Ask an Expert: Should My Son Go to a Teen Rehab?

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Ask an Expert: Should My Son Go to a Teen Rehab?

By Sion Harris 05/30/16

Our expert discusses why treating adolescents for substance abuse must be tailored to their specific level of development.

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Ask an Expert: Should My Son Go to a Teen Rehab?
Good idea?

Dear Expert,

My 15-year-old son has been having some trouble with drugs and has asked for help, and when I started doing some research I found that a local treatment center has an "Adolescent Track." But I'm wondering if it would make more sense to have him go to a facility that is exclusively for teens. Please let me know what you think.​

​Dr. Sion Harris: Thank you for your question. My suggestion would be to find a facility that specializes in treating teens. The reason is that there are a number of major differences between adolescents and adults related to substance use.

The first is that we now know that adolescence is a sensitive period for brain development and exposure to substance use during adolescence can have very different acute and long-term effects than substance use among adults. For example, adolescent brains have been shown to change more rapidly in response to substance use, and be more vulnerable to developing addiction than the brains of adults. Something like 90% of adults with addiction started their substance use in adolescence. There is almost a linear association between the age at which an adolescent starts to drink or use drugs, and the likelihood that they will develop a substance use problem or disorder. So, if a clinician detects ANY past-year substance use in a 14-year-old, this should be deemed of great concern, while any past-year substance use in an adult is likely of much less concern. In addition, substance use during a time of critical brain maturation can potentially derail brain development and cause long-term effects that may be irreversible.

Related to this is that problematic use patterns look very different between adolescents and adults. Daily drinking is almost never seen in adolescents - who tend to drink socially and primarily around the weekends - whereas daily drinking is more common among adults and more characteristic of adult problem drinkers. In addition, an adolescent regularly using substances when alone is much less common than among adults, and should be viewed with much more concern as an indication of more severe substance involvement. Therefore, screening for "problem" substance use among adolescents should be done using a screening tool specifically designed to be developmentally appropriate for, and validated among, adolescents, rather than using tools developed for use with adults. A screening tool called the CRAFFT screen (available for free at​ ​www.ceasar.org), which is brief enough for use in busy healthcare settings, is now the most widely recommended screener for use with adolescents, and it was specifically designed for adolescents.

​In many ways, the accurate understanding and treatment of teen substance abuse is very different than ​those applied to adults, so it would be ideal to find a program that understands those differences as opposed to one that takes a program geared for adult substance use disorder and tweaks it for adolescents. 

Dr. Sion Kim Harris is an Assistant Professor of Pediatrics at Harvard Medical School, and Co-Director of the Boston Children’s Hospital Center for Adolescent Substance Abuse Research (CeASAR). Full Bio.

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