Addressing Drug And Alcohol Use In Therapy With Teens

A Teen’s Drug and Alcohol Use Can Impact Your Family: We Can Help

Many parents ask us when their teens enter therapy how we, as a practice, deal with the issue of drugs and alcohol. As therapists, we get to be in the important position of being an adult that is close to the teen without being the child’s parent. Not being part of the family unit makes us more neutral and offers the opportunity to make a meaningful impact on how a teen views drugs and alcohol, as well as teach them how to make safe choices.  

We often view our work with individuals as family therapy, especially when it comes to kids and teens. Teenage substance use can have an impact on the whole family. It may also be an indication that the way the family is functioning is not working and needs to be tweaked. There are many ways the treatment can be set up, depending on the severity of the substance use and the need for direct parental involvement. For many teens, even with substance use present, there is a need for therapy to be a private space with not a lot of parental involvement. However, when there is opportunity to make a positive change or when the substance use is concerning and unsafe, bringing family members in will be imperative to treatment.

We Don’t Have A Zero Tolerance Policy For Drugs And Alcohol

The therapy space is safe for the teenage patient to explore thoughts, potential risks and social implications of substance use. We acknowledge that drugs and alcohol are ever-present for kids at a young age and for many adolescents, experimentation will be a part of life.

In our practice, we do not have an overarching zero tolerance policy for drugs and alcohol for teens or for patients of any age. We simply don’t think that is realistic. Drug and alcohol use is to be taken on a case-by-case basis. For some people, abstinence is the only safe choice. But for the majority of people we work with in our therapy practice, if we were to push abstinence, it would not teach them to stay away from drugs and alcohol. Instead, they would learn how to hide it from us.

This is particularly important with teens, who are at a higher risk for making missteps and getting themselves stuck in sticky situations. There are all sorts of scenarios where even a little drug or alcohol use can go awry and teens can make some bad choices involving driving under the influence and sex under the influence. Not to mention that alcohol use is inherently riskier in a legal capacity since teens are underage. It’s critical that if teens choose to use, they learn how to do it smartly.

Understanding the Root of the Drug or Alcohol Use is Key

In our therapy with teens, we believe that an honest and open dialogue about substance use is necessary to a teen’s health and development. When everything is out in the open, it gives us, as therapists, an opportunity to teach patients how to use substances safely. It also gives us an opportunity to explore what might be driving the patient to want to use. Is it genuine curiosity or is it something more troublesome like peer pressure? Or is there a desire to use because of dark underlying feelings, such as sadness or isolation?

What comes out of these conversations about substance use is a meaningful understanding of the root cause of the use. Curiosity about drugs and alcohol can be innocuous and age-appropriate, but when it is a symptom of something deeper, only through open dialogue can we address the real problem.

Empowering Teens to Become Choice Makers

We create a relationship with our patients in which they know where they stand with us and where our viewpoint matters. The teens we work with know what they can expect from us in regards to what they can talk about (anything!), our position on drugs and alcohol, and what we will and will not share with their parents. We also make it clear that while we are not here to judge them, if we have concerns, we will be direct about that and help them think through solutions.

A huge part of adolescent development is learning how to make safe and wise choices and drugs and alcohol are definitely no exception. Conversations about decision-making often include weighing the pros and cons of substance use and making it clear what the consequences of use could be. The legal, physical, and emotional consequences of drug and alcohol use are all real and are things that teens should be aware of.   

Trauma: The Underlying Cause of Much of Teen Substance Use

Even though we do not have an abstinence-only outlook on substance use, there are instances when a teen’s use is a problematic way to deal with negative feelings or trauma. In these cases, there is a need to attend to the underlying issue. For example, if a teen is using substances as a social lubricant and as a way to deal with social anxiety and insecurity, we, in therapy, will focus on strengthening how they feel in social situations so they no longer feel like drugs and alcohol are necessary.

It is important that this root issue is attended to not only to resolve it, but also to make sure that drugs and alcohol do not cause further harm. Decisions made under the influence that are harmful can only add to feelings of isolation and self-hatred and can exacerbate negative feelings that are already there. When a teen is showing poor judgment and/or got themselves into unsafe situations, it may be imperative that the use slows down or stops until they learn how to make better choices.

Will You Tell Me If My Kid Is Using Drugs and Alcohol?

In our experience, the types of relationships that we create with teens are really powerful. We are lucky to be able to have a positive impact on adolescents and when we express concern, we find that most of our patients really listen. Because of this relationship, most of the time teens are able to take in our concerns and apply that to their decision-making.

Attempting to resolve the concerning behavior within the therapy itself first without bringing parents into the picture is essential. For one, it is important that the teen feels they can speak freely in therapy without fear of parental judgment. And secondly, the way to create healthy, well-adjusted adults is by teaching teens how to make good decisions for themselves.

However, there are times when the underlying pain is so deep that the teen is unable to get the substance use under control on their own and when past trauma makes it impossible for them to make smart choices. In these cases in which we cannot trust the teenage patient to be safe, there absolutely is a need for parental involvement and reinforcement. Supporting a teen’s autonomy is very important, but keeping them safe is always our first priority.

Having Trouble Figuring Out Where To Locate Yourself With Your Teen’s Substance Use?

One of the biggest challenges of parenthood is giving your child space to make mistakes and figure stuff out on their own, especially as they move into adolescence. Sometimes it is hard to know how much space to give and how much involvement to have. It is normal and healthy to have these questions, as well as experience anxiety and concern if you know or suspect your teen child is using substances. Bring these concerns to your teen’s therapist and they will be able to give you some direction as far as what to do with these feelings. They will also be able to concretize a plan and be clear about why they think this particular plan is best for you and your teen.