When a teenager struggles with addiction, finding the right teen substance use treatment can feel overwhelming for parents trying to figure out the right steps, what to say, and what actually works. We sat down with two of Evolve’s clinical experts, Ellen Urtecho, LCSW (Clinical Director), and Dr. Arthur Chou, MD (Board-Certified Psychiatrist), to answer the most common questions parents ask about therapy, home support, and psychiatric medication for teen substance use disorder.
Part 1: Recognizing Teen Substance Use and Supporting Your Child
With Ellen Urtecho, LCSW
What exactly is substance use disorder?
Substance use disorder is a treatable mental health condition that can range from an individual struggling with dependence to full-blown addiction. Substance use can fundamentally change a person’s personality, behavior, and mood, deeply impacting their day-to-day life. It is crucial to understand that substance use is not a failure of willpower. Individuals often need clinical support to manage the intense urges they experience.
What are common signs of substance use disorder in teens?
It is more common than many parents realize, with about half of high schoolers attempting to use substances like alcohol or marijuana. Common behavioral signs include isolating, sudden changes in friend groups, a drastic drop in grades, irritability, and a loss of interest in passions they used to love. Physically, you might notice bloodshot eyes, sleep disturbances, or rapid weight loss.
How do I tell the difference between experimenting and addiction?
It comes down to control and consequences. Can your child control their urges, the amount they use, and the frequency? Furthermore, if there are natural consequences like failing grades or disciplinary issues and the behavior still does not stop, that indicates a loss of control. Normal teenage experimentation typically stops when natural consequences arise. When it doesn’t, it is time to seek help.
How can I talk to my teen about this without them blowing up?
Timing is everything. Never approach this serious conversation when you suspect they are currently under the influence. Go in calm and prepared, leading with “I feel” statements or gentle reflections rather than accusations. You might say, “I’ve noticed your grades dropped this quarter, can you tell me what’s going on?” or “I noticed you no longer want to play soccer with your friends.” If they do confess to using substances, your immediate reaction is critical. Validate their underlying feelings, thank them for their honesty, and work collaboratively on the next steps so they don’t shut down.
How can parents help at home?
First, remove access immediately. You cannot control school or friend groups, but you can lock up over-the-counter medications, prescriptions, and alcohol at home. Second, parents must remain completely consistent and aligned on expectations, boundaries, and consequences. If you set an expectation and they come home high, you must follow through with the stated consequence. Otherwise, you communicate that they can continue the behavior without consequence.
Should I drug test my teen at home?
When used correctly, at-home drug testing can be incredibly helpful for building trust and accountability. It also provides your teen with a tangible, effective “out” when facing peer pressure. Many teens find it relieving to simply tell their friends, “Sorry, I can’t do that, my parents drug test me at home.”
Does strict parenting prevent drug use?
Research suggests that overly strict, authoritarian parenting actually causes rebellion and secrecy. Instead, we encourage “authoritative” parenting. This means leading with warmth, love, and collaboration, while still maintaining high standards, clear expectations, and consistent boundaries.
What is the best approach for teen substance use treatment?
Integrated care is the absolute best approach for teen substance use treatment because it identifies underlying mental health conditions, like anxiety or depression, that drive the use. Family therapy is essential to repair relationship ruptures. Individually, Cognitive Behavioral Therapy (CBT) helps link thoughts, feelings, and behaviors, while Dialectical Behavior Therapy (DBT) helps teens identify urges and use tools to work against them. Recovery groups like SMART Recovery pair excellently with DBT because they focus heavily on actionable skills rather than just exploring the “why” behind the use.
What are some coping skills that actually help teens in the moment?
Three highly effective skills we teach are Urge Surfing, the STOP skill, and Playing the Tape Forward. Urge Surfing involves recognizing an intense urge and reminding oneself that it will eventually subside. The STOP skill teaches teens to stop before acting impulsively, step back, observe the situation, and proceed mindfully. Playing the Tape Forward helps teens visualize the immediate and long-term consequences of giving in to an urge versus staying skillful. These are easy to understand in theory but require practice to master in intense moments.
When should parents seek teen substance use treatment?
Seek help immediately if your child is using substances on a regular basis, especially if it is impairing their school performance, friendships, or family relationships. Getting teen substance use treatment early can be life-saving.
Part 2: Navigating Medication in Teen Substance Use Treatment
With Dr. Arthur Chou, MD Board-Certified Child & Adolescent Psychiatrist
Are there actually medications prescribed for teen drug addiction?
The most effective “medication” for substance use disorder is actually family therapy. Substance use is highly complex and multifactorial, spanning community, family conflict, and genetics; the whole family system generally needs to engage to change how things work. With the exception of buprenorphine for severe opioid use (like fentanyl or heroin), there isn’t a direct first-line medication to simply cure substance use for things like marijuana, alcohol, or cocaine.
How do I know when things have gotten bad enough to consider medication?
It depends on the teen’s phase of recovery. If a teen is in the “pre-contemplative” phase, meaning they are actively using and don’t think they have a problem, medication will likely just make them resist treatment more. Once a teen enters the “active” phase, where they are aware of the issue and motivated to reduce their use, medications can be highly beneficial to help curb cravings.
What do these medications actually do in the brain?
These medications generally work by reducing cravings or reducing the potential “high” a teen gets from a drug. For alcohol, Naltrexone acts as a “buzz killer” by blocking opioid receptors in the brain, meaning they don’t get the same rewarding feeling from drinking. For nicotine or vaping, Wellbutrin modulates dopamine and norepinephrine. For marijuana, a supplement called N-acetylcysteine (NAC) creates a better balance of glutamate in the brain. For opioid use, buprenorphine acts as a partial agonist; it satisfies the receptor just enough to prevent deadly withdrawals and cravings, but without delivering the dangerous high of a full opioid.
What are the side effects parents should watch for?
Side effects are generally mild and transient, feeling similar to a mild cold. Supplements like NAC or medications like Naltrexone might cause temporary headaches or nausea in 20-30% of kids. Buprenorphine can cause nausea, jitteriness, or constipation. Wellbutrin shares the same rare (1-4%) risk of suicidal thoughts in the first month as other antidepressants, and carries a very rare seizure risk, usually only occurring in kids who are severely medically ill or dehydrated, such as those with severe anorexia.
Will these medications affect my teen’s development?
Currently, no studies show that medications like buprenorphine, Naltrexone, or NAC have any long-term negative effects on puberty or adolescent development. However, we do try to limit the duration of Nicotine Replacement Therapy. While effective in the short term for quitting vaping, prolonged nicotine use can sensitize the developing brain to other drugs (like marijuana) and has been shown to negatively impact working memory and attention into adulthood.
Are there proven natural alternatives?
The only over-the-counter supplement with clinical evidence for substance use (specifically marijuana) is N-acetylcysteine (NAC). Every month a new supplement is touted online as a miracle cure. When evaluating these, always look for peer-reviewed, double-blind, controlled studies to ensure they are actually safe and effective, and check for any FDA recalls.
If the medication is working, does my teen still need therapy?
Yes. Family and individual psychotherapy remain the primary treatment. When a teen first starts actively reducing their use, weekly or bi-weekly therapy is crucial. Once they have sustained improvement for three to six months and relapses are rare, the frequency of therapy can drop to monthly or be replaced by community support groups like SMART Recovery.
Will my kid have to take these pills for the rest of their life?
For most substances, no. Teens typically use medications like Naltrexone or Wellbutrin for 6 to 12 months to support them through active treatment and the maintenance period. The exception is buprenorphine for opioid addiction. Because the risk of a fatal relapse is incredibly high if stopped too soon, patients often stay on buprenorphine for several years to keep them safely off dangerous drugs like fentanyl.
Is there a risk my teen will just become addicted to the new medication?
Generally, no. Addiction involves losing control and compulsively using a substance despite it destroying their life (ruining relationships, failing out of school). Medications like buprenorphine stabilize a teen so they can actually get their life back on track. While the body can develop a tolerance to these medications, meaning they might feel flu-like discontinuation symptoms if they stop cold turkey, they are not compulsively chasing a high. Buprenorphine has a “ceiling effect,” meaning taking more and more of it won’t increase the high or cause respiratory failure on its own.
How will we actually know if the medication and treatment are working?
You will know because your kid is getting back on track. We look for improvements across four developmental tracks: Family relationships begin improving, they start forming positive friendships, their academic performance recovers, and they return to their hobbies and passions like sports or art. Teens might still report feeling moody or complain that “life sucks,” but their daily functioning is the truest indicator that the teen substance use treatment is working.
About the Authors
Arthur Chou, MD
Arthur Chou, MD, is a board-certified physician specializing in child and adolescent psychiatry and a psychiatrist at Evolve Treatment Centers. He works with adolescents experiencing complex mental health and behavioral challenges. View Dr. Chou’s professional profile to learn more about his credentials, clinical experience, and areas of expertise.
About the Author: Ellen Urtecho, LCSW
Ellen Urtecho, LCSW, is a Licensed Clinical Social Worker and Clinical Program Director at Evolve Treatment Centers. She has extensive experience supporting adolescents and their families in both residential and school-based settings and takes a warm, person-centered approach to treatment. Ellen also serves as a Crisis Prevention Training Specialist for Evolve’s Southern California region. View Ellen Urtecho’s professional profile to learn more about her credentials, clinical experience, and approach to working with teens and families.
