Ask a Therapist: How Do I Help My Teen Recover From a Relapse? 

“My teen who has a substance use disorder started drinking again. How do I help him recover from this relapse?”  

To explore this topic, we spoke with Emily Evans, a licensed social worker and therapist at the Embark Behavioral Health short-term residential treatment facility in White Haven, Pennsylvania.

Substance Use Disorders: A Serious Problem for Teens

According to the Substance Abuse and Mental Health Services Administration’s 2020 National Survey on Drug Use and Health, 1.2 million American youths ages 12-17 had a substance use disorder involving illicit drugs such as marijuana or cocaine in the past year, while 712,000 had a disorder involving alcohol.   

However, in a recent study in the journal Drugs, researchers noted that previous studies have shown parents underestimate drug and alcohol use.  

As Evans noted, “Many parents may not realize their teens are using substances, as they’re often good at hiding the behavior.”   

Teens and alcohol use

In 2020, just over 1 in 5 American youths (21.6%) had tried alcohol by age 15, and over 1 in 3 (41.4%) had tried it by age 17, according to the SAMHSA survey. The survey further shared that in that same year: 

• 7.5% of youths ages 14-15 and 17% of those ages 16-17 used alcohol in the past month. 
• 3.3% of youths ages 14-15 and 9.1% of those ages 16-17 reported binge drinking in the past month. 

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of consumption that brings blood alcohol concentration (BAC) to at least 0.08%. According to an article in Alcohol Research: Current Reviews, a journal published by NIAAA, to reach that level: 

• For ages 14-15, it takes three or more drinks for girls and four or more for boys in a two-hour period. 
• For ages 16-17, it takes three or more drinks for girls and five or more drinks for boys in a two-hour period. 

“Alcohol use has been normalized among adolescents, whether it’s occasional drinking at a party on the weekend to more frequent use,” Evans said. 

Teens and drug use

According to the latest Monitoring the Future survey by the National Institute on Drug Abuse, covering 1975-2022, 11% of eighth graders used illicit drugs in the past year. The numbers were even higher for 10^th and 12^th graders, at 21.5% and 32.6%, respectively. These statistics don’t include prescribed drugs and legal substances.  

Evans noted that the recent legalization of marijuana in many states has led to an increase in the normalcy of marijuana use in teens. She also shared she sees many teens who regularly use nicotine and prescription medications.  

“Prescription medications, such as opiates and benzodiazepines, are being prescribed to teens for issues such as sports injuries and anxiety, which can easily lead to misuse,” she said. 

Why Do Teens Relapse?

When it comes to a substance use disorder, a relapse refers to starting to use alcohol or drugs again after a period of not using them. 

According to Evans and other substance use experts, there are several reasons why teens start using again, including: 

• Accessibility: In recovery programs where young people live on site, youths simply don’t have access to substances, and Evans noted that “A big thing that happens with teenagers is that once the substances become more accessible again, there’s a higher risk of relapse.” 
• Peer pressure: “If they’re hanging around with friends who continue to use, your teen may want to fit in and not disappoint people,” Evans said. “This often causes them to fall back into old patterns.” 
• Stressful or traumatic life events: Parents getting divorced, a friend dying by suicide, or a life-threatening illness are just a few examples of what can trigger teens to turn back to alcohol or drugs. 

How Parents Can Help Teens Recover

According to a recent study in the Annals of General Psychiatry, approximately 38% of participating youths ages 12-18 who’d struggled with drug use relapsed in their first five years of recovery. Relapse rates varied depending on factors like the type of substance being used, as well as how parents dealt with and were involved in their child’s treatment journey.  

If your teen was in substance use disorder recovery but started using drugs or alcohol again, Evans said there are several ways you can support them and help them avoid another relapse.  

Schedule an appointment with your teen’s therapist

Make an appointment with your teenager’s therapist, and let them know about the relapse. This is important because recent research in the journal Current Psychiatry Reports showed that psychosocial treatments, which include family-based therapy and cognitive behavioral therapy, are the most effective methods of treating adolescent substance use disorder.  

If your teen isn’t already receiving counseling, find a therapist who has substance use disorder expertise. This person can recommend the best treatment approach, which may be outpatient therapy such as an intensive outpatient program (IOP) or therapeutic day treatment program (also known as a partial hospitalization program, or PHP) or inpatient care, such as a short-term residential treatment center. 

To help your teen feel comfortable with this important step, Evans recommended normalizing the process of reaching out for help — and not positioning it as a punishment.  

“Normalize going to talk to someone,” she said. “The best way to really have teens engage with this is by making it about open dialogue. But if you come at it from an authoritarian ‘You’re in trouble’ standpoint, your child will automatically put up their walls.” 

Encourage your teen to connect with others

Encourage your teen to develop healthy social connections, which could happen through sports or hobbies or at school. Try to keep them from isolating themselves. According to a study in the Journal of Youth and Adolescence, isolation could lead to self-medication, resulting in higher substance use.  

You can also consider connecting your teenager with others through substance use support groups. However, Evans recommended talking to your child’s therapist about finding groups specific to your teen’s unique needs and triggers.  

“Substance use support groups can be a double-edged sword,” she said. “Having teens find a place to talk about their experiences can be useful and make them feel less alone. But it can also introduce them to other substances they may not have had knowledge of before.” 

Help your teen identify what triggered them to relapse

To help ensure your teen doesn’t have another relapse, it can be helpful to identify what caused them to start using substances again.  

“Ask your teen to reflect on situations where they felt uncomfortable,” Evans said, noting that this is an important tool in her approach to therapy. “By talking about what makes them feel comfortable vs. uncomfortable, it makes the process of identifying triggers less overwhelming for teenagers.” 

Evans added, “Once they identify what makes them uncomfortable, you can talk about how they coped with that discomfort. If they say they coped with marijuana, nicotine, alcohol, etc., you can point that out as a potential trigger.” 

Discuss how to address any overwhelming stressors

While healthy stress builds resilience and is necessary for personal growth, unhealthy stress, also known as “distress,” feels unmanageable and can become overwhelming for teens. 

“Teenagers tend to not deal well with distress,” Evans said. “They tend to just internalize it or have some sort of outward expression, which is why significant stressors can trigger a relapse. For example, a teen who’s failing an important class may deal with their stress by self-medicating with alcohol.” 

Work with your teen on how to address any overwhelming stressors. For instance, they may need to cut back on multiple extracurricular activities, or they may need a tutor to help them pass a class at school.  

Make sure they’re getting enough sleep and eating nutritious food

There is a link between a healthy lifestyle and a risk for substance use. For instance, a poor diet or chronic lack of sleep can affect your teen’s mental health and resilience during times of stress, which in turn may leave them more at risk of a relapse. 

In fact, according to research in Nutrition Reviews, those who are using drugs or undergoing treatment for recovery may benefit from a diet high in nutrients linked with improved mental health, such as B-complex vitamins, magnesium, and omega-3 fatty acids. 

Encourage your teen to eat a nutritious, well-balanced diet by stocking the kitchen with healthy staples and modeling healthy behavior (e.g., you can cook a nutritious dinner together). And, try to ensure they’re getting enough sleep. The Centers for Disease Control and Prevention recommends teens 13-18 years old get eight to 10 hours of sleep per day. It’s offered several tips for better sleep, including going to bed at the same time each night and removing electronic devices from the bedroom. 

Spend quality time together

Positive parental involvement has a protective factor against substance misuse, according to SAMHSA. The administration also noted that expert parenting can mediate the effects of multiple risk factors.  

To learn ways to build a strong connection with your teen, Evans recommended seeking out a local Al-Anon or Nar-Anon family member support group.  

“It’s a place to go to talk where people will understand where you’re coming from,” Evans said. “It’s useful for a family to recognize how they can support their loved ones who are going through an addiction issue but also not enable them.” 

Remind them of their coping skills

If you see your teen in a situation that they’ve said makes them feel uncomfortable, or you notice them struggling with stressors, direct them to use healthy coping strategies. 

“One that I use a lot with teenagers is called ‘cope ahead,’” Evans said, noting it’s part of dialectical behavior therapy, a type of cognitive behavioral therapy that works to change negative thinking patterns and pushes for positive behavioral changes. “Help them ‘play the tape forward.’ For example, ‘If I choose to drink alcohol, there’s a risk of me getting into an altercation.’ Cope ahead is very useful to get teens to pause and think through future consequences.” 

Evans said grounding techniques, such as paying attention to one’s senses, can also help your teenager. 

“Identifying things they’re hearing, smelling, etc., allows them to focus on those senses rather than urges they may be having,” she said. “Even going for a walk really grounds you. Grounding techniques can be very useful in times of high stress to help the teen avoid going to their automatic coping skill, which could be substance use.” 

Teen Relapse Wrapup

If your teen has relapsed, you can play a vital role in their recovery. From connecting them to a therapist to discussing how to deal with overwhelming stressors to reminding them to use coping skills, such as grounding techniques, your active engagement can make a real difference in their healing journey.  

That said, this journey can be emotionally hard for parents, so don’t negate the importance of therapy and social connection for you too.  

“Don’t be afraid to find someone you feel you can talk to about what you’re going through,” Evans said. “Make sure you reach out and find that support for yourself.” 

Embark is the most trusted name in teen and young adult mental health treatment. We’re driven to find the help your family needs. If you’re looking for support, contact us today!