What Factors Are Most Helpful to Reduce Substance Use by Teenagers?

substance abuseIf you have a teenager who is drifting into substance use or perhaps they are clearly abusing drugs or alcohol, which treatment approach should you consider?  What works and how does it work?

The article “Mechanisms of change in adolescent substance use treatment: How does treatment work?,” published in June of 2014 in the journal Substance Abuse, gives a good review of the literature. They found that positive social support, motivation to stop using drugs and alcohol, and positive parenting behaviors helped the most. You can read this article here…

There is often a discussion of whether cognitive behavioral therapy or motivational interviewing approaches work best. Since I work with this age group, trying to help those physically dependent or addicted to opiates (usually heroin), I am very aware of the high failure rate of treatment. My experience definitely supports the findings of this review.  Those parents or loved ones who remain engaged, supportive, while not being enabling, seem to have higher rates of success for their teenagers or young adults. Those substance users who plug into a 12-step or similar ongoing support program seem to remain motivated to stop the substance use.

When the endpoint is successfully stopping your substance use (be it alcohol, marijuana, opiates, methamphetamine, cocaine, or others) the study found that all roads that lead to reduced substance use travel through:

  • Supportive therapeutic or other relationships.
  • Increased motivation to reduce substance use.
  • Improved coping skills.
  • Increased self-efficacy to reduce use.
  • Improved affect regulation.


Cognitive behavioral therapy (CBT) was shown to work through coping skills training and increased self-efficacy to abstain or reduce use. Motivational Interviewing (MI) works through eliciting more client “change talk”, working best when the therapist was non-confrontational.

Parents, we can learn from this review article.  We should remain non-confrontational, supportive but not enable our teenager or young adult. This article did not address al-anon, an organization for the parents, family, or loved-ones of the substance user. As a parent who has found himself with young adults living in his home, eating the food and basically failing to find a job or even look for a job due to substance use, I have had to show these able-bodied, normal intelligence, young men, the door on more than one occasion.  Sometimes the hardest thing to do is to stop making it possible for them to use.  When faced with homelessness, each time my substance using young adults have found an apartment (sometimes we help make that happen) and gotten a job (some may need help with that). Al-anon is a place where you can get the support to stop enabling them and establish loving firm boundaries, if you are struggling with that.


Dr. Paul





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