Some decisions as a parent can feel more obvious. Maybe it’s choosing the car with the best rated safety features, or the apple that’s labeled “organic,” or the school district with an impressive track record of ivy-bound graduates.
But when it comes to addiction and substance use, it can be challenging to determine what “best” really means with so many different interventions, facilities, and therapies available. This is doubly true when your child is struggling with another mental health condition, what’s sometimes called a co-occurring disorder.
That said, while rehab isn’t exactly like an apple or a car, there is research-based, empathetic, and effective outpatient treatment available for teens — including those with dual diagnoses of substance use and conditions like anxiety, depression, PTSD, and more.
No two teens are the same, and no two recovery journeys are, either. So, this one-size-fits-one guide will also unpack how those treatments can be adapted to fit your teen’s unique situation.
In this article, we’ll address:
- What is outpatient rehab and how does it work for teens?
- How do residential and outpatient rehab programs compare?
- Will my teen need IOP, PHP, or residential?
- What is a dual diagnosis?
- What does the research say about dual diagnosis treatment for adolescents?
- What should I know about dual diagnosis treatment centers for teens?
- Next steps when considering outpatient rehab for a teen with dual diagnoses
We’re Evolve. For the last ten years, we’ve supported families in building empowered futures for teens struggling with substance use and other mental health challenges. With Evolve, you not only have the expertise of our clinicians and our research-backed approach — you have the compassion and collective strength of a dedicated healing community, here for you and your teen.
Learn more about our unique approach >>
What is Outpatient Rehab and How Does It Work For Teens?
“Outpatient rehab” describes treatment for substance use disorders that occurs during the day, for a set number of hours, with teens returning home when they’ve completed that day’s treatment.
Most rehabilitation centers offer two types of outpatient treatment. There’s intensive outpatient (IOP), which is usually a few hours per day, 3-4 days per week. And there’s partial hospitalization (PHP), in which clients are in-program during the day and return home at night, for anywhere from 5-7 days per week.
For teens specifically, you can think of IOP as an afterschool program — as we do here at Evolve — in which treatment hours happen after the course of a typical school day, and is a great option when disruption to a teen’s schooling would not be supportive of their goals and recovery.
PHP is more of a day program, where teens can return home at night but will spend most of their daytime hours in treatment. Rather than attending their usual schooling, teens would receive academic support and guidance through their treatment center, and integrate back into their schooling when they “graduate” from treatment.
Both IOP and PHP typically include individual and family therapy sessions, group therapy, psychiatric care (where indicated), and other experiential forms of therapy like art and music therapy. Some outpatient programs also include educational and skills groups.
At Evolve, for example, our skills groups are rooted in Dialectical Behavior Therapy (DBT), and teach teens the fundamentals of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness (crucial for healthy relationships), all vital skills for their recovery journey.
How Do Residential and Outpatient Rehab Programs Compare?
Outpatient rehab exists in contrast to residential care, in which teens are admitted and live on-site, with access to support and supervision 24/7.
You might consider residential treatment for your teen if:
- They’re struggling with suicidal thoughts and/or repeated self-harm
- The activities of daily living — like hygiene, eating, and sleep — are deeply impacted
- There are environmental factors impacting their well-being
For teens who do not require 24/7 supervision, however, PHP might be an appropriate option. PHP might be a better fit while teens can safely live at home, but their mental health and substance use does not allow them to engage in academic, social, and family life in healthy ways.
Teens returning home each evening, with the eventual possibility of a day off, also provides a unique opportunity in which they can develop their skills in recovery, and return home to practice implementing what they’ve learned in real life situations.
You might consider partial hospitalization (PHP) for your teen if:
- They’re struggling with suicidal thoughts and/or occasional self-harm, but they don’t require medical attention, and have enough supervision and stability at home to stay safe over the weekend and at night
- They’re struggling to stay sober and would benefit from more structure, but they don’t require significant, 24/7 monitoring
- Their mental health, substance use, and/or other behavioral struggles have made their academic performance plummet, and/or they refuse to go to school altogether
- Their family life is as such that the level of structure they need to maintain their sobriety is not available at home
- They have recently left residential treatment and still require a higher level of structure and support before returning to daily living
IOP is a great option for teens with higher support needs than a typical weekly therapy session can address, allowing them to participate in intensive care with minimal disruption to the activities of daily living, like attending school and engaging with family.
You might consider intensive outpatient (IOP) for your teen if:
- They’re struggling with suicidal thoughts and/or occasional self-harm, but they don’t require medical attention, and have enough supervision and stability at home to stay safe most of the time
- They’re struggling to stay sober and would benefit from more structure, and a higher degree of autonomy and independence would not put them at risk for further decline
- Their mental health, substance use, and/or other behavioral struggles have impacted their academic performance, but removing them from school altogether may not be warranted
- Their outpatient care (for example, weekly therapy, primary care, psychiatrist, etc) is not sufficient for maintaining adequate functioning in daily life
- They have recently left a higher level of care (residential or PHP) and still require some structure and support before returning to daily living
Will My Teen Need IOP, PHP, or Residential?
Every teen’s situation is unique. Should you reach out, a trained mental health provider at your treatment center of choice will conduct an intake assessment to determine what level of care is clinically indicated, while also getting input from your teen and their parent(s) or guardian(s) to better contextualize their challenges.
Some factors that providers use to determine a teen’s level of care:
- Their risk of self-harm and the presence of suicidal thoughts
- Their psychiatric and treatment history
- Their daily functioning (including academic participation, daily hygiene, family life)
- Their environment and its impact on their substance use and well-being
- Any co-occurring conditions that may warrant more specialized and/or intensive care
- Your insurance coverage (if not paying out of pocket)
Schedule an intake with Evolve’s admissions team >>
Is virtual rehab a good option for my teen?
For some teens, virtual IOP or PHP may be a supportive option, where treatment takes place on HIPAA-compliant, secure video platforms.
There is research to suggest that these options are just as therapeutic and effective as in-person care, especially for adolescents who may not have access to treatment otherwise due to geographic isolation, financial barriers, disability or chronic conditions, and/or social difficulties that impact a teen’s ability to comfortably attend in-person treatment (such as agoraphobia, autism, or social anxiety).
Virtual treatment can also be impactful in bringing a teen’s treatment directly into their home and daily living environment, where they can confront triggers and do the work of recovery directly in the settings which challenge them most.
What is a Dual Diagnosis?
When teens struggle with both a substance use disorder and another mental health condition, it’s what’s called a dual diagnosis (or, in treatment settings, a co-occurring disorder).
Some common co-occurring conditions for teens include:
- Mood disorders (such as major depression and bipolar disorder)
- Anxiety (including generalized anxiety, obsessive-compulsive disorder, and social anxiety)
- Post-traumatic stress (PTSD)
- ADHD
- Conduct disorders
- Oppositional defiance
- Eating disorders
- Gender dysphoria
- Personality disorders*
*With respect to personality disorders, it’s important to note that personality disorders are typically diagnosed in individuals over age 18, as teens are still developing, and substance misuse can often mimic other mental health conditions. If a clinician has diagnosed your teen with a personality disorder in the past, be sure to advocate for continual reassessment as they progress in their sobriety.
What Does the Research Say About Dual Diagnosis Treatment For Adolescents?
Dual diagnoses are actually the norm in addiction treatment, not the exception, especially for teens. Studies show that about two-thirds of teens with substance use disorders had at least one other mental health diagnosis in their history.
Because teens are still developing and substance use can deeply impact their neurobiology, having a clinical team that understands the nuances of adolescent behavioral health is crucial for your teen’s recovery from both a substance use disorder and any other complicating mental health condition.
What Should I Know About Dual Diagnosis Treatment Centers For Teens?
A dual diagnosis can certainly add some complexity to a teen’s recovery, as substance use disorders often develop as maladaptive coping tools in the face of unmanaged struggles.
For example, a teen may reach for alcohol to cope with grief after a traumatic loss, or spiral into drug use when they are unable to access meaningful support and relief for their major depression.
Untreated (or even misdiagnosed) mental health conditions can also lead to increased odds of developing a substance use disorder as well.
A teen who struggles with impulsivity due to ADHD, for example, may be more inclined to experiment with substances to self-regulate; a teen who was mistakenly diagnosed with depression, when they actually have bipolar disorder, may be more likely to use drugs and/or alcohol when they are experiencing untreated hypomania.
But that also means that accessing competent treatment that views your teen as a whole person with overlapping challenges — rather than treating each condition in isolation — is crucial in ensuring that their recovery can sustain and endure, getting to the root rather than only addressing the behaviors emerging at the surface.
Next Steps When Considering Outpatient Rehab For a Teen With Dual Diagnoses
Regardless of the treatment center you choose, it’s important to find a rehabilitation center that specializes in the challenges your teen is facing, including co-occurring or dual diagnosis.
While reviewing a rehab center’s website can be helpful, the intake process — in which you can ask their admissions team any questions you might have — is a crucial part of determining the right fit for your child.
During your teen’s intake, you might ask:
- How does a dual diagnosis of [DIAGNOSIS] impact your recommendation for my child’s level of care [PHP, IOP, or residential]?
- What is your level of experience supporting clients with [DIAGNOSIS]?
- How many clients would you estimate that you’ve worked with in the last year who have this type of dual diagnosis?
- What types of therapy do you offer for [DIAGNOSIS], and how is this different from clients who do not have a dual diagnosis?
- How often will my teen have their diagnoses revisited, knowing that substance use can often mimic other psychiatric conditions?
- How will we know if treatment is or isn’t effective? What signs should I be looking for as a parent, and what options are there if the recommended treatment isn’t working?
Specialized care looks different for every teen.
At Evolve, one of our areas of expertise is dual diagnosis treatment for adolescents. We consider this one of our specialties because we not only use evidence-based treatments, but personalize our approach to meet the needs of each unique teen we work with.
This includes gold standard treatments such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), which help address the relationship between a teen’s thoughts, emotions, and behaviors.
We also offer Motivational Interviewing (MI), which helps teens unlock their own personal goals, values, and inner compass for recovery, ensuring their journey feels self-directed and empowering, rather than coerced or forced upon them. As motivation is key to recovery for teens and adults alike, this is an essential component of the support we offer.
Support isn’t limited to teens alone, either — we incorporate family therapy to ensure a recovery mindset and healthy environment is fostered in all touch points of a teen’s life, including in the home.
We also offer more experiential therapies that incorporate play, creativity, curiosity, and connection, like drama therapy, art therapy, music therapy, yoga, and more. Often, these fundamental human experiences of play and creativity are lost in the fog of addiction.
And because safety is foundational to any kind of mental health recovery, we also offer a treatment model called “Seeking Safety,” which is a trauma-informed approach that combines trauma and relationship education alongside skill-building in a group setting.
Learn more about our evidence-based approach >>
You Believe in Your Teen’s Future. At Evolve, We Do, Too.
As a parent, we know that you won’t give up on your child’s future.
At Evolve, you aren’t alone in that conviction — we know that recovery is possible, because we’ve had the honor of witnessing it firsthand in the last decade of our work, supporting families just like yours.
