematurely.
How Can I Help My Teen Stay Clean?
Following rehab, a teenager is thrust back into the world. Temptations lie around every corner. For millions of people who struggle with addiction, their problem stays with them for years after treatment, or even or a lifetime. After you’ve helped your child kick their habit, aid them in preparing a plan to prevent relapse.
Joining a 12-step program is one of the most common forms of aftercare. Groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) date back decades, and have assisted millions of recovering addicts around the world by welcoming them into their community. Approximately 2.3% of AA members in the US are under the age of 21. When your teen becomes a member of AA or a similar group, they’ll be introduced to others dealing with similar issues, and they’ll be assured that they’re in a judgment-free zone. At each meeting, they’ll go over the group’s mission statement — often laid out in 12 principles or “steps” — and discuss their personal progress in staying sober. Teen Addiction Anonymous, a 12-step program geared towards teens, reports that 90% of teens with substance problems show a significant decline in their usage after attending 6 or more meetings. Support groups like these are often free of charge.
Outside of community support groups, scheduling one-on-one counseling for your teen is another treatment option that can help them stay proactive in their recovery. Substance abuse counselors are often recovered addicts themselves. Encouraging positive lifestyle changes in your teen — and the rest of your household, for that matter — are another big way to promote their sobriety. Health-forward habits like sports, after-school clubs, learning new skills and eating right can give your teen a new lease on life following treatment, and help them distance themselves from their old ways.
Treatment Within the Criminal Justice System
Teen addicts may not get help until their problems land them in hot water. In 2008, there were an estimated 2.1 million juvenile arrests in the US, 10% of which involved drug abuse or drunk driving. One study showed that nearly half of juvenile detainees have an SUD, and 77% of teens who are arrested reported substance use in the last 6 months.
Drug and alcohol counseling is available in around 40% of juvenile correctional facilities, and is usually offered as a supplement to jail time for those who need it. In a study of prison inmates who received treatment, only 3.3% were rearrested in the first 6 months after being released, compared to 12.1% of inmates who didn’t receive treatment. Those who received treatment were also half as likely to use drugs at all after being released.
Most of the substance abuse treatment options offered in the criminal justice system (70%) are offered onsite, among the general inmate population. But many addicts (28%) receive treatment in specialized units, and 2% receive it in traditional hospital inpatient environments. Drug education courses are also offered to (or required of) drug offenders in many jails.
Dual Diagnosis and Co-Occurring Mental Health Problems
For a great many teens, an abusive relationship with drugs or alcohol is only half the problem. These problems are often the result of preexisting mental health problems — and in some cases serious mental health disorders can develop from substance abuse. When a teen has both an SUD and a second mental health disorder, no matter which came first, it’s referred to as a “dual diagnosis.” Around one-third of teens with a mental illness also struggle with substance abuse. Approaching either of these problems is difficult enough. When a teen has concurrent, overlapping problems, their journey to get better can be immensely more troublesome.
These cases require a specialized approach that integrates treatment for both problems simultaneously. In an ideal scenario, you can reach any single problem in your teen before a second one develops. But thousands of families are not so fortunate. Recovery is still possible for teens with a dual diagnosis, but each day that passes makes it a bigger challenge.
Does My Teen Need Rehab?
If you notice signs of drug use or alcohol abuse in your teen, you should address them immediately. Share these symptoms with your child’s doctor, who can help you analyze the situation and figure out what is happening. If substance abuse is happening at any level, it calls for a discussion with the doctor. Oftentimes, teens benefit from some sort of counseling even if they have only experimented with substances and do not have a diagnosable substance use disorder.
However, if your family doctor determines that addiction is present in your teen, they will likely recommend that you immediately consider treatment options. A doctor’s assessment of the situation can help paint an objective picture of your teen’s future, with and without rehab.
It can be daunting to realize that your teen needs to undergo treatment. Do not go through this difficult time alone, but reach out to loved ones and create a support network. We at TheRecoveryVillage.com are here to help you find the very best treatment for your child, so that they can experience long-term recovery. We have years of experience helping families like yours come through the darkness of teen addiction, and into the light of recovery. Take the first step out by giving us a call.
- “Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5.” National Institute on Alcohol Abuse and Alcoholism. National Institutes of Health, May 2013. Web. 19 Jan. 2016.
- Willenbring, Mark. “DSM-5: The End of One-Size-Fits-All Addiction Treatment?” Pacific Standard Magazine. The Miller-McCune Center for Research, Media, and Public Policy, 8 May 2013. Web. 18 Jan. 2016.
- “National Study Reveals: Teen Substance Use America’s #1 Public Health Problem.”CASAColumbia. Columbia University, 29 June 2011. Web. 19 Jan. 2016.
- Winters, Ken C., Andria M. Botzet, and Tamara Fahnhorst. “Advances in Adolescent Substance Abuse Treatment.” PubMed Central (PMC). National Center for Biotechnology Information, Oct. 2011. Web. 7 Dec. 2015.
- “Adolescent Substance Use: America’s #1 Public Health Problem.” CASAColumbia. Columbia University, June 2011. Web. 20 Jan. 2016.
- “Drug Addiction Treatment in the United States.” National Institute on Drug Abuse (NIDA). National Institutes of Health, Dec. 2012. Web. 19 Jan. 2016.
- “How Effective is Drug Addiction Treatment?” National Institute on Drug Abuse (NIDA). National Institutes of Health, Dec. 2012. Web. 19 Jan. 2016.
- Keesmaat, Shelagh. “How Does Therapeutic Recreation Apply in the Treatment of Addictions.”Leisure Information Network | Resources for Parks, Recreation and Active Living Practitioners. Homewood Health Center, n.d. Web. 20 Jan. 2016.
- “Results on Drug Abuse.” Teen Addiction Anonymous. Social Venture Partners, 2012. Web. 19 Jan. 2016.
- “What Are the Unique Treatment Needs of Juveniles in the Criminal Justice System?” National Institute on Drug Abuse (NIDA). National Institutes of Health, Apr. 2014. Web. 18 Jan. 2016.
- Schmidt, Guy. “Drug Treatment in the Criminal Justice System.” National Criminal Justice Reference Service. Office of National Drug Control Policy, Mar. 2001. Web. 18 Jan. 2016.
- Duckworth, Ken, and Jacob L. Freedman. “Dual Diagnosis Fact Sheet.” NAMI: National Alliance on Mental Illness. NAMI: National Alliance on Mental Illness, Jan. 2013. Web. 28 Jan. 2016.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
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