When you know your teen is drinking, using drugs, vaping…it’s stressful – anxiety producing even.

You talk to them about it until you’re blue in the face, you issue consequences, monitor, snoop, talk some more, lose sleep worrying about their health, their safety and whether or not they might develop a real problem.

We know there’s a line, that once crossed, indicates their use has become something much more.

Where is that line though? And how do we know it’s been crossed?

And then what?

 

Today, in this 7^th episode in my series on adolescent substance use, I want to talk about how to know if your teen has a real problem with substances and what to do if you think they’ve indeed crossed that line. Don’t go anywhere.

 

PODCAST INTRO

If you’re anxious about your child’s substance use right now, let me just say, I’m sending you all my love. I remember lots of restless days and sleepless nights worrying about my son’s behavior around substances and terrified he was throwing his life away.

But the fact that you’re listening to this episode tells me that you’re going to do what it takes to insure your child’s future is secure…and you’ll get there. Just hang on tight and keep moving forward.

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So, let’s start today clarifying some terminology that’s always confused me; what’s the difference between a substance use disorder and an addiction? Is there any?

The DSM (the Diagnostic and Statistical Manual) is the reference guide used by mental healthcare professionals for diagnosis and classification of mental health disorders. The DSM doesn’t use the word “addiction” – the term used is substance use disorder.

The DSM asks the practitioner to look at a list of 11 criteria within a 12-month window of time – and if just 2 or 3 of the criteria are met within that period, the person’s considered to have a mild disorder, if they meet four or five, it’s considered moderate and six or more indicates a severe disorder.

Briefly, these are the criteria:

using larger amounts of the substance than the person intended or using it for a longer period of time than they intended.

the person continually wanting to cut back or stop using or trying to and being unable to do so.

spending lots of time and effort to obtain the substance, use the substance, or recover from using it.

Craving, or a strong desire or urge to use substance.

using it is causing the person to be unable to do what they need to at work, home, or school.

Continued use even though using is continually causing problems with relationships

the person skips important social, work, or recreational activities because of their use.

using in situations where it could be physically hazardous (like driving or boating under the influence.

the person continues to use despite physical or psychological problems it’s causing

they’ve developed a tolerance, for the substance (meaning, it takes more and more of it to get them drunk or high)

Withdrawal, when the substance isn’t used (which doesn’t happen with all substances)

So, the focus of the DSM criteria is on the lack of control the person has over the substance use, the problems the substance causes for them, the risk involved with their use, their tolerance for the substance, and withdrawal symptoms.

Significantly, the DSM does not quantify what a substance use disorder looks like by saying, if you smoke more than 8 grams of weed a day or if you drink more than 11 beers a day, you have a problem (and by the way – I totally pulled those numbers out of thin air – I have no clue what “a lot” would even be of either of those substances).

So, the DSM evaluates the situation by looking at the issues caused by the substance and not the amount consumed.

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And, how is this different from an “addiction” – or is it?

Well, there are different definitions of the word addiction according to who you ask: the National Institute of Drug Abuse (NIDA), The American Psychological Association, the American Society of Addiction Medicine, England’s NHS.

Some of these definitions seem to focus more on it being about the changes that occur in the brain. For example, NIDA says addiction is a “chronic disorder” that can cause long-lasting changes in the brain, where a person compulsively seeks out the substance and continues using it despite all the harmful consequences it causes.

So, after doing a good bit of reading, it seems to me that the term, “addiction”, is used to describe a severe “substance use disorder”.

Scientifically speaking, if there’s a diagnosis, it’s going to be a mild, moderate or severe substance use disorder or SUD for short. Although many people use the terms addiction and SUD, interchangeably, I’ll use the term SUD unless I’m talking about a severe SUD – in which case, I’ll use the word addiction. That seems correct to me.

Back in episode 175 that kicked off this series, I explained how the adolescent brain’s revved up reward system, in combination with the still growing prefrontal cortex, makes it quite easy for teens to develop an SUD.

As teens use a substance, the brain gets used to it and then requires more to get the same “rewarding” experience and a physical dependency is produced where in many cases, if the teen doesn’t use the substance, they can start to feel sick – it just depends on the substance.

These brain changes also impact memory which is why people refer to certain things as triggering them to use when they’re trying to quit. If their brain learned to associate a certain sight, sound, smell, etc. with using the substance (which happens easily in teens), when they experience that stimulus, again, it triggers that memory of using, which results in a strong urge to use the substance again, which is often almost impossible to resist.

For example, a teenager who smoked weed at high school football games may be triggered by attending those games. A kid who used to listen to a certain band’s music while drinking, could be triggered by that same music, if they used with certain people, hanging out with those people will likely bring on that urge (not to mention the fact that those people are likely still using).

This is one reason it’s so important to change environments, friends, and activities when your teen is trying to stop using substances. And yes, it’s much easier said than done.

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One issue that’s often debated - is whether addiction (a severe SUD) is a disease or a choice. I believe it’s both. The Partnership to End Addiction agrees.

As they point out on their website, people generally decide to use a substance in the beginning, and then based on their individual and environmental risk factors (as I discussed in episode 176), they may be more or less likely to develop a substance use disorder.

And if their use progresses into an SUD, they no longer have as much control over the issue. It’s all based on how their body and their brain responds to the substance. They may be able to stop for a while or cut back but it’s so much harder than for someone without the disorder.

The central tenant of the “addiction is a disease” theory, is that it’s considered a chronic condition that can be “controlled but not cured”.

But no matter how you want to look at it - the bottom line is, it is absolutely possible, even in the most severe of cases, to overcome it and live a full and happy life, with the right treatment and support. As a matter of fact, there are many people with an SUD who are able to stop on their own or with minimal support.

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So, how do you know if your teen’s drinking, vaping or marijuana use has actually rises to the level of a substance use disorder?

For starters, you can look carefully at those criteria named in the DSM. (Put in show notes)

If your teen or tween meets 2 or 3 of the criteria within the last 12 months, it’s at the very least an indication that you need to seek out a professional to do a screening or a thorough psychological evaluation.

But who? Actually, your family physician or pediatrician may be a good place to start. If your concerned about your teen’s substance use, and they’re willing to talk to the doctor about it. Many physicians use a screening tool – like a simple questionnaire - to determine the risk level for a substance use disorder. They’re not actually diagnosing but evaluating the risk and based on their assessment, may refer your child for further services.

However, this screening, of course, depends on your kid’s willingness to talk to them and to tell the truth.

The Substance Abuse and Mental Health Services Administration  - an agency of the US government (which goes by “Samsa”) has issued guidelines for primary care doctors (and possibly others who may be in a position to screen your kid – like maybe even a school counselor or a youth center).

Those guidelines direct the doctor to conduct a screening, and if they find their risk is in the mild to moderate range, provide motivational interviewing techniques with them to try and prevent progression of their substance use and even help them create a plan to quit.

The guidelines also say if the doctor (or whomever) finds their risk is in the severe range, they should refer them for treatment services.

If you want to start with your doctor, just call the office and ask if he or she follows the Samsa SBIRT protocol for screening adolescents for substance use. If they have no clue what you’re talking about I wouldn’t start there.

And you may not want to anyway because they generally lack the training and experience. If they miss the problem with your child (either because they’re untrained, use a bad tool or simply don’t get the truth out of them), you’ve missed an opportunity to get help right away.

Personally, I would much rather see you start with a psychologist or a licensed alcohol and drug counselor who works with adolescents, for a thorough evaluation. Even better, find a psychologist who also diagnoses substance use disorders.

More often than not where there’s an SUD there will be a co-occurring mental health disorder. As I mentioned in episode 176, substance use in teens often goes hand in hand with anxiety, depression, ADHD, childhood trauma - so a psychologist who can evaluate everything would be the best bet.

The psychologist then may also be able to treat your teen or may refer you for treatment elsewhere.

According to the authors of a recently published article in the National Institutes of Health – National Library of Medicine – their research and best practices suggest that treating adolescents for an SUD is multi-dimensional.

It requires an approach that incorporates treatment of the cooccurring mental health disorders, the family relationship, helping the teen to learn how to interact better with other teens, improving their relationship with school and academics in general, therapy to help them with problem solving and relapse prevention (Dialectical Behavioral Therapy, or DBT specifically).

The authors also point out that if your teen is admitted to a facility for treatment - that there’s sufficient after care, so the transition back home goes well. In other words, they don’t just leave the facility and then hope for the best – there’s a plan in place for counseling and guidance to prevent relapse.

Also integral to treatment is that it takes place over an adequate period of time. Now, there’s no generally recommended time for treatment of adolescent substance use disorder because of all the variables involved, but for adults 3 months is often considered the minimum amount required to get someone to reduce or stop their substance use altogether.

And I’m sure you’re thinking – well, what sort of treatment are we even talking about and how do you even get all of these issues covered?

Well, you may be able to find one treatment program for your teen – one source that provides most of these elements. In my opinion, based on past research, that one source would likely be a university hospital program with access to various departments and treatment providers where everything is coordinated. That doesn’t necessarily mean that it would be an inpatient situation, but my guess is that it probably would be.

There are also residential treatment facilities that aren’t associated with a large university that can provide many of these things. (I’ll come back to this in a minute).

The professional who evaluates your teen will likely give you options and recommend the level of care they need. Level of care simply refers to the intensity of the effort required to treat their SUD.

Your teen may not require a ton of services, depending on the intensity of their SUD. The lowest level of care would be weekly outpatient therapy. They may be able to talk to a substance use counselor or addictions specialist (whatever they’re called in your state) and do really well.

If the evaluator feels your teen needs a bit higher level of care, they may recommend an intensive outpatient program or IOP.

Here, your teen would likely attend a program at a facility or office setting, several days a week for several hours a day – depending on the program. IOPs generally provide group therapy and teach coping skills and strategies for avoiding substances, and other relevant help.

I’ll also add that there are counseling centers that provide something in between weekly counseling and an IOP. There was a center in Greenville, SC where we lived at the time, that provided counseling for parents and the teens and had group sessions weekly and even a mentor program. So, look in your area and see what you can find.

The next level of care up from an IOP is a partial hospitalization program or PHP. Again, your teen would attend therapy and other services during the day – but mostly likely every day during the week and for at least 5 hours a day.

Of course, if the SUD is severe or there are more severe mental health concerns, it may be recommended that your teen receive the higher level of care of a residential treatment facility or a wilderness program.

As I said a minute ago, some of the most comprehensive programs that combine lots of resources for treatment, will be found through university- residential treatment programs (or RTCs as they’re called).

From what I’ve seen myself, it’s a little  more difficult to find a non-university affiliated residential treatment program that is able to pull together so many different resources for their clients.

As a matter of fact, it’s hard to even find one that places the same importance on mental health as substance use (and the two almost always go hand in hand).

Harder still – and this would be true no matter where you get treatment, if you depend on insurance to pay (as most of us do) – it’s hard to get insurance to pay for in-patient longer than a few weeks and in many cases, longer than a few days.

You have to don your battle gear the minute you know your child will be admitted – really even before they’re admitted – to be able to keep them there long enough to get the help they really need. Insurance companies resist paying for these expensive RTC, at every step.

As a matter of fact, many RTCs don’t even take insurance. They’ll give you ideas on where to borrow the money and they’ll give you a bill you can submit to your insurance company to try and get reimbursement but that’s about it.

On the other hand, there are some really well-regarded RTCs that do accept insurance. And, by the way, they don’t have to be in your state of residence to accept your insurance. My son went to an RTC in California, and our South Carolina insurance paid for 2 months (after the fight). So, don’t assume – pick up the phone and call the facility and they will check your insurance.

The other “in-patient” treatment option is a wilderness program. And yes, there have been issues with some of these programs but there have also been thousands of families who’ve had wonderful outcomes, including Collin MacDonald from episodes 168 and 169, who now helps teens and young adults coming out of treatment. You simply have to do your homework.

Insurance will not pay for wilderness programs – perhaps some of the individual or group therapies provided at the program - but not the program as a whole. The last time I checked into one in 2018, it was somewhere around $25,000 a month for the one I looked into in North Carolina.

A website that I highly recommend is allkindsoftherapy.com. The last time I checked, the owner, Jenney Wilder who used to be an educational consultant, doesn’t take ad money or kickbacks from the residential treatment centers and allows you to search and compare them on her site, according to different factors like what disorders they treat or whether or not they take insurance. So, definitely check out that website.

And, speaking of educational consultants, (also known as therapeutic consultants or behavioral health consultants) – these folks can be a valuable resource for inpatient facilities, if you can afford it, (and you find one who doesn’t work for or take money from the facilities).

Now, of course, you can skip psychologists and evaluations and jump straight to counseling or a higher level of care if you already feel strongly that your teen has a problem with substances and likely has an SUD of some sort.

The problem, as with anything regarding teens, is getting their buy-in and cooperation. If they don’t feel they have a problem, or they know they do but don’t want to do anything about it, your job as a parent is 10,000 times harder. And I think, for most of us, that’s where we find ourselves.

If that’s where you are, my guess is that your relationship – your connection is probably terribly strained at the moment.

If this is the case, and there’s more fighting than talking and very little there between you, other than animosity, you really have to step back and work on your connection and build your parenting skills, so they’ll be more likely to cooperate.

If you’re not in dire straits with their SUD and can work on that first, it may be that after a few weeks or months, you’re able to get them to cooperate with some form of treatment without the fight. You can listen to episode 165 and my connection series – I’ll link to them all in the show notes.

However, if your teen’s SUD and or mental health disorder is severe at this point and you’re afraid for their safety and can’t give it weeks or months to get them the help they need, you may have no other choice but to force them into residential treatment (if legally allowed, where you live).

I would caution you to at least consult with a mental health professional to get their advice first. And understand that you are still going to need to repair the connection with your teen and build your parenting skills, during their time in the RTC and after they come back home - because if you don’t – they’ll end up (your whole family will end up) right back where you were before they left to go in. If you’re new to the podcast, you can listen to episodes 130-137 to get an idea of what I’m talking about regarding parenting skills.

One more thing I want to say – dealing with a child who’s using substances or has a disorder, is so very trying and stressful and anxiety-provoking. Please remember to take care of yourself. See a counselor yourself. Download a meditation app. Exercise. Go out with friends. Your child needs you to be whole and functional if you want to help them. Put that oxygen mask on first and stay healthy and stable for yourself and for them.

I’m going to wrap up this series next Tuesday and talk about Community Reinforcement and Family Training – CRAFT. You can read about in the book Beyond Addiction, which will help you understand your child, their motivation for using substances, how change happens, and what role you play in that change. So don’t miss that episode.

Alright, that’s it today for Speaking of Teens. Thank you for staying until the end. I hope I’ve provided some nuggets of information that will be of help to you. And if you could help me spread the love and education to other families, I would really appreciate it. I really need you to share the podcast with as many people as you can. If I’ve helped you – please pay it forward and help others by sharing.

If you need more support, come join us in the Facebook group. The link is at the very bottom of the episode description right where you’re listening.

And until next time, please be sure you’re connection with your teen or tween every day in some small way.