Parents as First Responders in Adolescent Substance Use

By Pat Aussem

“I have a 16-year-old son who is using marijuana, dab and I think molly. … I believe he is dealing drugs to make money or to buy drugs as he has depleted his bank accounts. He had a job but lost it due to not showing up. … I’m scared to death of what will happen to him and I don’t know what to do or who to turn to. My husband, his father, wants to kick him out of the house or have him arrested as he looks at it as tough love. … Does anyone have any suggestions?” (Excerpted from a post at drugfree.org ).

Many parents, like the mom who shared this comment to a blog entry on drugfree.org, find themselves as the first responders to their teen’s drug or alcohol use and don’t know what to do. This all-too-common situation highlights the resentment, fear, frustration and discord that many parents and caregivers feel when attempting to respond effectively to a teen’s substance use.

Studies show that 90 percent of people with substance use disorders began using during their teen years when the brain is still developing, so taking action is important regardless of the level of use. While the most recent survey from Monitoring the Future, an ongoing study of U.S. high school students, shows a decline in teens’ use of alcohol, it still shows that two in every five high-school seniors have consumed alcohol in the past year, with one in every six teens engaged in binge drinking (more than five drinks in a row) once or more often in a two-week period.

One in every 17 high school seniors smokes marijuana daily, with a majority of seniors reporting that they see no harm in regular marijuana use.


Parents discover their child’s substance use in a variety of ways, including being told by the child or someone else, according to a 2013 Partnership For Drug-Free Kids study. Parents also uncover substance use by noting changes in behaviors — such as a change in sleep patterns, different friends, avoidance behaviors and/or a drop in performance at school or work. Finding empty alcohol bottles, rolling papers, Visine and other forms of drug paraphernalia are also common.

Typically, parents try to discipline their way out of the problem, grounding the teen, taking away a cellphone, restricting video games and Internet use, taking away car privileges, etc. While these tactics may seem to work, they typically don’t solve the problem. Rather than stopping their substance use, the teens up their game in terms of hiding it.

Sometimes parents will disclose concerns with close family members or friends who can be somewhat dismissive of substance use as experimentation (as in this Partnership for Drug Free-Kids PSA). They fail to understand substance use as a health issue, affecting cognitive abilities, emotion regulation and physical safety.

Other parents turn to their pediatrician for direction, but may find the medical profession short on answers. This is a function of lack of training in medical school, lack of acceptance of the disease model of addiction, negative attitudes and few role models among physicians in addressing these issues medically — as well as limited reimbursement for providers to perform services, according to a CASA report.

The typical medical protocol is to suggest that parents find a counselor for their teen and attend a 12-step support group meeting. Parents will be advised to use “tough love,” “let him hit bottom,” and, “your kid’s got to want treatment or it’s a waste of time.” Alternatively, families may be told their only hope is an intervention, confronting the teen about his or her use with the expectation that the teen will agree to treatment.

While there may be some success with these approaches, the evidenced-based Community Reinforcement and Family Training (CRAFT), developed by Drs. Robert J. Meyers and Jane Ellen Smith, has been proven to be more effective. In repeated studies, 64 to 86 percent of families were able to engage a loved one in treatment using CRAFT, compared to less than 50 percent with the other approaches.

CRAFT is a skills-based program designed to teach parents behavioral and motivational strategies for interacting with their children to encourage behavior change while enhancing their own self-care. Parents learn, for example, how to use positive communication rather than vaguely expressing what they want, blaming the child for their problems, allowing resentments to build and delivering messages that sound like lectures.

CRAFT teaches specific skills, including:

• understanding what motivates a teen to use substances (e.g., thrill-seeking, boredom, stress, anxiety, weight control, etc.);
• effective communication;
• positive reinforcement strategies rewarding healthy behaviors;
• problem-solving skills to address rule breaking and unstructured free time;
• attending to the parents’ self-care and modeling healthy behaviors;
• allowing natural consequences to play out;
• using domestic violence precautions in the case of aggression; and
• engaging a teen in appropriate treatment.

Many of these skills are valuable, even if the adolescent does not enter treatment or has already begun the treatment process, with the result being better family cohesion.
CRAFT is not a quick fix, but rather an approach that can benefit both a teen and family in the short and long term with a comprehensive plan of action and a more positive outlook.