Don’t wait for your son or daughter to come to their senses - teens almost never self-recognize addiction and they rarely ask for help. Learn why they can’t see the truth and why this matters when picking treatment.

Fact: teens rarely admit to a substance abuse problem and almost never ask for help on their own.

Teens rarely see themselves as needing help since:¹

• They don’t connect negative consequences with their substance use.
• They don’t usually experience withdrawal symptoms.
  
• Parental protection shields them from many natural consequences.

This complicates recovery as:

1. Though teens are more predisposed to addiction and to a quicker progression from experimental use to addiction, teens almost never seek help on their own.
2. People who don’t believe they have a problem don’t tend to engage in the treatment process - and though you can sometimes force an adolescent into treatment, you can’t force a new way of thinking.

This is why you need to make sure you find quality adolescent-specific treatment.

• Effective adolescent addiction treatment programs are designed to help teens gain a more accurate picture of their behaviors and their consequences and structured to keep teens engaged in the treatment process for long enough to start seeing the benefits.
• Sending a teen to an adult treatment program rarely works, since adult programs rely on self-awareness and self-motivation that adolescents just don’t have.

Why Teens Can’t Self Recognize Addiction

1. They don’t usually get withdrawal symptoms.

Popular culture presents an addiction portrait that rarely corresponds to adolescent reality – for example the desperate opioid addict doing ‘anything’ to get a fix – or the alcoholic needing a drink in the morning to quiet their shaking hands.

While some adults with substance use disorders progress to this type of dependence, adolescents rarely do.

• Teens most commonly abuse alcohol and marijuana. When drinking they tend to binge drink (rather than necessarily drinking each day) and they rarely experience withdrawal symptoms when going a few days without use – largely due to a shorter use-history.

But though teens may not experience withdrawal symptoms, they can experience other telltale addiction symptoms, like losing control over use and continuing to use despite serious consequences.

2. They don’t experience as many adverse consequences.

It often takes years of addiction and addiction-related consequences (divorce, financial problems, legal problems, etc.) to convince an adult to seek help. A teen with a shorter use history wouldn’t have experienced the same level of ‘wreckage’ and might also have trouble connecting actions with their consequences.

Also, adolescents, especially teens living at home, enjoy a degree of protection from the outside world that can insulate them from some of the natural consequences of drug and alcohol abuse.

• An adult who spends all their money on drugs might face eviction – an adolescent living at home wouldn’t have the same problems.

Unfortunately, research suggests that one of the greatest predictors of adolescent incentive for change is the degree of negative consequences experienced: teens who can recognize that drinking or drug use has led to severe consequences are more likely to engage in treatment than teens who cannot self recognize this association.²

Treatment Implications

One size fits all treatment doesn’t work – and treatment that helps adults doesn’t necessarily help teens.

Because teens rarely perceive a need for treatment (even when everyone else can see it clearly) quality adolescent treatment is designed to keep teens engaged in the process and to help them see the true consequences of their actions (as well as the consequences to come.)

Common elements of effective adolescent treatment programs include:

• Motivational enhancement therapies – helping teens identify the pros and cons of continued use, so they can decide for themselves of a need for change.
• Rewards – providing rewards for meeting treatment goals helps keep teens engaged in the process, especially in the early stages, when they may not yet see a need for treatment or experience many rewards from abstinence (abstinence rewards come slower and later.)
• Skills training – providing teens with the skills they need to refuse drugs or alcohol and deal with cravings and temptation. Teaching problem solving and interpersonal skills.
• Replacing unhealthy behaviors – helping teens replace unhealthy behaviors with more constructive activities.

Taking Action and Finding Help

You don’t necessarily have to send your child to teen rehab (you’d almost always try counseling or outpatient treatment first) but when there's drug or alcohol abuse, you do need to take action, since drugs and alcohol affect teens more:

• Teens, with still-developing brains experience greater drug and alcohol related brain damage and structural alterations than adults. Even adolescent marijuana addiction can have a lasting impact,
  
• Drug and alcohol use in adolescence can lead to social and family problems and school performance issues, and left unchecked, these can have lifelong consequences.
• Teens who abuse drugs or alcohol may not achieve the essential developmental tasks of adolescence. By responding to problems, boredom and leisure time with intoxication they don’t explore and learn healthier living skills.
• Early drug and alcohol abuse is strongly correlated with later in life addiction issues.

So if your son or daughter uses drugs or alcohol, and you can’t get them to stop, you need to take action today. To learn more, read:

• The top 5 reasons why teens use drugs and alcohol.
• Selecting a level of addiction treatment that makes sense.
• A guide to trauma sensitive teen treatment.
  

If you prepare yourself for high-risk situations and learn strategies to prevent relapse you have a great chance of being able to quit on your own – learn how to succeed here.

Trying to quit marijuana?

This article is not about whether or not you should use marijuana - that’s a different topic entirely. This article is simply about learning effective ways to quit and stay quit. This article is for you if:

• You're an adolescent or young adult marijuana user
  
• You've decided, for personal reasons, to stop smoking marijuana
• You have difficulty quitting for good
• You want to increase your odds of success
• You want to try quitting without professional assistance (without getting parents or therapists, etc. involved)

Some people quit with ease and then wonder why others have such a hard time with it, but many people have trouble staying abstinent for good.

If you’ve decided you want to quit, it’s entirely reasonable to try quitting on your own first – you don’t necessarily have to create a lot of drama and get your parents or specialist professionals involved.*

If you’re smart and motivated you have an excellent chance for success, no matter how addicted you find yourself; and you can improve your odds further with a little preparation, such as by:

1. Learning about what types of situations commonly lead to relapse
2. Making a plan for how you’ll deal with these high-risk situations

*However, if you try your best to stop using and you can’t do it on your own, then you probably should get some outside help – after all, isn’t the definition of futility doing the same thing repeatedly and expecting differing results?

10 Situations/Mindsets That Lead to Relapse

It’s best to know what you’re up against. Here’s a list of 10 mindsets/situations that are very commonly associated with relapse. Read the list and:

1. Think about which situations threaten your quit attempt
2. Think about how you’ll handle these high-risk situations without relapsing

1. Daydreams about the Good Times

You probably had a lot of fun while high on marijuana. After you quit you might feel a sense of loss or grief about the future ‘fun’ that you’ll miss…and never again can feel like a very long time!

When you catch yourself fantasizing about the good times, remember to balance the equation with thoughts of your reasons for quitting.

2. Wanting to Relax

You can learn to relax without taking drugs – but there’s no denying that drugs offer an easier path to instant relaxation. So how will you take the edge off when you can’t turn to marijuana for relaxation?

Learning to relax without chemical assistance takes more effort, but once you learn self-soothing skills you get all the benefits without any of the negative consequences.

3. Socializing

• When everyone around you is smoking, it’s going to be hard to say no.
• If you’re used to smoking before meeting new people as a way to overcome anxiety or shyness, you’re going to feel tempted when in such situations.

How will you deal with these types of situations?

4. Thinking That People Are Tired of Sober-You

Do you ever feel like people liked the old easy-going high you better than the new uptight not-high you?

Remember that withdrawal symptoms like irritability can last for a while, and it might take you a few weeks or longer to start feeling like your old self again.

5. Dealing with Stress or Crisis Situations

If you usually squash uncomfortable stress with a joint how will you handle negative emotions without marijuana?

6. Deciding to Test Yourself

After a while, it’s easy to grow overconfident:

• Sure it was a problem before but now you’ve got it all under control, so why not have a little fun?...Just once in a while....
  

Remember, it’s easy to talk yourself into relapse; it’s much harder to work back out again.

7. Feeling Like You Need a Break

Sometimes you feel like you need to get away - to take a little mini-vacation from all your problems.

Getting high provided instant escape. What will now substitute?

8. Feeling Like You’re a Better Person High

If marijuana gives you confidence or helps you forget low self-esteem you may feel tempted to use again whenever you feel especially in-confident or down on yourself.

9. Screw It!

When you reach the end of your rope and you’re frazzled and tired and nothing’s going right…it’s so easy to slip into a moment of weakness, think screw it, and accept that joint that’s going around.

(Read the strategies below for tips on how to fight this impulse to give-up.)

10. Losing the Faith

You can’t quit unless you believe you can quit – otherwise, when things get hard you’ll give up before you even get started.

Strategies for Success

There are 2 parts to a successful quitting attempt:

1. Identify what threatens your quit try
2. Make a plan for dealing with high-risk situations

So you've already started thinking about the circumstances that lead to relapse, now here are some ideas to help you maintain your resolve during these high-risk situations.

5 Strategies for Overcoming Temptation

Use any or all of the following – choosing whichever make the most sense to you.

1. Wait 30 Minutes

Here's a simple but effective technique:

• Make a promise to yourself that if you ever decide to smoke again, you’ll wait at least 30 minutes after making that decision before lighting up.

And if you make yourself this promise - be true to it - and really wait like you said you would.

Usually, after 30 minutes, you won't want to smoke so badly anymore and you'll feel grateful and relieved that you held-out.

2. Make a Plan to Call Someone before You Fold

Enlist a friend that supports your quit attempt (probably not someone you get high with) and ask them if you can call should you ever feel strongly tempted to use.

All they have to do is distract you for a few minutes and remind you of all your good reasons for quitting in the first place.

3 Carry a List of Your Reasons for Quitting

It’s easy to get stuck in daydreams about the good old days – about how much fun you had while high – but when you’re craving you rarely spend much time thinking about all the bad times or negative consequences.

• Make a list of your top 4 or 5 reasons for quitting and keep that list on your person at all times. Whenever you’re tempted to smoke, make sure you take a moment to read your list of negatives first.

Slam on the brakes!

It’s so easy to get caught up in a moment of weakness, or stress, or fatigue or celebration and just forget for a second why you’re working so hard to stay clean; and unfortunately, it only takes a brief moment to undo the hard work of weeks or months. This is why anything you can do to add some brakes to a risky situation helps you to achieve your larger goal of staying abstinent.

4. Carry a Picture to Inspire You

Carry a picture of a person or people that would be really disappointed in you for relapsing and really proud of you for holding-out. Make a promise to yourself that before you smoke again, you’ll take a moment to look at this picture and consider the consequences.

5. Get Out of the Situation

If you decide to smoke again, you’ll have a whole lifetime to do it, so before you relapse, promise yourself that you’ll at least try to hold-off by removing yourself from whatever situation is causing your cravings.

Image Copyright: John Steven Fernandez

Considering residential rehab treatment for your teenager? First read this warning-sign checklist to spot and avoid dangerous or ineffective programs.

As a last resort, parents sometimes consider adolescent residential treatment as a preferable alternative to hospitalization, incarceration, serious injury or worse. 

This can be the right choice, but it’s not something to take lightly - and it’s not something to consider until exhausting all interventions that would keep your child in the family home.

Should you decide on residential treatment (after consulting with other professionals) you need to find a program that:

1. Can likely help your teen
2. Won’t worsen the situation
3. Protects your child's safety and well-being
   

In this article you’ll find some information on picking the right teen program (get qualified professional help for this) and more information on how to avoid a program that won’t help and could hurt.

Learn:

1. Why you need to worry about residential treatment safety
   
2. A check-list of points of concern and potential red-flags to consider
3. The basic rights you should demand for your child
   

Private Teen Treatment – An Unregulated Industry

The Federal Trade Commission (FTC) cautions consumers that no federal regulations cover private adolescent residential treatment programs - and many run as unlicensed and unregulated operations. Examples of private adolescent residential treatment programs include:

• Therapeutic wilderness programs
• Therapeutic boarding schools
• Boot-camp programs
• Behavior modification programs
• Emotional growth academies
• And programs under other names

Of course, a residential program can be unregulated and still safe and effective, but without any significant oversight or standardization, it’s really up to parents to thoroughly investigate any program before signing on. Before sending any child away, the FTC recommends that parents:

• Visit the residential program site
• Research the program on the internet (looking for negatives, as well as positives)
• Ask many questions
• Get all agreements and promises in writing
• Ask for documented proof of staff credentials and facility licensing and accreditation¹

To help you spot potential problems, consider the list of 16 red-flag warning signs below for any program under consideration.

Residential Programs Checklist: Points of Concern

Here is a checklist of potential points of concern, or in some cases, red-flag warning signs. Do not send a child off before going through this list and feeling satisfied on every count; no program is perfect but you should never compromise on safety. Reviewing programs carefully will take some time and effort, but you need to invest the time now to avoid mistakes you can’t undo later.

1. A warning sign doesn’t necessarily indicate a serious problem – though it might.
2. Take your time when selecting a program. Things are almost never so drastic as to preclude a few days/weeks of careful consideration, and in fact, you should consider any undue attempt to rush your decision a cause for concern (you are not buying a used car here; strong sales tactics are unethical.)

1. Check for an Appropriate State License and Any Accreditation

If the program is licensed, be sure to ask what agency issued the license, and then confirm with that agency that the license remains valid and is appropriate to the situation you are considering.

In some cases, a program may have licensure or accreditation for one aspect of their program, but not another. If a program offers educational services, residential care and therapeutic services, their licensing should reflect this.

2. Check for Consumer Complaints

Past problems may indicate present challenges. Contact your state Attorney General, the Better Business Bureau and your local Consumer Protection office and ask for:

• Any publicly available information on complaints or actions filed against the program
  
• Copies of site visit evaluations
• Violation reports
• Corrective actions mandated

 Be very concerned if you find reports of past problems with:

• Insufficient staff supervision
• Medical neglect
• Violations of youth or family rights
• Any physical or sexual abuse, either between residents or involving staff
• Poor diet
• Unsanitary or unsafe living conditions
• Forced exposure to extreme physical situations

3. Check Staff Credentials

If a program advertises a psychiatrist on staff and that professional checks in for a few hours once a month to ‘assess’ a large group of clients, is this a deception?

You can answer that question for yourself, but it’s a good idea to spend some time investigating the experience level of the staff who’ll be spending the most time working with your child.

Ask:

• Who will spend the most time in direct contact with my child? What credentials and experience do they have? Are they licensed in this state? What agency provided licensure? Can I see copies of relevant licensing documents?

Confirm:

• For peace of mind, take 2 minutes to confirm the accuracy and validity of licenses by contacting the issuing body. This is a very normal and routine request to make of these agencies.

Obviously, any misrepresentation of staff qualifications is a huge red flag.

4. Ask about Background Checks

Are background checks performed on all staff that will be in contact with your child? If so, what is the name of the agency that conducts these checks? Consider contacting the agency that did the checks to confirm that checks are up to date. Have all employees been cleared by your state’s child abuse registry?

5. Check If You’ll Be Asked to Give up Your Rights

As a parent, you should have reasonable access to your child at any time and you should be the person to make important decisions. Be wary of any program that would restrict your ability to communicate with your child or that asks you to relinquish – even temporarily – any of your normal custodial rights.

6. Will You Have Open Access to Your Child?

Quality programs relish family involvement, knowing that caregivers play an essential role in the therapeutic process.

Ask:

• How often can you visit? Can you visit whenever you want to? If you can’t, why not?
• Do children ever lose family contact ‘privileges’ for rule violations?
• Will staff listen in to phone calls or read letters? You do not want to put your child in a position where they are geographically isolated and unable to communicate with you about problems or abuses.

7. Check Specific Treatment Practices

You child has a completely unique history and personality, faces unique challenges and needs personalized treatment, not cookie-cutter solutions.

You send a child to residential treatment to work on a specific problem. There is little point in sending a child away unless you feel confident they will benefit from the experience.

To make sure you get appropriate benefit, confirm that the program uses effective therapies that are suitable to your child’s unique situation. Ask:

• What therapies will you use to treat my child?
• What research evidence supports the use of these therapies?
• Is there research evidence to support the use of these therapies for my child’s key challenge?
• How will you measure whether these therapies are working for my child?

Learn more about evidence based therapies

8. Check Disciplinary Practices

How do staff discipline? Ask for specifics. Ask if staff, under any circumstances, make use of any of the following corrective techniques:

• Humiliation – ‘breaking down to build back up’
• Isolation (solitary confinement or forced silence or ostracizing)
• Restraint (other than in very extreme cases to protect the safety of the child or others, and always in a manner that is compliant with federal law and best practices)
• The withholding of food, water or medical care
• Denying contact with family members as punishment

According to The Community Alliance for the Ethical Treatment of Youth (a residential treatment safety group) restraint or seclusion indicate dangerous treatment breakdown – these should never occur as normal disciplinary practices.

Likewise, it is inappropriate and unethical to deny a child contact with his or her family as a disciplinary technique.

The best programs use positive reinforcement and build on strengths, rather than tearing down weaknesses. If a child doesn’t feel ready or willing to share personal information, how is this handled? Is this a rule violation that’s met with discipline?

9. Ask about the Use of Escort Services

Only you can decide if your situation warrants the use of an escort service, but do not agree to the use of an escort service before considering the possible consequences.

• Escort services come into your house (at your invitation) in the middle of the night, restrain your son or daughter (if necessary), and force them into transportation to a facility.

Before agreeing to such an intervention, think carefully about the potential long-term consequences, such as loss of trust, humiliation, trauma and PTSD, etc.

Before agreeing to an escort service, find out what type of background checks the escort company performs on their employees.

10. Check for Trauma Sensitivity

Some children develop emotional or behavioral problems after experiencing trauma, such as abuse, the death of a parent, violence, foster care, neglect and others.

Children struggling with trauma fear a loss of control. These children can be further traumatized by:

• Confrontational tactics
• Interventions designed to bring out an extreme emotional reaction
• Being pushed to reveal their story before they are ready to do so

If trauma is an issue for your child, be sure to ask about the program’s trauma-sensitive adolescent treatment practices.

11. Medication Issues

Many teens with behavioral or emotional issues severe enough to require residential treatment are on one or more medications. Some of these children are likely over-medicated and some are likely under-medicated. Given this, the program shouldn’t have an extreme philosophy on medication (for example…"We need to wean kids off too much medication.")

Ask:

• Will program staff get in touch with my child’s doctor to discuss medication needs?
• Who hands out medication to children? What qualifications does this person have?
• Do other children ever hand out medications?

12. Watch for Pressure Sales Tactics

According to the Alliance for the Safe, Therapeutic and Appropriate Use of Residential Treatment (ASTART) deceptive marketing and pressure sales practices are unfortunately common within the industry.

Parents don’t usually consider residential options until the family situation reaches a crisis point. From this position of great stress, it’s normal for parents to struggle with a mix of negative emotions, like:

• Anger and frustration
• Anxiety about your child’s future
• Worry about the well-being of others in the household
• Exhaustion and a need for the ‘drama’ to end

It's hard to make calm analytic decisions from an emotional position - and what’s worse, unscrupulous admissions ‘counselors’ may stoke fear to make a sale.

Be skeptical about the true motivations of anyone who urges a quick decision on residential treatment, especially if they present worst-case scenario outcomes as likely if you delay.²

13. Quick Assessment over the Phone or Internet

Programs that will diagnose and admit a child after a brief conversation about behaviors and symptoms cannot be considered ethical healthcare providers.

1. Get in touch with a professional who truly specializes in your teen's challenges and request a thorough evaluation and recommendation. An example could be a psychologist who publishes research on conduct disorder, or a psychiatrist who researches and specializes in the treatment of ADHD.
2. Make sure that any professional you approach has no financial or professional relationship with any organization under consideration.
3. Remember that all things being equal, the closer program is the better program – families should be a part of the process and proximity allows for more frequent visitation.³

14. One-Size-Fits-All Treatment

If your child has a serious mental illness or substance abuse problem, you need to send them to a specialized program that’s designed and staffed to meet the challenges inherent in this type of treatment. If the program claims to treat an A to Z list of problems and mental illnesses, you should proceed with caution.

15. Ask about Education

If academics play a role in the program, ask:

• Are teachers certified, and if so, by what agency?
• Does learning occur via classroom teaching or through independent study?
• Are credits earned transferable to your local school? (You may want to double check this.)

16. Ask about Undisclosed Financial Relationships

If a professional or agency has referred you to a program, be sure to ask about the existence of any business relationship. If an agency is paid to refer students, can they be impartial?

When to Consider a Residential Treatment Program

In some situations, adolescent residential treatment makes sense, but according to the National Alliance on Mental Illness (NAMI), in the vast majority of situations, you should only consider sending your teen away after ‘utterly exhausting community mental health care resources.”

Additionally, any residential phase of treatment should:

1. Be as short as possible
2. Be focused on achieving a very specific goal – such as assessment, stabilization or respite
3. Be centered on a goal of having the adolescent return to the home with as little stress and disruption as possible.⁴

Your Child’s Rights

Programs that respect your child’s basic rights are less likely to be abusive or neglectful. Check to make sure that:

• Your son or daughter will have regular access to a phone and to unsupervised phone calls.
• You and your son or daughter are provided with hotline phone numbers to call to report any program abuses.
• Program staff never use abusive disciplinary techniques, such as forced seclusion or restraint, denying medical care, food or water, sedation with medications, inducing fear, humiliation or any form of corporal punishment.
• Parents or caregivers should be notified promptly after sickness or injury.
• Parents or caregivers should be notified with 24 hours about medication regimen changes or missed dosages.
• Parents or caregivers should receive notification within 2 days of any investigation into allegations of child abuse or neglect, violations in health or safety standards of violations of licensing standards.

Learn more about how trauma and substance abuse co-exist, the importance of trauma-sensitive care (and where to find it) and what parents can do on their own at home to help.

“There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.” Laurell Hamilton¹

It's hard enough just navigating the everyday turmoil of adolescence. It’s hardly surprising that for teens who experience trauma, alcohol and drugs can become necessary self-medication.

• If your son or daughter has survived a traumatic experience, be on the lookout for lingering trauma stress symptoms, know that these won’t necessarily go away on their own and that without healing, trauma stress symptoms can snowball into life-long problems.
• And if trauma co-occurs with substance abuse (and it often does, for many reasons) know that alcohol and drugs impair a person’s ability to get past trauma stress and that trauma stress complicate addiction recovery.

Fortunately, effective treatments exist and the quicker you address either trauma or trauma and substance abuse, the better the prognosis.

Read on to learn more about

1. What causes teen trauma stress and the warning signs of a problem to watch for.
2. Information on when to seek help.
3. Information on the importance of trauma-sensitive care (trauma-insensitive care can actually worsen the situation) – what defines it, where to find it and how to evaluate different programs.
4. What parents can do at home to help.

What Is Trauma?

Any situation in which a person fears for their life or safety or for the life and safety of a loved-one can lead to traumatic stress, for example: a car accident, a violent assault, the traumatic death of a loved one, a life-threatening illness, natural disasters, war, sexual or physical abuse and many others.

Trauma can be acute – such as a mugging, or chronic (several incidences occurring over a period of time). Some examples of chronic traumatic stress include childhood neglect, chronic sexual or physical abuse or ongoing domestic violence situations.

Some trauma-exposed teens experience few or no later consequences, while others may develop PTSD. Therefore, parents need to learn what to watch for and be prepared to intervene with help if necessary.

Warning Signs of Adolescent Traumatic Stress

Post traumatic stress disorder symptoms generally fall into three categories:

1. Re-experience – Flashbacks, nightmares, physical or emotional responses to reminders (triggers).
2. Avoidance – Avoiding anything and anyone that reminds of the event. This may also lead to feelings of disassociation.
3. Arousal – Feeling constantly on-guard, increased jumpiness and agitation, being easily startled and quick to anger, having difficulty concentrating.

After trauma exposure, be on the lookout for the following warning signs which may indicate traumatic stress:²

• Starting to take unhealthy risks
• Signs of depression
• Increased irritability or jumpiness
• Problems at school
• Getting upset or angry more quickly and easily than in the past
• He or she feels like they’re going crazy
• He or she feels different from everyone else
• Sudden antisocial behavior change – becoming more oppositional, ignoring social norms, risking the safety of self and others
• Becoming suddenly sexually active
• Talking about the traumatic event in exceptional detail
• Avoiding places or people that remind of the traumatic event
• Sleep disturbances
• Numbing symptoms - saying that they have no feelings at all about the traumatic occurrence
• Using unhealthy coping mechanisms, like alcohol or drug use, cutting or disordered eating

Traumatic stress symptoms usually start quickly after the traumatic event but in some cases, symptoms may not emerge for months after the fact. Symptoms that persist for more than 4 weeks without dissipating indicate a serious problem.³

The Importance of Dealing with Traumatic Stress

Whether or not traumatic stress leads to substance abuse, if your child isn’t coping well after trauma, it’s important to intervene. Unresolved trauma can cause emotional, cognitive and behavioral problems that can worsen over time.

Adolescents who struggle with trauma may experience delays and deficits in emotional and behavioral regulation, and this can lead to a range of consequences, such as:

• A diminished ability to consider the likely consequences (risks and dangers) of an action – this can lead to reckless and dangerous behaviors.
• Or the opposite reaction - becoming overly fearful and unwilling to face any risks – this can delay maturation and psychological growth.

Trauma can also derail academic and social performance.

• Teens struggling to cope with traumatic memories may have trouble focusing on schoolwork or attending to friends and forming normal beneficial relationships.

How Are Trauma and Substance Abuse Linked?

If you have one, you’re more likely to have the other - for example:

• Teens with a history of physical or sexual abuse are 3 times more likely to report past or present substance abuse than teens without any history of trauma.
• Some studies indicate that up to 59% of teens with PTSD will develop a substance abuse problem.
• A survey study of teens enrolled in addiction treatment programs found that 70% had a history of trauma.⁴ 

Teens coping with trauma may turn to drugs or alcohol for self medication or escape and teens who abuse alcohol or drugs tend to engage in activities that increase the risks of trauma exposure (sexual assault, car accident, etc.) In fact, for more than half of teens with trauma and substance abuse issues, substance abuse preceded trauma.

Teens with substance use disorders are also more likely to develop PTSD after trauma than teens without substance use disorders. The compromised emotional, social and cognitive functioning that co-occurs with adolescent substance use disorders likely also reduces a teen’s ability to cope with trauma exposure.

When to Seek Help

For substance abuse:

• Though you’d never want to consider residential care until you’ve fully explored progressive levels of stay-at-home interventions, you’d definitely want to consider some form of treatment should (persistent) drug or alcohol use become problematic.

For trauma:

• Though a person might experience severe trauma stress in the first days after an incident, stress symptoms usually dissipate and you start to feel better within a few days or weeks.
  
• Seek help when an adolescent experiences lingering trauma symptoms that worsen or don’t diminish in intensity over time, when symptoms are severe enough to interfere with normal functioning or when symptoms are highly distressing.⁵

So whenever you’re dealing with a situation where severe persistent trauma symptoms co-occur with drug or alcohol abuse you should strongly consider professional help.

1. A person may be self-medicating severe symptoms with drugs or alcohol, and since untreated stress symptoms may not go away on their own, this can easily lead to serious addiction issues.
2. Alternatively, when substance abuse precedes trauma, the drug or alcohol use can diminish a person’s ability to bounce back from trauma and so the substance use worsens the situation.

In the next sections:

• How trauma affects treatment needs
• Finding a trauma-sensitive treatment provider
• Elements of effective care for teens with trauma and substance abuse issues
• Beyond professional help – what parents can do at home to help

How Does Trauma History Affect Treatment Needs?

A trauma history complicates the addiction recovery process.

• Integrated treatment is important - When trauma and substance abuse get treated separately, post-treatment relapse is more likely.
• In general – a history of abuse worsens treatment outcomes.
• Teens dealing with trauma and substance abuse are less likely/able to heed warnings about the consequences of actions, change peer groups and find other ways to have fun or manage stress or negative emotions.
• Teens struggling with PTSD and substance abuse have more difficulty maintaining recovery since trauma reminders increase drug and alcohol cravings - Emotional and environmental triggers can spark traumatic stress symptoms and drug or alcohol cravings.

The Importance of Integrated Treatment

While a drug abusing teen without a trauma history might experience cravings when confronted with people, places or things that trigger memories of using, a teen with a trauma history would also experience cravings when exposed to anything that triggers reminders of past trauma. Unless a person can learn to manage these emotional trauma reminders, relapse is likely. For this reason, substance abuse treatment needs to also address trauma symptoms.

Take Home Message

1. Teens with traumatic stress benefit from integrated treatment that addresses the linkages between substance use and traumatic stress.
   
2. Because a trauma history complicates treatment outcomes, it’s important to intervene early, to stay involved with treatment throughout the continuing care phase and to be ready to re-engage with treatment should relapse occur.
   
3. Since trauma complicates treatment, a teen with trauma and substance abuse issues will likely need more intensive treatment than a teen facing only one of these significant challenges.⁶

Finding an Integrated Program – What to Look For

The importance of trauma-informed care.

The last thing you want to do is make the problem worse, and unfortunately, treatment practices that aren’t sensitive to the needs of trauma-affected youth can do just that:

• Imagine how forced transport to a treatment facility or military style confrontation tactics at a boot camp could worsen feelings of mistrust and helplessness.
  

When looking for a treatment provider, one of the first things you want to look for is ‘Trauma-Informed Care’. Programs offering trauma-informed care are different from conventional treatment programs in 2 important ways:

1. They don’t worsen the trauma

Since certain treatment practices may trigger trauma symptoms or even re-traumatize, trauma-sensitive programs strive to promote a safe and welcoming atmosphere at all times and deliver interventions that provide hope and empowerment to youth. All staff members are trained to be trauma-aware.

2. They offer trauma-specific interventions

These interventions address the trauma and help young people learn to self regulate behaviors and emotions.

An effective trauma-sensitive treatment program will make emotional and physical safety an absolute top priority, be aware and sensitive to client boundaries and work to promote client trust.⁷

Elements of Effective Trauma-Sensitive Treatment

OK – so you need to find a provider or program that will treat trauma symptoms and substance abuse/addiction at the same time and you should definitely prioritize finding a trauma-sensitive program – but beyond this, what else should you look for when searching for an effective program for your son or daughter?

Well, according to The National Child Traumatic Stress Network (NTCSN), when looking for an adolescent trauma + substance use disorder treatment program/provider, here’s what to look for:⁸

• The provider offers more intensive treatment options for youth and families dealing with trauma and substance abuse (so while youth in an outpatient substance treatment program might attend 2 sessions per week, youth with trauma issues might attend 3 and have an additional weekly family session on top of that, for example.)
• The provider strives to build a collaborative, open and trusting relationship.
• The provider emphasizes managing both substance abuse and trauma symptoms right from the start of treatment.
• Relapse prevention skills for both trauma symptoms and substance use are taught early in the program.
  
• The program includes skills training on stress management (relaxation training, re-framing, etc.) and on dealing with negative emotions (identifying emotions, communicating effectively, working to improve negative emotions.)
• Therapy staff use cognitive behavioral techniques to teach ways to correct and overcome negative thinking patterns.
• The program offers social skills training, if needed.
• The provider links teens and family members to community resources, such as mutual self-help groups.
• The program offers an educational component, to teach youth and family members about trauma and substance use disorders, and to encourage reasonable expectations.
• Parents are encouraged to get involved in the treatment process, hopefully to increase parenting, conflict resolution and communication skills. Parental involvement is very important. When parents get actively involved in treatment and are willing to work with treatment providers the odds of a positive outcome go up.

Finding a Trauma + Addiction Treatment Program

One tool you can use to discover your local trauma-sensitive programs is SAMHSA’s Mental Health Treatment Locator Tool.

Instructions:

1. Use the locator tool to find a list of all mental health providers in your area
2. Once you have this list, click on the ‘Change Service Selections’ button.
3. In the advanced search menu, click on the button linked to the correct age group, the button next to ‘Individuals with PTSD’ and the button next to ‘Individuals co-occurring mental and substance abuse disorders.’
4. Click submit and you’ll receive a list of trauma-sensitive teen addiction treatment providers in your area.

Choosing a Trauma-Sensitive Treatment Program

Finding a program that uses evidence-based interventions.

When interviewing prospective providers or staff members at prospective programs you should ask about trauma interventions.

1. Interventions with research proving their effectiveness are called evidence-based programs, and SAMHSA keeps a registry of these programs that you can access.
   
2. Ask any provider under consideration which evidence-based trauma programs they use.
   
3. Then visit the evidence-based program registry to learn more and to evaluate for yourself the appropriateness of the intervention for your situation.

Here is a link to the evidence-based registry and to 24 evidence-based trauma interventions for youth from ages 13 – 25. 

Programs that make use of evidence-based interventions are likely more effective than programs that do not.

What Can Parents Do at Home?

Teens dealing with trauma are at increased risk of substance use and abuse, criminal activities, anxiety and other psychological disorders and social and legal problems.⁹

The two things that help most to mitigate these increased risks are:

1. Early professional intervention
2. Parental support

So when trauma symptoms persist for weeks and cause significant distress, it’s important that you seek professional help, and since the longer symptoms endure the greater the developmental damage (like a snowballing effect) it’s important to act without delay.

But though professional treatment is essential, trauma-sensitive parenting practices can also help your teen cope with traumatic stress. Given this, consider the following parenting practices:¹⁰ 

• Help your teen deal with guilt – survivor guilt is a common phenomenon after trauma. Talk to your child about feelings of guilt and work on identifying what he or she is and is not responsible for. This can help your child to let-go of inappropriate guilt and shame.
  
• Try to understand what triggers reminders and trauma symptoms and know that triggers can lead to a loss of behavioral or emotional control. Be patient and supportive.
• Help your teen get past embarrassment that might block open communication. Make sure your teen knows that their post-trauma emotional reactions are normal and nothing to be ashamed of. Try to get them talking about their feelings.
• A traumatic event can cause a major shift in your teen’s world view and this can lead to a lot of anger and disruptive impulses. Talk about this and try to help your son or daughter find constructive ways to express their emotions. Finding a constructive outlet reduces feelings of helplessness and reduces the potential consequences associated with engaging in antisocial acts as an alternative outlet.

Parents can also aid in recovery by:

• Encouraging normal sleeping and eating habits and patterns.
• Encouraging a reconnection with supportive friends and loved-ones in the community.
• Encouraging participation in any personally relevant spirituality or faith community.
• Encouraging participation in community support groups.¹¹
  

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Once you decide your adolescent needs addiction treatment, the next vital step is determining what level of care is required. Read on to learn more about the 6 factors professionals consider when deciding on an appropriate level of care.

Your adolescent son or daughter has a problem with drugs or alcohol. You are probably very worried about the situation and you know he or she needs some sort of help.

But what kind of help does your teenager need?

Does he need to go to a rehab program for teenagers? Would she do OK if she just worked with a therapist or addiction counselor? What about a wilderness camp for behavioral change…?

You have many options to choose from, the tricky part is knowing which option best meets your family’s needs.

Well, to start with, consider the following few facts:

Fact 1: Although we tend to think of addiction in very black and white terms, the truth of it is more complicated. You may want to know if your son is or is not an alcoholic/addict, but unfortunately, this basic 'either/or labeling' doesn't really match the complexities of the situation. Adolescent drug and alcohol use actually occurs along a long continuum of severity, from very mild experimentation to more recreational use to increasingly regular and more problematic use and ultimately to daily and very problematic use and dependency.

Fact 2: Teen substance abuse treatment also occurs along a continuum of care, and for best chances of a positive outcome it’s important to match your son or daughter to an appropriate level of care. Levels of treatment along the continuum of care range from counseling or outpatient addiction treatment programs to more intensive and structured day-long outpatient addiction treatment programs to residential addiction treatment programs and ultimately to hospital based inpatient treatment.

Fact 3: In some cases, moderate consumption (not abstinence) is an appropriate treatment goal.

Fact 4: As a general rule, experts usually recommend starting with the least intrusive level of care (outpatient counseling, for example) unless the person is at serious risk of harm. Factors that might require an upping of intensity to residential care include the co-presence of another mental illness like depression, suicidal ideation or the regular engagement in very high risk activities while intoxicated. Examples of high risk activities include drunk driving, unprotected sex, crime or aggressive behaviors, among many other possible behaviors.

So if it’s important to match the level of care to the situation, how can you know which level of care is needed for your son or daughter?

Finding the Right Level of Care – 6 Details to Consider:

Learning more about the ways professionals determine appropriate levels of care should help to demystify the addiction treatment process and may help you to make a better decision about where your son or daughter needs to be.

That being said, you don’t have the experience or third-person neutrality of a knowledgeable addiction professional and there is great value in getting a professional to do an assessment and make a treatment recommendation before committing to any course of action. Some of the factors a professional would likely consider when making a treatment needs assessment are:

1. The severity of the drug or alcohol use problem
2. The age of the adolescent
3. Personal risk factors
4. The young person’s preferences
5. Any existing mental health issues
6. The degree of stability and support in the young person’s home and social environment

The Severity of the Drug or Alcohol Use Problem

When determining the severity of the problem experts tend to weigh 2 variables:

1. The frequency and quantity of consumption
2. The seriousness of consequences arising from the drug or alcohol use

Based on information on consumption and consequences, from the adolescent and from family and friends, an expert might try to classify the adolescent into 1 of 4 groups:

1. An experimental user – a person who has used drugs or alcohol once or a couple/few times and has yet to experience any adverse consequences from that use.
2. A recreational user – a person who uses drugs or alcohol occasionally, likely at special events. A recreational user probably won’t have experienced any significant consequences from their use and they won’t be preoccupied with getting or using drugs or alcohol.
3. A regular user – A regular user takes drugs or alcohol on a regular basis, sometimes during the middle of the week, and use is not limited to any special recreational events. This person is likely preoccupied with getting and using, is often drunk or high or hung-over and is starting to experience negative consequences from their use
4. A dependent user – Teens dependent on drugs or alcohol will use almost every day (or daily). They will experience negative consequences from their use and they will continue to use despite an awareness of these negative consequences. They may also experience physical withdrawal symptoms when they do not or cannot take drugs or alcohol.

There are no hard and fast rules, but as a very general guide, experimental and recreational users will probably do well in outpatient treatment, regular users may require more intensive treatment, such as day treatment and dependent users may require residential care. These recommendations, however, will vary based on the individual circumstances to be discussed below, for example:

• A 13 year old recreational user would probably require more intensive treatment than an 18 year old recreational user
• A regular user with co-occurring depression or anxiety might require residential care while a regular user without mental illness might do better in day treatment.

The Young Person’s Age

Younger teen drug and alcohol users may require more intensive treatment than older teen users.

• The younger an adolescent starts using/abusing drugs or alcohol the greater their likelihood of developing problems down the line.¹
• Substance abuse during the early teen years may impair a young person’s ability to resolve the necessary developmental tasks of adolescence.
  

Based on these two risk factors, a younger teen might require more intensive treatment than an older teen, even if these two young people were using similar amounts of drugs and or alcohol.

Personal Risk Factors

Certain risk factors may increase a teen’s susceptibility to substance abuse and or addiction, and so the presence of predisposing risk factors may factor into a decision about treatment placement.

Examples of personal risk factors that increase an adolescent’s vulnerability include:

• Substance abuse in the family
• Having a learning disability
• Developmental delays
• Low social skills
• Having a history of behavioral problems
• Others

The Adolescent’s Preferences

If at all possible, it is preferable to listen to and incorporate a teen’s goals and preferences into a treatment plan.

Recommending a course of action that contrasts with a teen’s treatment wishes and goals can backfire as the young person may become more oppositional and less interested in participating in the treatment process.

If following a teen client’s wishes isn’t considered advisable (for example, she wants no treatment and wants to continue with drinking and the treatment assessment indicates a need for residential care and abstinence) it may be best to make some compromises and to work towards a goal that is at least acceptable to all parties (for example day treatment and working towards reducing the harms of use through moderate drinking strategies).

The Co-Existence of Mental Health Problems

Mental health problems frequently co-occur with substance abuse and addiction. Unfortunately, when psychiatric symptoms arise, it’s sometimes hard to know whether they are caused by true mental illness or as a side effect of the ingestion of drugs and or alcohol.

• The presence of a known mental illness increases the appropriateness of residential treatment.
• If mental illness is suspected and the adolescent will not maintain sobriety, then it is difficult to know what’s really causing what. In this situation, a period of residential treatment and enforced abstinence is probably warranted to allow for an accurate assessment of the situation.

Environmental Stability and Support

Teens with a high degree of social stability and support are better candidates for outpatient treatment. Environmental variables that professionals might consider when looking and stability and support include:

• Does the adolescent have a stable and supportive living environment?
• Is he or she working or attending school?
• Does the client have non drug or alcohol abusing supportive friends?
• Does the client participate in any healthy social activities, such as at school, through community sports or at church?²

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With addiction and drug abuse teens are at risk for a host of peripheral social problems, including suicide, violence, mental health difficulties and poor academic performance. Get educated about the risks facing your teen, and learn what really helps if there is a problem.

Teenagers that start experimenting with drugs or alcohol run a great risk of developing a substance abuse problem or even a dependency; and even those youth who do manage to avoid addiction suffer through any involvement in drug taking behaviors.

Not only is the use and misuse of alcohol or illicit drugs a very risky behavior, it is also especially detrimental to the still developing minds and bodies of teenage users, and the negative health consequences of use are magnified in still growing adolescents.

In addition to the risks of addiction and the direct risks of physical and mental developmental delays and deficits, participation in even recreational drug or alcohol taking behaviors increases the risks for a host of peripheral social, academic, psychiatric and legal challenges; and those youths who do not engage in substance use and abuse are far better protected against a great many serious challenges during adolescence.

Parents who can keep kids from experimenting with drugs and alcohol until the age of majority protect them from a range of problems, and may even save their lives.

In addition to the risks of addiction, to chronic mental and physical health deficits and to acute overdose or poisoning; the peripheral risks of drug or alcohol experimentation include an increased risk of suicide, decreased academic performance, greater rates of mental illness, more violence both committed and experienced and a greater likelihood of traffic accidents and DUI's.

Academic Performance

Both drug and alcohol use is directly and negatively correlated with academic performance.

Alcohol or illicit drugs are very harmful to the still developing mind, and cognitive and memory impairments can be both transient, and sadly also permanent. The greater the frequency of use the worse the academic performance, but on average, any drug or alcohol use correlates with a lower overall grade point.

Of kids who do not use alcohol or drugs 72.5% maintain an A or B average, yet only 57.7% of kids who binge drink can attain the same level of performance. 72.2 % of kids who reported not having used marijuana in the last month maintained an A or B average, while only 44.9% of kids who had used marijuana 5 or more times in the last month could maintain better than a C average.

Suicide

Experimentation with illicit drugs stronger than marijuana is directly correlated with an increased risk of suicidal ideation. Kids who use drugs harder than marijuana are almost 3 times more likely to self report thinking about suicide than kids who did not use drugs or alcohol.

Violence

Kids who use drugs or alcohol are far more likely to engage in violent acts, and also to experience violence committed against them.

Kids who self reported having participated in a group violent assault were twice as likely to have also used drugs or alcohol in the past year as kids who had not, and over half of all kids who reported having committed two or more types of violent assault over the past year had also used alcohol or drugs.

Estimates have over 800 000 American kids carrying handguns each year, and the odds of carrying a hand gun are greatly increased by concurrent use of illicit drugs or alcohol, and kids who had used illicit drugs were 3 times more likely than non users to carry a gun, kids who binge drank 4 times more likely and kids who drank heavily 5 times more likely.

Whether due to the behaviors of intoxication, association with other risk taking youths or other factors, the data clearly indicates that teens who engage in illicit drug or alcohol use are far more likely to also engage in violent acts… and the heavier the use, the more likely the violence.

Keeping Kids Safe from Drugs and Alcohol

Adolescence is a normal period of exploration and experimentation, and these behaviors are a necessary part of the growth and maturation process, but they also lead teens into certain dangerous and harmful behaviors. For their own safety, health and wellbeing, they need to be protected from the devastation of drug and alcohol use and abuse.

Statistics show that every year parents can keep their kids from using drugs and alcohol the better the chance of a life free from addiction and a decreased risk for a great many serious peripheral problems.

If parents do find their kids experimenting, they need to enforce discipline against future usage, and if a problem of abuse or addiction has developed, parents need to get immediate professional help. Substance abuse or dependency never gets better untreated, and parents must intervene for the long term benefit of their kids.

Teenage Mental Health

In addition to a greatly increased risk of suicide, teens who experiment with drugs or alcohol are at a greatly elevated risk for a number of mental health conditions. Mental health challenges are always related to increased rates of substance abuse, but it seems as though teens who start using younger and who use more, are far more likely to develop psychiatric conditions that both complicate the treatment of substance abuse, and also often exacerbate substance abuse behaviors.

The younger that kids start experimenting with marijuana the greater their eventual risk for mental health challenges. Marijuana has been conclusively linked with psychosis like conditions and with anxiety and depression.

A recent study comparing the rates of mental health illness in adults with different ages of marijuana use onset revealed that youths who started using marijuana before the age of 12 were almost twice as likely to suffer from mental health challenges as those who waited until the age of 18 before experimenting. Of youths who used before the age of 12, 21% had experienced a mental health challenge in the past year.

Mental illness also exacerbates rates of drug and alcohol abuse amongst teens, and teens that experience depressive symptoms are more than twice as likely to use illicit drugs, and almost twice as likely to use alcohol.

The mind is a fragile thing, and teens who experiment with intoxication and drug or alcohol abuse too often fall victim to concurrent mental health conditions. Although substance abuse increases the risk for psychiatric conditions at any age, the very young are especially susceptible to increased rates of mental health illness with substance abuse.

Criminality and DUI

Traffic accidents kill more teens than anything else, and far too many teens are involved in fatal DUI's (29% of teens killed in car accidents had been drinking alcohol).

A far greater number are involved in non fatal alcohol induced accidents and hundreds of thousands are arrested for impaired driving…and face legal repercussions. Nearly 21% of all teens aged 16 or older reported having driven under the influence of drugs in the last year, and 16% having driven under the influence of alcohol.

Almost half of all kids ever interned in a jail or detention center report last-month use of drugs or alcohol, and almost 24% of these kids report an addiction to either drugs or alcohol…far above the average for youths never involved in the criminal justice system.

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Statistically speaking, your teen son or daughter is more likely than not to use drugs or alcohol well before finishing high school. By knowing when your child is most exposed to drugs and alcohol and most likely to try experimenting you may be able to prevent or minimize the extent of that experimentation. Read on to find out more about the stages of adolescence that are associated with the greatest likelihood of drug and alcohol use.

When Are the Risks of Drug Use Initiation Highest?

Drug abuse researchers say that adolescents are most likely to initiate substance use and abuse use during times of great transition in life, such as:

• When transitioning from elementary school to middle school –At this stage in life, in the very early teen years, children are exposed to a much wider set of peers, and are likely to have some initial exposure to drugs during this transitional stage
• When transitioning from middle school to high school – During this transitional stage, adolescents experience social and emotional challenges and are exposed to a much larger circle of drug and alcohol users, as well as to easier access to drugs and alcohol
• When transitioning from the family home to more independent living in later adolescence – Older teens leaving home for the first time to live independently, at college or elsewhere, face a sudden dramatic increase in personal freedoms that can result in increased substance use and abuse. ¹

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The 5 most common reasons why adolescents use drugs or alcohol - Until you understand the motivation behind the drug use it’s hard to respond appropriately.

Most teens will experiment with drugs or alcohol. It’s a parent’s job to work to disrupt or limit the extent of this experimentation.

Teens are drawn to the thrills of drugs and alcohol but unfortunately, with still-developing brains, early-use can have lifetime consequences – for example, teens who start drinking at age 10 – 11 are 10 times more likely than teens who wait until the age of 19 to become alcohol addicted in adulthood!

So if your son or daughter regularly uses drugs or alcohol you need to get them to stop, but until you understand what motivates the behavior you can’t really know how to respond.

• A teen who uses alcohol as a way to ease social anxiety needs a far different intervention than a teen who binge drinks for the fun and excitement.

So why does your son or daughter experiment? To help you answer this primal question, here, according to the National Institute of Drug Abuse, are the 5 most common reasons why teenagers use drugs or alcohol.¹

The 5 Motivations Behind Teen Substance Use

1. To Have Fun/ Feel Good

Drugs and alcohol can induce euphoria and decrease social inhibitions. Just as adults do, teens may use drugs and alcohol simply to have fun or get pleasurably high.

2. For Excitement

Just for the thrill of it…

Adolescent brains are hard-wired to seek out novel excitement and thrills and far less able than adults to control risk-taking impulses.

From a developmental viewpoint, this is explained by the fact that the brain's reward systems develop and mature far earlier than the cognitive systems we use for impulse control – these don’t fully mature until a person’s mid-twenties.²

3. To Be One of the Gang

Teens will sometimes use drugs or alcohol simply because their friends or peers do or because they feel pressure to fit in.

Your child’s friends have enormous influence – associating with substance using friends increases a teen's addiction vulnerability.³ As teens progress through adolescence it’s easy to lose track of their friendships and social schedule, but for this reason (and others) it’s important to stay involved in your child’s life and know the people he or she hangs around with.

4. To Feel Better

Many teens use drugs or alcohol to self-medicate anxiety, depression, stress, ADHD symptoms or even physical pains.

A person using alcohol as a tool to ease social anxiety would obviously have very different needs than a person over-using alcohol to get drunk and have fun.

5. To Perform Better

Some teens abuse drugs or stimulant medications to increase school or athletic performance.

Stress is a significant risk factor for substance use disorders at all ages.

Responding to Substance Use

So get and stay involved in your child’s life and try to understand what motivates their behaviors. If substance use becomes a recurring problem that you can’t stop then professional help is entirely appropriate.

• With treatment, the rule is to start with the least intrusive method that’s likely to get results and move up in intensity only if needed.
  
• For this reason, working with a family or adolescent counselor who specializes in substance use would be a great place to start.

For more resources and information on how to respond, read:

• How to find trauma-sensitive adolescent treatment – Trauma sensitivity is essential for any teen using drugs or alcohol to self-medicate trauma stress, in fact, certain forms of treatment, such as anything overly-confrontational in nature, can actually worsen the situation.
• A teen marijuana addiction self-test – If your teen smokes marijuana but denies the existence of a problem, ask them to take this 2 minute self test that’s clinically proven to correctly identify marijuana dependence.
• Adolescent addiction treatment options - If you ultimately decide that treatment is needed, you’ll have to also decide on an appropriate level of care. This article outlines the different levels of care with basic guidelines for each.

Is your son or daughter smoking marijuana? Learn the signs of marijuana use and be ready to spot a problem before it gets out of hand.

Is your teen child smoking marijuana; how can parents know? Here are 15 warning signs of marijuana use to look out for.

You may catch them in the act, get a call from the school or the police or be dealing with a positive drug; and then although your worst suspicions are confirmed, at least you know the truth and at least you've identified the problem.

Not knowing is sometimes worse - when you sense there's a problem but you feel powerless to do anything about it.

So move past uncertainty into constructive action.

Here are some common warning signs of marijuana use. These don’t prove marijuana use for certain, but they should cause you concern.

15 Signs of Marijuana Use

1. Visine - If you find a bottle of eye drops while doing the laundry, you have real cause for concern. Healthy teens don’t often need eye-strain medication, red-eyed marijuana smokers concealing their use do need this.
2. Rolling papers, pipes, a bong, roach clips etc. - Drug paraphernalia is a pretty good indicator of a problem, and once a person acquires marijuana accessories, you can be sure they’ve passed the initial experimentation stage of use. They are not holding these things for friends.
3. Incense - Incense hides marijuana smells. Incense in the bedroom or a sweet/perfumed smell on clothes can be a warning sign of drug use.
4. Mouth wash, air fresheners etc. - Like with incense, if your teen suddenly wants or buys scent masking agents this could indicate drug use.
   
5. Small burns on the thumb and forefinger - A characteristic injury caused by smoking a joint down to the very end. Nothing else causes this type of burn.
6. Marijuana stickers or posters - A lot of teens identify with marijuana culture and advertise their association with stickers, pins on school bags and books, or through posters in the bedroom. A marijuana poster above the bed is a pretty good signs of an unhealthy interest in the drug! The code 420 refers to marijuana smoking, and you can often see 420 stickers on school bags.
7. Talking in code or in a secretive manner with friends while you are in earshot.
8. A sudden change in friends, especially if long-held good friends get discarded for a new group of seemingly less savory friends.
9. A sudden need for more money without much to show for it - A marijuana habit can get expensive.
10. Signs of depression or isolation from the family - Teens crave independence and autonomy, but an unusual demand for isolation in the bedroom and a refusal or strong reluctance to participate in family activities may indicate a problem.
11. A sudden drop in academic performance - When your previously A and B teen becomes a C and D teen, something is going on.
12. Your teen no longer participates in activities they used to find very enjoyable and rewarding - Suddenly abandoning sports, music or clubs without replacing these activities with anything other than "hanging out with friends" is not a good sign.
13. Appearing stoned - An obvious one, but it's easy to explain-away odd behaviors with wishful thinking. If your teen seems confused, slow and lethargic, they may be high.
14. A sudden willingness to take the dog for a late night walk may be an excuse to get out of the house to smoke a joint.
15. They don't seem motivated to accomplish any worthwhile goals - Normal teens will have interests, passions and desires. These desires may not be academic, and they may not be interests that you approve of, but most teens have interests and activities.
    

Obviously, unless you catch them in the act it's hard to be sure (unless you catch them with paraphernalia…that's a real giveaway) but the more worrisome changes in behavior and activities that you see, the more concerned you need to get.

7 More Giveaway Signs

1. Hidden Edibles

Marijuana is most commonly smoked, but you can also consume it orally through edibles like brownies or cookies (and in many other forms). Be suspicious if you find well hidden homemade baked goods or if your child develops a sudden interest in baking, especially baking that’s done when you aren’t around the kitchen.

2. Blocking Bedroom Door Cracks to Hide Smoke

If you see that your child is taking precautions to block the crack under the bedroom door, or in any other way block smells from leaving their bedroom to the rest of the house – they are probably smoking something (most likely cigarettes or marijuana).¹

3. Finding Marijuana Seeds and Stems

When rolling a joint, most marijuana users will discard the stems and seeds (which can burn unevenly). If your child rolls joints in his or her bedroom, you might sometimes find evidence of use in the form of this extra material. Marijuana seeds are round and look similar to coriander seeds.

4. A Nagging Cough or other Respiratory Problems

Heavy marijuana smokers will sometimes develop a ‘smoker’s cough’ or lung infection. If your son or daughter doesn’t smoke cigarettes, respiratory signs might indicate drug use.

5. Cotton Mouth

Marijuana can cause dry mouth, also known as cotton mouth. Marijuana smokers might need to drink small sips of liquid frequently while high and the dry mouth is sometimes visibly obvious.

6. Laughter at Inappropriate Times

One of the reasons why marijuana can be enjoyable is because it can turn the everyday into the hilarious. If you observe your son or daughter, or your child and his or her friends often laughing hysterically without any apparent reason, or at inappropriate times, marijuana could be the cause.

(Of course, teens will always laugh at in-jokes that parents aren’t aware of, so it’s really just extreme and very out of character laughter that you should watch for.)

7. Impaired Short Term or Working Memory

Marijuana can affect short term and working memory. If your son or daughter seems to lose the thread of conversations easily, especially if this is out of character – this could indicate marijuana intoxication.²

How to React To Overwhelming Evidence

Even if all the signs to point to marijuana and even if you have undeniable evidence - don’t panic and don’t overreact.

According to a 2013 Gallup poll, 38% of Americans have tried marijuana at least once, and most of these people likely experienced few or no serious adverse consequences from their use.³ Marijuana experimentation isn’t a good idea, especially for a younger teen, but it’s not a life or death situation either.

• That being said, marijuana can get your teen in trouble. Heavy use, especially from a young age, can have lasting consequences and a certain percentage of users (about 1 in 10) will develop marijuana dependence and experience more serious adverse consequences.

So though you don’t want to panic, you need to act and work with your son or daughter to change this risky behavior.

Start with a Conversation

Your child may believe that marijuana is pretty harmless. She might not know that marijuana affects the still-developing teen brain differently than adult brains, and as a consequence, early marijuana initiation is associated with:

• Diminished thinking: diminished short term memory and impulse control, verbal and non-verbal short term memory, processing speed, attention and executive functions.^{4 5}
  
• Lowered lifetime I.Q.: In one study, teens who smoked heavily at a young age lost an average of 8 I.Q. points by age 38 when compared to teens who did not smoke heavily in young adolescence.⁶
• An increased risk of lifetime schizophrenia, anxiety and depression.⁷⁸

Learn as much as you can yourself and then sit down for a calm - blame-free discussion on the pros and cons of using marijuana as a teen. At the end of the day, he or she does not have to agree with your decision to prohibit use, but it's helpful if she can at least see that your arguments make logical sense.

So talk to your child about the risks of marijuana, but make sure you get educated before you broach the subject. If your child admits to a regular marijuana habit, and is willing to participate in a quick exercise, ask them to take a 2 minute adolescent marijuana addiction self test.

Take It Step by Step

1. Start within the family and work with your son or daughter to move forward away from marijuana.
2. If you find that despite your best efforts, your son or daughter continues to use marijuana (or other drugs or alcohol) then you should strongly consider enlisting professional help.
3. As a general rule, you want to start with the least intrusive intervention that gets results, so starting with counseling or family counseling would make sense in most cases. Once linked-in with a professional, you can ask this person for further advice on treatment needs and recommendations.
4. If low-intensity interventions do not create behavioral change, then you will generally need to consider higher-intensity interventions, like an outpatient program, an intensive outpatient program, day treatment or even residential treatment (in extreme cases).

Learn more about teen addiction treatment level of care.

Earning a reputation as a notorious party school does little to enhance the prestige of an institution, but reactions to these persistent reputations vary drastically between colleges. Some schools have enacted fundamental policies designed to influence substance use, while others have offered little more than lip service reactions.

College is a major risk period for binge drinking and the development of substance abuse problems, and parents and prospective students should examine the drug and alcohol policies of a prospective school carefully before committing to four years of temptation.

As much as school administrators try to minimize the negative repercussions of a "party school" reputation, there is a statistical correlation between greater rates of alcohol and drug abuse and dependencies at these so called party schools than at other comparable colleges.

Substance abuse in college

College alcohol and drug abuse is a pretty big problem, and the percentage of alcohol and drug abusing people at colleges statistically exceeds the levels of abuse in non academic environments. There are a number of factors that contribute to increasing substance use and abuse during the formative transitional years out of the family home through college, but one of these is certainly a persistent collegiate culture which promotes binge drinking and recreational drug abuse.

With as many as 33% (Harvard medical school reporting) of college students meeting the criteria for substance abuse, and a significant percentage of these students meeting the more serious criteria for alcohol or drug dependence, addictions professionals acknowledge that college substance use represents a significant challenge to health.

When Choosing A College…

While the Princeton Review rankings are unlikely accurate, parents and concerned students can enhance safety from abuse and from the negative behaviors of other abusing students by enrolling in schools with sound alcohol policies, and alcohol free residential areas.

College is an exciting, stressful and experimental period, and the corresponding risks of abuse and dependence during these years are tragically high. Choosing a lower risk facility may be a wise choice for students worried about social environments conducive to destructive substance use and abuse.

The University of Georgia should be commended for its efforts to limit the destruction of substance abuse within its campuses, and the University of Colorado at Boulder deserves ridicule for its transparent press release reaction to a persistent problem. With too many deaths, and tens of thousands of addictions developing each year at party colleges across the country, fundamental and institutional change is required to increase the safety of a transitional four year period into adulthood.

Party Schools, and Attempts At Change

Two opposite ends of the spectrum responses were elicited by the University of Colorado at Boulder and the University of Georgia, both included within the top ten rankings in recent years.

Image Copyright: m31.

What are the real marijuana risks for teens? Regular moderate marijuana use won’t do an adult much harm, but it will harm a teenager. Brain development continues through adolescence. If you smoke marijuana regularly during certain key periods of adolescence, you pay a lifetime price. Parents – get your son or daughter to just delay marijuana use to the age of 21 and save them from a host of permanent cognitive impairments.

Marijuana risks for teens - as a parent, you may wonder about the true dangers associated with adolescent marijuana use - how harmful is it, really?

On the one hand, you don’t want to see your children taking any drugs - but on the other hand, if they’re going to experiment with drugs (and about half of all students will by the end of high-school*) maybe we should feel grateful that it’s only marijuana, after all:

• You may have used it (or use it) and experienced few negative consequences.
• It seems increasingly accepted and commonplace within popular culture.
• Medical marijuana advocates have raised awareness about the drug’s medicinal qualities.
• Some states have moved toward decriminalization.

But here's the thing - though many adults can use marijuana without significant adverse effects (though some will develop addiction) teens, with their still-developing brains, may experience lasting (lifelong!) adverse consequences.

1. Marijuana is not as toxic as meth (or alcohol for that matter) or as addictive as cigarettes, but it is still a powerful mind-altering substance. Research shows that using it regularly during important developmental stages causes lasting brain changes and functional impairments that can last a lifetime.
2. Some potential brain-change consequences include diminished cognitive capacity (lowered I.Q.), an increased risk of mental illness, lowered academic success and an increased lifetime risk of substance abuse.
3. However – if you can keep your child from developing a marijuana habit until young-adulthood – say until the age of 21 – you help him/her bypass virtually all of the risks associated with early marijuana use. You don’t have to keep them from marijuana forever – just help them delay initiation to when it won’t do so much harm.

In this article you will find out how marijuana affects the still-developing teen brain and why a younger age of regular use increases the risks of whole-life problems. This article will present research findings from major studies which illustrate the increased risks associated with earlier marijuana use across a range of domains, such as:

• The cognitive consequences
• The mental health consequences
• The academic consequences
• Addiction Issues

*According to the Monitoring the Future Survey Study, as of 2012, 49.1% of high school seniors had tried at least some kind of illicit drug at least once and 45.2% of grade 12 students had tried marijuana at least once.¹ 

The Cognitive Consequences of Marijuana Use

The research summaries below demonstrate that adolescent marijuana users experience thinking and impulse control deficits that may diminish academic performance and increase the likelihood of bad-decision making.

Regular users will experience these deficits at all times (not only while high) but these deficits are reversible with sustained abstinence – so after a month or so of avoiding marijuana, thinking powers return to normal.

However, regular users who start smoking at a young age do not demonstrate this same recovery with abstinence. If you get heavily into marijuana in young adolescence, you can cause lasting brain damage that may limit your whole-life potential - even after you stop using.

The Effects on Current Thinking Abilities

If your son or daughter smokes a lot of marijuana as a teen, will they be as sharp during their high school years?

Possibly not. This is likely dose-dependent (the more you smoke, the greater the impact) but research shows that adolescents who smoke marijuana do not perform as well on tests of short term memory and impulse control as teens who do not use marijuana. These deficits could easily affect school performance.² Other studies have shown that teen marijuana users may also show deficits in verbal and non-verbal short term memory, processing speed, attention and executive functions.³

Marijuana's Effects on Lifetime Thinking Abilities

If you smoke marijuana as a teen, will it affect your potential as an adult?

Unfortunately, research suggests that adolescent marijuana use can have a lasting influence, especially with a young age of initiation.

The University of Oregon Study

Adolescents who smoke heavily (defined as 4 days a week or more) may do irreversible brain damage and shave-off a significant chunk of potential I.Q.⁴

University of Oregon Researchers examined data from a pool of over a thousand people who were followed from birth in 1973/74 to age 38. All subjects were assessed for I.Q. at age 13 and each subject was interviewed about marijuana use patterns at ages 18, 21, 26, 32 and 38.

The Results:

At age 38:

• Subjects who started smoking as adolescents were more likely to become heavy persistent smokers into adulthood than those who started in young adulthood.
• Heavy marijuana smokers scored worse on measures of I.Q., memory and concentration than those who abstained from marijuana.
• Subjects who began smoking as adults but then cut back as they aged recovered from the cognitive deficits associated with marijuana use, but those who smoked heavily in young adolescence did not show the same cognitive recovery, even after cutting back with age.
• Subjects who smoked heavily as teens lost an average of 8 I.Q. points over the ages of 13 to 38. This is considered a significant decline.

As an associational study the authors cannot prove that marijuana use causes irreversible I.Q. deficits, nevertheless, the study authors postulate that marijuana may be toxic to the adolescent brain in a way that it is not to the adult brain.

The Harvard Study

Researchers at Harvard tested the cognitive performance of three groups of adult study subjects. Subjects in the first group were non-users. Subjects in group 2 were heavy using adults who had started using marijuana after the age of 17 (late onset) and subjects in group 3 were heavy using adults who had started using prior to age 17 (early onset). All marijuana users had been abstinent for at least 28 days at the time of cognitive testing.

• After 28 days of abstinence, adults who had started smoking marijuana after the age of 17 showed no differences in cognitive performance to non-using adults. Subjects from the early onset group, however, performed significantly worse in cognitive tests, particularly tests of verbal intelligence, even after 28 days of abstinence.⁵

Brazilian Study

Cognitive testing on treatment-seeking chronic adult marijuana users shows that those who started with marijuana prior to the age of 15 perform significantly worse on measures of executive functioning (working memory, problem solving, cognitive flexibility and planning) than those who started after the age of 15.⁶

Attention Dysfunction Study

The brain’s visual scanning system matures greatly during a developmental stage that occurs between 12 and 15 years of age.

When testing adult study subjects on a quick-reaction computer task that involved visual scanning ability, subjects who had initated regular marijuana use prior to age 16 (early onset) performed significantly worse than subjects who initiated use after age 16 (late onset). Late onset marijuana users performed equally well to control subjects, indicating that marijuana is toxic to the visual system during certain developmental stages.⁷

Observable Brain Changes

Beyond observing differences in thinking, researchers can also see how an early age of marijuana onset causes MRI visible brain alterations. Earlier ages of onset are associated with progressively decreased white matter integrity⁸ and decreased cortical thickness.⁹

Academic Consequences of Teen Marijuana Use

While there are always exceptions, in general, students who use marijuana get lower grades than students who abstain. The Washington State Healthy Youth Survey Study revealed that marijuana using high school students were more likely to get Cs, Ds and Fs than non-users.¹⁰

Given that current marijuana use impairs attention, working memory and impulse control it’s hardly surprising to find an association between use and lower school performance – but are there unique academic risks associated with earlier age of regular use?

Yes, as with cognitive consequences, earlier age of regular use is associated with greater declines in school performance.

• Australian researchers found that teens who started smoking marijuana at least once a week by the age of 15 were far more likely to drop out of school prior to completion than students who started with weekly use at an older age or those who abstained from marijuana - the younger the age of regular use – the greater the risk of school drop-out prior to completion.¹¹

Postulated explanations for why marijuana use - especially early onset use – is associated with academic underachievement include:

• Marijuana-caused learning difficulties
• Greater involvement with non-academically oriented peers

Or, it could be that young people attracted to early marijuana use are also more exposed to other risk factors that also predict school non-completion.¹²

Mental Health Consequences

Adolescents who smoke marijuana raise their risk of developing a psychotic disorder in adulthood and smoking earlier in adolescence increases the dangers.¹³

• A  major Swedish study found that smoking heavily by the age of 18 raises your risk of adult schizophrenia by 600%.
• A follow-up study from New Zealand replicated the increased risk findings. In this study, the researchers found that people who had smoked marijuana by the age of 15 were 4 times more likely than control subjects to be diagnosed with schizophrenia by the age of 26 and that those who started at 15 were at greater risk to develop schizophrenia than subjects who started after the age of 18.¹⁴

Who’s Most at Risk?

Not every teenager using marijuana has the same schizophrenia risk. Teens more at risk include:¹⁵

• Those with a close family member with psychosis or another serious mental illness.
• Those who have already had an unusual psychological experience after using marijuana (such as a break from reality).

Addiction Consequences

• The younger a person starts using marijuana, the greater the risks of lifetime addiction.
• The earlier in adolescence a person starts using, the more rapidly addiction develops.¹⁶

Take-Home Message

Whatever your opinion on marijuana for adults, it seems clear that initiating regular use before the age of 18 puts an adolescent at risk of serious and lasting neurocognitive deficits. In fact, given that the brain continues to mature and develop to the age of 25, it seems likely that delaying marijuana use even beyond the age of 18 would be prudent – to that end, the California Society of Addiction Medicine advocates helping young adults delay first use to the age of 21.¹⁷

If Concerned about a Teen Not Currently Using

• Talk to your children about marijuana. Don’t scaremonger (you’ll lose credibility if you do) and don’t stray from the facts, but make sure you explain that marijuana is dangerous to teens in a way that it is not to adults - and that starting young could have lasting or even irreversible consequences.

If Concerned about a Teen already Using

• Communicate the facts, and consider interventions (counseling, etc.) if necessary, to help this person achieve behavioral change.
• Ask the person to take a quick adolescent marijuana addiction self test.
  

Image Copyright: Tom Coates

Once you do know for sure that your teen son or daughter is experimenting with marijuana, you have to take steps quickly to make sure that the problem doesn’t get worse.

But What Can You Do?

Firstly, take it seriously but don’t panic.

Even if your teen is using heavily, when you get emotional and when you lose your objectivity, you reduce your ability to affect change and you reduce the chances that your teen will listen to what you say. You may be furious, but you need to act concerned and in control.

• Addictions professionals generally recommend that when dealing with drug use, you start with the least intrusive method and move upwards if that doesn’t work. If you catch your teen experimenting with marijuana, it's not necessarily the time to send them to drug rehab. That may come later, but only as a last resort.

Start within the Family

Start first in the family, if that doesn’t work, get some professional outside assistance on an outpatient basis, and if that doesn't work, consider inpatient treatment.

You do have to act and in some cases, when you can see that the problem has become severe and is having harmful consequences, you may want to disregard the above stages of intervention and move directly to professional help.

For most teens though, you have a good chance to create change by dealing with the situation within the family.

In the Family

You need to start with a real communication of your concerns for their health and well being, and before you start talking, you’d better get informed. Your teen likely has a pretty good body of knowledge about the drug…possibly more than you do. What they know may not be totally accurate, but if they think it is and you can’t contradict them reasonably, your words aren’t likely to have much impact.

Get Educated Before You Talk

Get educated about the real risks…and no scaremongering. You'll lose all credibility if you blow the risks out of proportion, and since the real risks are legitimate and serious, you have no need to lessen your credibility with half-truths your teen will likely spot from a mile away.

Explain the risks, explain your concerns, and explain the family policy on drug use once again. Ask your son or daughter to take an easy marijuana addiction self test, to rule out dependence issues. Explain how family rules may change (because of their drug use) and reiterate clearly the consequences for further experimentation. Be prepared to follow through in full with any promised disciplinary consequences.

Keep Your Cool and They'll Listen

By talking rationally and with concern your son or daughter is more likely to listen and less likely to react defensively or in anger.

• Be prepared to reward any improvement in behaviors. Positive change is tough, especially when friends are all "doing it"  - and if they can stay off marijuana, they deserve credit and reward for doing so.
• If it becomes apparent that drug use continues after your attempts to keep things in the family, it's time to enlist professional help.

Professional Help

If family-level interventions aren't working, find an experienced family or teen therapist with knowledge of addiction issues and get started with individual drug counseling and/or family therapy. If use isn't yet addiction, brief professional interventions can work wonders.

• Counseling can be expensive, but it's far less costly than inpatient care, and if it can better the situation, it is definitely money well spent.

Outpatient Care

The next level of intensity after personal/family counseling is a teen-specific outpatient addiction treatment program. These programs help adolescents overcome ambivalence to behavioral change and help foster an internal motivation to do better – after all, you can’t force thinking-change, your son or daughter has to believe that change is possible and decide for themselves to work for it.  

Outpatient programs also offer support and teach:

• Skills to help young people overcome avoid unnecessary temptation and resist cravings.
• Better communication skills.
• Conflict resolution skills.
• Problem solving skills.
• Many more.

Outpatient programs have an advantage over residential programs in that they allow young people to practice the skills they learn in the real-world and stay active in school.

If a regular outpatient program is not sufficient, the next level of care is the intensive outpatient program, and then a whole-day treatment program.

Outpatient treatment programs are effective, less costly and they keep kids in the family home, so in most situations, they make a lot of sense. In some situations however, such as when a teen cannot or will not stay off drugs or alcohol, when there is concurrent mental illness or when there is instability in the family home, residential care may be necessary.

Inpatient Care

Getting your teen into rehab should be a last resort, but when it's obviously needed you need to act with confidence and strength to get your teen into a program that's going to make a difference.

Teen Drug Rehab

Teen-specific drug rehab offers your child the most intense therapies, a necessary and enforced period of sobriety away from access to marijuana and enough time for them to gain a little self awareness and control over their drug seeking behaviors.

You need to stay actively involved in the process for the best chance of success though. Teens are little removed from the kids they recently were, and although they can act tough, they still need the support and love from mom and dad when going through challenging phases of life. Involved parental participation and loving support throughout the rehab process has been proven to exert the single greatest influence over the likelihood of eventual rehab success.

Don’t Panic, Do Act

You must take serious action when you find your teen experimenting with marijuana, but for the best chance of success you need to stay in control, get educated and take the steps that are going to work. Have the courage to do what's needed, even when it gets difficult.

Very few parents ever look back regretfully from an overreaction to the threat of drug use, but far too many parents, whose kids get trapped in the web of addiction, wish that they had acted before things got bad, and while they still had a real chance to make a difference.

Smoke marijuana? Got 2 minutes to spare for a self test? If so, answer yes or no to 12 questions to make sure you don’t have a marijuana problem.

If you’re a teen who smokes marijuana regularly, then you might as well spend 2 minutes on a self-test to check yourself for signs of possible marijuana addiction.¹

Answer yes or no to the following 12 questions.

1. Do you smoke alone more than you used to?
2. Has marijuana ever gotten you in trouble with the police?
3. Have you ever been physically ill after smoking marijuana?
4. Do you ever feel apprehensive about meeting new people when you are high on marijuana?
5. Are you spending more time hanging out with friends who smoke marijuana than with friends who do not smoke marijuana?
6. Have friends told you that you smoke more than you should?
7. Have you ever passed out after smoking too much?
8. Have you ever felt very paranoid after smoking?
9. Have you ever had chest or lung pains after smoking too much?
10. Have you ever developed a nagging lung infection or cough related to your marijuana habit?
11. Do you ever worry about how much money you spend on marijuana?
12. Do you ever worry that you are drifting away from friends and family members that you care about?

Scoring

Count your yes answers:

• A score of 3 or more yes answers indicates likely marijuana dependence.*

*Marijuana dependence as based on DSM-IV-tr criteria. In independent testing of this scale (the CPQ-A-S), a cut-off score of 3 or greater led to the correct identification of 83% of subjects with confirmed marijuana dependence and a score of less than 3 correctly identified subjects as not marijuana dependent 77.5% of the time.

Do You Need to Take Action?

So if you scored three or higher on the test (indicating a likely marijuana problem) does this mean you need to take any kind of action – after all – even if you smoke too much, is it really doing you that much harm?

Well, this is something you have to decide for yourself, but to help you frame your thinking, compare your current situation to some common dependence-related problems and complaints; how many of these have you/do you experience?

• Weighing the balance: Is your marijuana habit providing you with enough enjoyment to compensate for any associated negatives? Do the positives still outweigh the negatives?
  

Complaints and Consequences²

• Do you have debts related to your marijuana habit?
• Have you ever sold or pawned your belongings to buy marijuana?
• Do you ever have to lie or make excuses to explain your lack of money?
• Have you ever been caught lying about money?
• Have you ever been seriously hurt after getting high? Have you ever had to go to the hospital for treatment after getting hurt while stoned?
• Has smoking marijuana led to unneeded weight loss?
• Do you take care of your physical health as well today as you used to?
• Are you as healthy right now as you used to be (before you smoked as much)?
• Do you have less energy today than you used to before you smoked as heavily?
• Have you recently felt depressed for a week or longer? Have you ever had suicidal thoughts?
• Have you given up previously enjoyable hobbies or recreational activities in favor of time spent getting high?
• Do you find that activities you used to find enjoyable aren’t as fun as they used to be (when not high)?
• Do you ever drive stoned?
• Is your concentration worse than it used to be?
• Are you as motivated to do well as you used to be (based on a personal definition of 'do well')?
  
• Do you ever worry about feelings of detachment or isolation?
• Have you become less interested in school work?
• Do you ever go to class high? Does getting high ever keep you from completing schoolwork?
• Are your grades as good today as they were before you started smoking heavily?
• Do you smoke marijuana on school property?
• Have you ever been suspended because of marijuana?
• Are you late for a full or part time job more often now than you used to be?
• Do you ever go to work high?
• Has smoking marijuana made you less capable at work?
• Have you ever been reprimanded at work for being high?
• Have you ever been fired from a job?
• Have you ever had an accident at work after getting high?

Is marijuana a relatively low-risk outlet or are you smoking too much and experiencing significant physical, mental health, social, legal or work/school consequences?

Only you can answer this question, but remember, habits that are benign in moderation can become harmful when taken to excess – there’s nothing wrong with a cookie now and then, but 50 a day will lead to disease and early death.

• If you recognize that heavy marijuana use causes you problems, then take steps now to quit or moderate your marijuana habit and minimize the potential harms.
• If you recognize that your habit does you harm and though you try, you cannot control your use, then getting professional help of some sort makes a great deal of sense.

So many options - outpatient, intensive outpatient, residential, high intensity residential…how are parents supposed to know what’s needed? Here’s a brief explanation of the different American Society of Addiction Medicine Adolescent Levels of Care with case study examples to illustrate.

If your teen son or daughter needs substance abuse treatment, it’s essential that you find an appropriate level of care. You’d never want to send a teen to residential treatment if she could get treated while staying in the family home, but on the other hand, you’d never want to under react and keep an in-danger teen from getting the intense residential care that could make all the difference.

But though as a parent you generally know what's best for your child, you probably don't have addiction treatment expertise and you probably don't know what kind of treatment your son or daughter needs most.

So this puts you in a pretty tough spot. How are you suppose to make the right decision?

Well, as a starting point, consider the following two, somewhat contradictory truths that can help to guide your decisions.

1. Since you’re not an expert, it makes sense to seek out an experienced professional for a comprehensive assessment of the problem and a recommendation for a starting-point level of care. Your doctor can likely recommend a behavioral health assessment professional in your area.
   
2. Though you’re not a treatment expert, you are the world’s leading authority on your child and his or her needs and wants. You should accept expert advice, but always filter it through your own expertise and gut-sense of what’s most needed.

If you get a professional assessment you will probably get a recommendation that’s based on the American Society of Addiction Medicine’s (ASAM) levels of care. Before you can evaluate for yourself the appropriateness of this treatment recommendation, you need to understand how experts determine treatment needs and know what’s involved with each level of care.

Read on to:

1. Learn about the different levels of care and about how a teen gets matched to an appropriate level.
2. Find case-study examples that illustrate situations that match with outpatient, intensive outpatient and residential treatment levels of care
3. Learn about what happens at the end of treatment – does it just end or do you step-down to less intensive treatment?

ASAM – The 5 Levels of Addiction Treatment

According to the widely used ASAM adolescent placement criteria, there are 5 basic levels of teen addiction treatment.

The 5 levels of care are:

1. Level 0.5 – Early intervention
2. Level 1 – Outpatient
3. Level 2 – Intensive outpatient treatment or partial hospitalization
4. Level 3 – Residential or intensive inpatient treatment
5. Level 4 – Medically managed intensive inpatient treatment

To determine an appropriate level of care, professionals look at the situation across 6 assessment dimensions, which are:

• Acute intoxication and withdrawal – looking at how much medical management of withdrawal might be needed, for example.
• Biomedical complications – assessing for other health conditions that might complicate the recovery process.
• Emotional, behavioral and cognitive conditions or complications – looking for other mental health, developmental or behavioral conditions that might complicate the recovery process and lead to a higher level of care requirement.
• Readiness to change – the more ready and motivated for change the lower the treatment intensity that is required.
• Relapse or continued use potential – teens able to control use and maintain abstinence for moderate periods require less intensive treatment than teens unable to stop for even short periods of time.
• Recovery environment – Teens without a safe and stable recovery environment may require higher intensity care, such as residential treatment, to make lasting gains.

Case Studies

To illustrate how the placement criteria translate, in real-world terms, into level of care recommendations, here are three case-study examples: one for a teen who would benefit most from outpatient care, one for a teen who would benefit from an intensive outpatient program and one for a teen who would benefit most from a residential program.

Case Study 1 – Outpatient

Outpatient programs generally provide 3 or more hours per week of therapeutic programming.

Jesse is a 16 year old teen with a marijuana problem. He has been grounded on numerous occasions for breaking house rules but he continues to use. The school guidance counselor tried a brief intervention conversation, but behaviors haven’t changed for the better.

Although his repeated drug use is worrisome, he is not yet physically dependent and is in no risk of serious withdrawal. His current level of use doesn't put him in serious physical danger and his social and cognitive functioning is not yet affected. He has no physical or mental health problems that would complicate treatment.

Jesse says he can quit if he wants to but he has not yet demonstrated an ability to do so. Though he is ambivalent about behavioral change, he has promised his parents that he is willing to try. Jesse’s parents are involved in the treatment process and willing to do what they can to facilitate a good outcome.

By evaluating this situation across the assessment dimensions you would come to a recommendation of outpatient as a most appropriate starting point. Should outpatient treatment fail to help, Jesse would probably need to progress up to intensive outpatient treatment.

Case Study 2 – Intensive Outpatient

Intensive outpatient programs provide a minimum of 6 hours per week of therapeutic programming. The next step-up in intensity would be a partial hospitalization or day treatment program, which provides a minimum of 20 hours of programming per week^.1

Laura is a 15 year old regular marijuana user and binge drinker.

Though she’s not drinking every day Laura says she feels anxious when she can’t get drunk or high. She’s not drinking at a level that puts her in immediate risk of harm but she is not motivated to quit – her parents are forcing treatment - and though her social functioning isn’t yet affected, her school performance has dropped significantly in the last few months.

Her parents say they’ve tried everything, including family therapy, but nothing has helped. Although her parents are well-meaning, there is significant conflict in the home and home-stress contributes to the problem.

Because of her lack of motivation to stop (she says she doesn’t have a problem), because she continues to use and because she doesn’t have a totally stable/supportive  home-environment, she requires more frequent interventions and motivation help than she’d get in an outpatient program.

Case Study 3 – Medium Intensity Residential Treatment

Rob is a 17 year old meth user.

Rob is at risk of moderate withdrawal symptoms but these aren’t expected to be severe enough to require medical monitoring. He has no mental or physical impairments that would complicate treatment but he has been engaging in multi-day drug binges that put him at moderate risk of harm and which compromise his ability to function socially and at school (he has dropped out). Rob has no interest in recovery but is court-mandated to participate.

Rob has no proven ability to maintain abstinence. His family is supportive but Rob typically stays with other drug using friends in a very unstable environment.²

When Does Treatment End?

It takes as long as it takes.

Behavioral change isn’t easy and it doesn’t always happen on a 28 day treatment schedule. When starting with treatment, it’s best to consider starting with the lowest intensity treatment that’s likely to work, but to also consider an open-ended treatment timeline – treatment doesn’t end on a schedule, it ends with the resolution of the problem.

When reassessing the situation at the completion of any scheduled treatment:³

1. If the person hasn’t yet resolved their difficulties but is making progress or seems about to make progress, and the person is working hard at achieving treatment goals, continue on with more treatment at the same intensity.
2. If the person has achieved their treatment goals, either end treatment or transfer down to continuing care treatment of a lower intensity.
3. If the person does not improve, despite legitimate effort and/or modifications of treatment plans at any given intensity, consider intensifying the treatment level.
4. If the problem behavior worsens, consider intensifying the treatment level.

Cause for Concern - Reason for Hope

Teens do better when parents get involved in the treatment process, so get involved right from the start by learning all you can about treatment needs and by making sure that whatever level you start with makes the most sense for your situation.

Adolescence is a time of continuing brain development (this continues into the early twenties). This continuing development has both positive and negative implications.

• Drug and alcohol abuse can affect essential developmental tasks and so substance use during adolescence can have greater consequences than it would during adulthood. This underscores the importance of addressing the situation as quickly as possible.
• But though the stakes are high, teens have such an innate capacity for change – it’s really what defines adolescence – that with help and guidance they can make enormous gains in a short period of time.

So though the stakes are high, with appropriate treatment, you can be very hopeful for a positive outcome.

Image Copyright: -Eko-

What do the experts suggest? Learn about the ideal values that drive effective adolescent treatment (teens aren’t just mini-adults) and learn the essential questions you need to ask to get the right care for your son or daughter.

Teens in age-inappropriate programs do poorly and adolescent programs that simply copy adult treatment practices aren’t as effective as programs specifically designed to meet the cognitive, social and emotional needs of a younger audience.

But what are these specific requirements and how do quality adolescent treatment programs respond to these needs?

The Essential Values of Teen Treatment

Well, according to the California State Department of Alcohol and Drug Programs, effective teen treatment programs are developed and operated on certain essential values that maximize respect and dignity and improve outcomes. These values are:¹

• Flexibility – Adolescents can change quickly. Programs need to offer responsive individualized programming that changes to meet the needs of each teen participant as his or her needs change.
• Dignity – Teens have a right to dignity and personal privacy and to services that are respectful of cultural differences. Though you can force a teen to change behaviors, for a while, it's impossible to force a change in thinking. To accomplish the thinking-changes that lead to lasting behavioral change you need to build a trusting and collaborative relationship - and this requires dignity and respect.
• Hope – Every teen is treated as a person that’s capable of making amazing changes in life.
• Service Coordination – Here’s a saying that ideally guides quality adolescent treatment, “One team with one plan for one person!” More scattered services decrease overall treatment compliance. Since recovery is typically multifaceted, effective treatment programs work to coordinate services and to encourage full participation in all the social, psychological, legal, physical-health and other services necessary for full recovery.²
• Self Determination – You can force an adolescent to stay in treatment but you can’t compel genuine participation. Programs that encourage teen participation in treatment planning and goal setting have a better chance of motivating lasting behavioral change.
• Active Involvement – Teen clients are considered full partners in the treatment process. They are invited to participate meaningfully in all aspects of treatment, from treatment planning and goal setting, to participating in therapies, to evaluating progress at set intervals and to adjusting treatment as necessary.
• Strengths Based – As one component of individualized care, each teen designs a treatment plan that makes use of personal strengths.
• Advocacy Support – Teens are given tools and support to advocate for themselves.

Teens Are Treated as Humans, with Respect

So when looking for adolescent addiction treatment, try weighing any program under consideration against the list of ideal values above – programs that differ greatly from this list of ideal values may not offer treatment that’s as compassionate or effective as you want for your son or daughter.

For example, if you compared the practices of a discipline-heavy boot-camp style program, you’d notice that many of the philosophical underpinnings of such programs run counter to the recommend best-practices list above – (little privacy or dignity protection, no individualized treatment, no teen self-determination, no building on strengths, etc.) and this may explain the generally poor outcomes seen with these types of programs.³

Finding the Right Treatment - Questions to Ask

It’s hard to get the answers when you don’t know the right questions to ask, and without objective information, it’s tough to effectively compare between your treatment options.

According to the American Academy of Child and Adolescent Psychiatry, (AACAP) here are some questions to ask of potential providers when searching out potential treatment options.⁴

• Why do you believe your program is the best fit for my child? How does your program compare to other options available?
• What experience and credentials do staff on the treatment team have? Are these professional staff on site on a full-time basis? Is the adolescent substance abuse treatment accredited by any outside agency? (In some cases, a treatment facility may advertise JCAHO or other certification, but that certification only applies to certain specific programs, and may not apply to adolescent treatment, for example.)
• What specific treatment interventions are used?
• Based on your evaluation, do you believe my child has a co-occurring psychological problem requiring treatment? If so, how will this be addressed?
• How will other family members be involved in treatment? How are family members involved in discharge decisions?
• How much does treatment cost? What percentage of this is covered by insurance or health plans?
• How long will treatment take? Is treatment step-down as necessary?
• What types of continuing care will be available to my child?

Screening for Co-Occurring Disorders

If your son or daughter has a substance abuse problem – why is it so necessary to test for mental illness?

No matter what type of treatment you decide on (individual counseling, an outpatient program, residential care, etc.) it’s vital that your teen son or daughter receive a pre-treatment assessment to look for the possible co-presence of a complicating mental disorder.

Among teens with addiction issues, co-occurring mental illnesses are prevalent, so if your teen has a substance abuse issue severe enough to warrant treatment, you need to either rule-out mental illness or identify it so you can find the specialized co-occurring treatment that’s needed (teens with co-occurring disorders who receive only addiction treatment aren’t likely to have successful outcomes.)

• One large research study, the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, found that within 6 months of testing, 76% of adolescents with substance use disorders met the criteria for a co-occurring mental illness.²

The Power of Hope

You need to get educated and spend a little time making sure that the treatment you select is the treatment that’s most suitable for your son or daughter.

Once informed you’ll know what to ask and what to look for and you’ll be in a better position to weed out those options that just don’t make much sense. Trust your gut and find a program that treats you and your child with dignity and respect; trust your mind and find a program that’s competent and able to help.

Image Copyright: Pink Sherbet Photography