The Consequences of Untreated Addiction

It’s not easy to admit your teenager has an addiction problem. It’s a realization that can take parents years to come to terms with. The evidence may have been right in front of you, plain to see, from the first time your child stayed out past curfew. Or the time they came home with glassy eyes or and alcohol on their breath. You may have chalked those up to one or two poor decisions, levied appropriate consequences, and considered the matter concluded. Six months later when you found a suspicious looking device – a vaping pen? a pipe? – in their backpack, you may have believed, against your instincts, that your teenager was really holding it for a friend.

Let’s take just a moment and use that excuse as an object lesson to illustrate how parents default to denial when it comes to their kids and substance use disorders. Which, by the way, is the way mental health professionals refer to drug and alcohol addiction these days. They’re called SUDs (Substance Use Disorders), a term that allows mental health providers to discuss the topic without getting into semantic quibbles over the precise definition of the word addiction or the need to differentiate it from potentially problematic behaviors such as gambling, internet use (including cell phone and social media), video game use, disordered eating, or excessive exercise.

We’ll get back to the holding it for a friend excuse quickly, we promise. But first, we want to make sure we’re on the same page with what constitutes an SUD. The Substance Abuse and Mental Health Services Administration (SAMHSA) – following criteria established by the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-V) – defines a Substance Abuse Disorder as:

“…the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.”

Now that we’re clear on that, back to that old excuse. There’s a decent chance you used it yourself, back when you were a teenager. You looked at your mom or dad, couldn’t bear to tell the truth for any number of reasons, and told them the [weed, pipe, flask, etc.] was not yours. You were simply doing a friend a favor so they wouldn’t get busted by their parents. You knew you were lying, they knew they were lying, but you both went with it.

Why?

Because the consequences of untreated SUDs are not good. Back then, your parents didn’t want to face the fact you may have been developing a problem (hopefully you didn’t) and now, you don’t want to face the fact your child might be developing a SUD. Decades of data indicate that adolescent substance use can increase the likelihood of:

• Poor academic performance
• Social disruption
• Familial discord
• Physical, sexual, or emotional abuse
• DUI-related automobile accidents
• Risk-taking behaviors
• Sexually transmitted diseases
• Arrest
• Incarceration

Those are serious consequences. As a parent, it’s safe to say you don’t want your child to experience any of them. That’s why it’s hard to accept your teenager may have a problem, and why it’s crucial to get your teen help if they do have a problem.

The Elements of High-Quality SUD Treatment for Adolescents

 In 2003, a group of behavioral health scientists from Cornell University in New York and the U.S. Department of Public Health in Washington, D.C. launched a research project with a lofty goal: “to conduct the first systematic evaluation of the quality of highly regarded adolescent substance abuse treatment programs in the United States.” They published their findings in a paper called “The Quality of Highly Regarded Adolescent Substance Abuse Treatment Programs,” which, among other things, established nine key elements necessary for the effective treatment of adolescents struggling with SUDs. Twenty-two subject matter experts, including ten researchers, nine clinicians, and three senior policy-makers, determined that in order to offer teenagers a high quality of care, the following components must be present in a treatment program:

1. Assessment and Treatment Matching: Treatment centers should conduct comprehensive assessments that contribute to the formation of a full biopsychosocial picture of the teenager’s life. Screening instruments must be evidence-based, time-tested, and accepted by the mental health community. They should be sensitive to capable of identifying co-occurring disorders, family situation, social factors, and any other salient issues in the teenager’s life. The center must then form a treatment plan that addresses all the issues revealed during the assessment process, not just the substance use disorder.
2. Comprehensive, Integrated Treatment: The treatment plan, based on the comprehensive assessments, must provide evidence-based therapies that help to heal all aspects of the teenager’s biopsychosocial evaluation.
3. Family Involvement: Treatment plans must include the participation of parents or primary caregivers. Research shows family engagement increases the likelihood of better treatment outcomes.
4. Age-Appropriate Program: Treatment must include therapies, activities, material, and support tailored to meet the needs of teenagers. Adolescents and adults have different treatment requirements and capabilities. What works for adults will not automatically work for teenagers, a fact which must be recognized and acted on by the treatment center.
5. Engagement and Retention: Treatment programs must work to establish trust, cooperation, and total buy-in from their teenage clients. This means altering therapy styles, activities, hours, and the therapeutic environment to meet adolescents where they are and in a manner likely to resonate with them. This increases time in treatment, which in turn increases the likelihood of positive outcomes.
6. Qualified Staff: Treatment center staff must be trained in adolescent-specific therapy. Staff must be trained in adolescent development, adolescent substance abuse treatment, and have experience in treating co-occurring mental disorders in teenagers, not only adults.
7. Cultural and Gender Sensitivity: Treatment programs must understand and serve the divergent needs of their entire population. Staff must be aware of and trained in therapeutic requirements specific to boys, girls, LGBTQ individuals, and cultural/ethnic minorities.
8. Full Continuum of Care: Treatment programs must include robust and proactive aftercare plans and sustainable sobriety strategies. Successful aftercare plans include strategies for family engagement, ongoing therapy, positive peer involvement, and ongoing community-based support such as 12-Step programs or other similar resources.
9. Treatment Outcomes: Treatment centers must commit to an ongoing, rigorous, evidence-based evaluation of therapeutic methods and outcomes in order to allocate resources responsibly and improve quality of care.

Finding the Right Treatment Center for Your Teen: What You Can Do

Once you determine – with the assistance of a qualified child psychiatrist or therapist, of course – that your teenager is struggling with an SUD and needs treatment, it’s time to do your research. Explore the recommendations of your child’s therapist or psychiatrist. Gather information about treatment options from friends, family members, and colleagues in whom you’re willing to confide.

That’s the first step: identifying potential treatment centers for your teenager. This includes factors such as location, insurance coverage, out-of-pocket costs, and the specific needs of your teen. Though that process is crucial and can be emotionally draining, the next step is more important:

You have to be that parent.

The one who comes to teacher conferences with a folder full of data, ready to advocate for their child without fear or reservation. The one who wants details about everything related to their child’s education. The difference is that in this case, you’re advocating for your child’s treatment, not their education. You’re advocating for their present and future mental, physical, and emotional health. You’re advocating for both their short-term ability to achieve sobriety and long-term happiness and well-being.

Make a copy of the nine key elements of highly regarded treatment centers provided above, then reach out to all the centers on your list and speak to someone on their admissions team or a member of their clinical staff. Don’t be shy and don’t be afraid to ask a million and one questions. Don’t worry about taking up their time on the phone – that’s their job – and don’t worry about seeming neurotic or over-protective. They get it. If they don’t seem to get it, that’s a red flag: hang up the phone and move on to the next center on your list. Go through all nine elements, and ask specific questions about one of them. If you get stuck or tongue tied, simply go back to basics: for each element, ask who, what, why, when, and how. Like this:

Who will be my child’s therapist?

What kind of therapy will they provide?

When (and how often) will it be provided?

Why is this type of therapy necessary?

How will it be provided?

Repeat the process for the entire list, then ask any follow-up questions that pop into your mind. No question is too small, and no topic is too large to bring up. Remember: you’re not only advocating for their successful treatment, but you’re also advocating for their life.