Sarah Bagley: The first step to identify substance use in an adolescent is to recognize some of 

the warning signs as early as possible. 

Parents and all adults who interact with adolescents and young adults should be 

aware of some of the warning signs of substance use, these might include: 

Changes in behavior like becoming more withdrawn or seeming more 

depressed. 

Changes in grades.

Maybe dropping out of school or losing a job. 

Changes in friends.

Becoming less interested in activities or in sports that the adolescent or young 

adult used to be excited about.

Some other signs that substance use may be a problem for an adolescent or a

young adult is not being able to stop using after having a conversation with a 

parent or other adult about stopping use. Trying to hide alcohol or substance 

use, or becoming really defensive in conversations around substance us. 

These signs can be really subtle and it's important to recognize that some of 

these signs might be symptoms of having a mental health diagnosis like 

depression or anxiety. And so, it's really important that parents or other adults 

involved in an adolescent or young adult's life is able to have an open and 

honest conversation about what's going on and ensure that that adolescent and 

young adult has access to an assessment to figure out whether or not it is 

substance use or other mental health problems that may be causing their 

symptoms. 

It's also important to realize that a lot of these signs can be subtle and 

sometimes they don't exist at all or may not show up until later on when 

substance use has become more problematic, and parents shouldn't feel guilty 

if they missed these signs in their adolescent. 

Physicians such as primary care providers are trained to ask adolescents in a 

confidential way at their annual exam about substance use. And parents can ask 

their primary care providers to make sure that, that assessment is happening 

every year. 

When a substance use disorder is identified in an adolescent or in a young adult 

it's important that the first message that, that teen or young adult is receiving is 

that no matter what happens the parent or the other caregiver is going to be 

there for them. This can be a really difficult time and the teen or young adult 

may feel really alienated. And if they feel like they can't have an open and 
honest conversation then it's going to be really difficult to engage that person in 

any kind of treatment. 

It's important then to find substance use disorder services that are appropriate 

for teenagers and young adults. A lot of the treatment that's available for 

people with substance use disorder are tailored toward adult and teens and 

young adults have different needs. You should make sure that you look for 

treatment that has professionals who are trained in taking care of teens and 

young adults. And you can always talk to your primary care provider to ensure 

that, that treatment is appropriate. 

Parents should look for treatment that addresses both the physical an the 

mental health needs of their teen or their young adult. Treatment should also 

include support for both the patient and also the family. For example, at the 

CATALYST clinic where I work at Boston Medical Center, we have a team-based 

approach. Our team is composed of physicians, social workers, nurses, a 

recovery coach and so that way we're able to really wrap around our patients 

and make sure that all of their needs are being addressed. 

Part of support for a family whose adolescent or young adult is going through 

substance use disorder treatment is helping the family realize that this isn't their 

fault. A lot of the families that we meet feel guilty or they wonder whether or 

not they missed any signs or symptoms of what was going on with their child. 

We try to be really clear that addiction is a really complicated disease and it's 

easy to miss the signs, and the parents shouldn't feel guilty about that. And 

moving forward it's important to make sure that we're supporting them and 

figuring out how to communicate and support their child struggling with a 

substance use disorder. 

We offer our services in a primary care clinic, which allow us to address both the 

physical and the mental health needs of all of our patients and their families. 

We offer primary care, we offer assessment and diagnosis of substance use 

disorder. We treat patients with medications for alcohol and opioid use 

disorder. We offer our patients therapy and recovery support. In addition, we 

screen our patients for HIV and Hepatitis C and link them to treatment as 

needed, and also link them to psychiatry care if indicated. 

Some additional components of the substance use disorder treatment that we 

offer at CATALYST may include, monitoring for drug use with urine drug testing. 

Offering overdose education and naloxone for patients and their families. And 

also offering recovery support through outreach services. 

We found that a lot of our patients have barriers that are related to social issues 

such as housing and transportation. We recognize that it's critical to address 

those issues too if we want our patients to meet the recovery and have the 

recovery that they want.
Substance use disorder services offered to teens and to young adults are 

different than those services that are offered to older adults. Some of the key 

differences are that oftentimes involvement of family is critical to the success of 

a teen and a young adult with a substance use disorder. It's also important that 

we recognize that peers play a major role in the lives of teens and young adults 

and for some teens and young adults they may rely on their peers more than 

their family. Part of the work that we have to do is to help them find sober 

networks of friends so that they can find ways to enjoy activities without 

substances. 

Another component of treatment that's different is that some of these teens 

and young adults may have dropped out of school or are having trouble 

finishing school. In order for them to go on to get the jobs that they want and 

again have the lives that they want and the full recovery means that our services 

have to address getting them back into school or helping them finish school or 

finding employment. 

An additional key difference between treating adolescents and young adults 

compared to older adults is that we have to sometimes go into the community 

to find them where they are. Older adults may be more likely to actually come 

to a clinic or come to a program to receive treatment. The teens and young 

adults have a lot of ambivalence and may not want to go to the doctor's office. 

And so, part of the work we do is going to find them where they are, which 

might be in schools, might be in community centers, or in other places where 

teens and young adults congregate.