Blog : addictions

Teen Addictions: From Warning Signs to Treatment

Teen Addictions: From Warning Signs to Treatment


By: Steve Greenman, MA, LPC, NCC

Sam came into my office with fear in his eyes. His father had called me and stated he needed to find some help for his boy – all had not been right for a while. Sam was a freshman in college and had been doing outstanding in his studies. During the Christmas break, Sam had gone to a party and though he has smoked pot occasionally, he was about to experience drugs in a whole new light.

The mixture was LSD and Ecstasy – candy flipping. Being inexperienced with the drugs, he took five times the normal dosage and three months later, he was still dealing with side effects.

After the pleasurable effects of candy flipping, Sam dealt with unwanted after-effects, which typically occur two to three days after the drug use and are known as blues or suicide Tuesday:

  • Depression, anxiety, panic attacks, paranoia
  • Problems with sleeping
  • Poor concentration
  • Fatigue
  • Loss of appetite
  • Craving for the drug

But what made it even worse for Sam was not just the normal side effects but he had incurred possible brain damage with side effects still affecting him months afterwards: difficulty sleeping, erratic behavior, temper issues, balance and difficulty with light tracing.

Sam had to drop out of the following term and was struggling with holding a job and at times, dealing with simple reality. What began as an experimental night out with friends became a struggle to understand for the family: Would this be his new reality for the rest of his life?

Teen Dilemma

  • In 1998, nearly 10 percent of adolescents (age 12 to 17) reported using an illicit drug at least once during the past month. About one in 12 youth (8.3 percent) in this age group are current (past month) users of marijuana, the most frequently used illicit drug, and 19.1 percent are current users of alcohol.
  • More than half (55 percent) of our nation’s 12th graders have tried an illicit drug and more than one-quarter (29 percent) have tried a drug other than marijuana, such as cocaine, inhalants and heroin.
  • Youth age 16 to 17 have the second highest rate (16.4 percent) of current illicit drug use in the country. The highest rate (19.9 percent) is found among young people age 18 to 20.
  • It’s estimated that 400,000 adolescents are in need of substance abuse treatment
  • Reports from eighth graders first use of substances by the fourth grade: alcohol 6.8%, cigarettes 7.3%, inhalants 3.6%, and marijuana 1.1%
  •  Although consumption of alcoholic beverages is illegal for people under 21 years of age, 10.4 million current drinkers are age 12 to 20. Of this group, nearly half (5.1 million) engage in binge drinking, including 2.3 million who would also be classified as heavy drinkers.

Being Attentive

People who interact with adolescents in the home or community need to be alert to changes in an adolescent’s behavior and appearance that may signal substance abuse.

By recognizing the potential warning signs and symptoms of substance use, you may be able to get help for a teenager in need of treatment. The following behavior changes, when extreme or lasting for more than a few days, may indicate alcohol-related or drug-related problems and the need for further screening by a professional.

Sudden changes in personality without another known cause:

  • Loss of interest in once favorite hobbies, sports, or other activities
  • Sudden decline in performance or attendance at school or work
  • Changes in friends and reluctance to talk about new friends
  • Deterioration of personal grooming habits
  • Difficulty in paying attention, forgetfulness
  • Sudden aggressive behavior, irritability, nervousness, or giddiness
  • Increased secretiveness, heightened sensitivity to inquiry


Adolescents face unique risks associated with substance abuse. The use of substances may compromise an adolescent’s mental and emotional development by interfering with how young people approach and experience interactions. In addition, adolescents are at serious risk for a number of direct and indirect consequences, including the following:

  • Delinquent Behavior—Adolescents who use marijuana weekly are six times more likely than non-users to report they run away from home, five times more likely to say they steal from places other than home and four times more likely to report they physically attack people.
  •  School-Related Problems—Adolescent substance abuse is associated with declining grades, absenteeism from school and dropping out of school. Cognitive and behavioral problems experienced by teens abusing substances may interfere with their academic performance.
  • Traffic Accidents—Nearly half (45 percent) of all deaths from traffic accidents are related to the consumption of alcohol and an estimated 18 percent of drivers age 16 to 20 (or 2.5 million adolescents) drive under the influence of alcohol.
  • Risky Sexual Practices—Adolescents who use drugs and alcohol are more likely than non-using teens to have sex, initiate sex at a younger age and have multiple sex partners, placing them at greater risk for unplanned pregnancies and HIV/AIDS, hepatitis C and other sexually transmitted diseases.
  • Juvenile Crime—Adolescents age 12 to 16 who have ever used marijuana are more likely at some point to have sold marijuana (24 percent vs. less than one percent), carried a handgun (21 percent vs. seven percent) or been in a gang (14 percent vs. two percent) than youth who have never used marijuana.
  • Developmental Problems—Substance abuse can compromise an adolescent’s psychological and social development in areas such as the formation of a strong self-identity, emotional and intellectual growth, establishment of a career and the development of rewarding personal relationships.
  • Physical and Mental Consequences—Smoking marijuana can have negative effects on the user’s mind and body. It can impair short-term memory and comprehension, alter one’s sense of time and reduce the ability to perform tasks that require concentration and coordination, such as driving a car. Evidence also suggests that the long-term effects of using marijuana may include increased risk of lung cancer and other chronic lung disorders, head and neck cancer, sterility in men and infertility in women.
  • Future Use Disorders—The earlier the age at which a person first drinks alcohol, the more likely that person is to develop an alcohol use disorder. A person who starts drinking alcohol at age 13 is four times more likely to develop alcohol dependence at some time in his or her life than someone who starts drinking at age 20.


Treating adolescents for substance abuse requires special consideration of the adolescent’s individual experience and how it affects the nature and severity of his or her alcohol or drug use. Understanding the adolescent’s situation will help explain why alcohol or drugs are used and how they became an integral part of his or her identity. Factors that need to be considered when tailoring treatment for adolescents include the following:

  • Developmental Stages—Treatment for adolescents must address their unique developmental needs, which vary with the age of the client. Developmental features of younger adolescents are different from those of older adolescents. For example, older adolescents are more capable of abstract thinking and are more likely to openly rebel than younger adolescents.
  • Ethnicity and Culture—Norms, values and health beliefs differ across cultures and can affect substance abuse treatment. For example, some cultural groups may consider treatment invasive; others may wish to involve the extended family. Treatment services need to be culturally competent and use the preferred language of adolescent clients and their families.
  • Gender and Sexual Orientation—Factors that influence adolescent substance abuse and involvement in treatment differ by gender. For example, whereas adolescent girls more often have internalizing co-existing disorders such as depression, boys are more likely to have externalizing disorders such as conduct disorders. Effective treatment for gay, bisexual and transgendered youth includes helping them to acknowledge and accept their sexual identity.
  • Co-existing Mental Disorders—Adolescents with substance abuse disorders are more likely than their abstinent peers to have co-existing mental health problems such as anxiety disorders, attention deficit-hyperactivity disorder and depression. In these teens, substance abuse may disguise, exacerbate or be used to “self-medicate” psychiatric symptoms. Without tailored treatment, co-existing mental disorders could interfere with the adolescent’s ability and motivation to participate in addiction treatment and could increase the potential for relapse.
  • Family Factors— An adolescent’s family has a potential role both in the origin of his or her substance abuse problem and as an agent of change in the adolescent’s environment. Treatment should take into account family factors that increase risk for substance abuse problems in youth, such as any history of parental or sibling substance abuse problems or addiction; domestic violence; physical, sexual, or emotional abuse, and neglect. Whenever possible, parents should be involved in all phases of their adolescent’s treatment.

Parental Influence

Alcoholism and other drug addiction tend to run in families. Children of addicted parents are more at risk for alcoholism and other drug abuse than are other children:

  • Family interaction is defined by substance abuse or addiction in a family.
  • Families affected by alcoholism report higher levels of conflict than do families with no alcoholism.
  • *A relationship between parental addiction and child abuse has been documented in a large proportion of child abuse and neglect cases.
  • Children of addicted parents have a high rate of behavior problems.
  • Children of addicted parents experience greater physical and mental health problems and higher health and welfare costs than do children from non-addicted families.


Adolescents who are in treatment or recovery need all the support they can get from their families and communities. Consider taking one or more of the following actions to support youth undergoing treatment for and recovery from substance abuse. Encourage schools to offer student assistance programs, counseling on substance abus, and confidential referral to treatment and recovery resources in the community.

  • Encourage purchasers of health insurance to obtain comprehensive coverage for substance abuse and mental health services.
  • Encourage treatment centers, schools, and community-based youth organizations to conduct support groups for children of parents who are addicted to alcohol and drugs.
  • Encourage adolescents who have recovered successfully from addictive disorders to participate in community events that target their peers.
  • Because alcohol and drug use among youth often occurs in groups, be aware that encouraging one young person to seek help may lead others in his or her social group to seek treatment.
  • Encourage environmental changes in your community that promote recovery such as reducing the number of billboards advertising alcoholic beverages and holding alcohol-free recreational events.
  • Encourage the participation of family members in all aspects of the treatment and recovery process for adolescents and foster the availability of family-centered support groups and other services that address the needs of the entire family.
  • Be a positive role model for young people in treatment and recovery by not engaging in any illegal or unhealthy substance use.
  • Get involved in organizations that to support substance abuse treatment and recovery programs for adolescents.
  • Stay informed about available local resources for treatment and recovery and use this knowledge to help others.


Steve Greenman, MA, LPC, NCC is a counselor at Mental Wellness Counseling in Traverse City, MI. He specializes in helping families dealing with complex family situations, addictions, and transitions. Steve is also helping clients through the Intensive Recover Program, which helps with recovery treatment, alcohol treatment, and other addictions treatment. Contact Steve at 231-714-0282 Ext. 701

Steve Greenman Traverse City Counselor
Steve Greenman, MA, LPC, NCC | Thoughtful Experience
The Family’s Role in Addiction and Recovery

The Family’s Role in Addiction and Recovery

By: Steve Greenman, MA, LPC, NCC

“It is one of the most beautiful compensations in life that no man can sincerely try to help another, without helping himself.” Ralph Waldo Emerson

Stephanie Brown, in her book The Alcoholic Family in Recovery, discusses four distinct stages that the alcoholic and the family surrounding him or her must go through to achieve recovery:

The 1st stage is the Drinking Stage and is highlighted by the family denying that any family member has a drinking problem, while at the same time giving reasons to anyone who will listen why the drinker has the right to drink.

The 2nd stage is labeled Transition, and the focus is the beginning of abstinence for the drinker. This is a time for the family of the alcoholic to finally come to the realization that the alcoholic cannot control his/her drinking and the co-alcoholic cannot control the drinker. (A co-alcoholic is defined as the person(s) who enables an alcoholic by assuming responsibilities on the alcoholic’s behalf, minimizing or denying the problem drinking, or making amends for the alcoholic’s behavior [, accessed 4/28/2015].)

The 3rd stage, called Early Recovery, is when this couple works on individual healing, versus the healing of the whole of the family unit.

The 4th stage is Ongoing Recovery, where “individual recoveries are solid and attention can be turned back to the couple and family” (Brown, 1999, p114).

 Stage 1: The Drinking Stage

Therapists working with the family in the drinking stage must focus not only on the drinking behavior of the alcoholic, but also the distorted belief system of the rest of the family that emotionally and physically supports the drinking. The family must quit denial and support of the drinking, and begin to find avenues to reach out for help.

For the therapist dealing with a drinker in the drinking stage, the imperative is for the drinker to begin abstinence. Attempts are made to help the drinker gain insight into why life has become for so many in the family unit unstable. However, in the final analysis, it is up to the drinker to begin the process of recovery. The therapist helps to break down the walls of defiance in the drinker’s belief system that they are in total control.

Stephanie Brown describes the insanity of the drinking stage in being like a dance: “The drinker leads and the co-alcoholic follows in a way that keeps them dancing. The leader may stumble, drift away, step all over the follower, or even break up the dance by changing partners. The co-alcoholic’s only response is to try and keep the dance going” (Brown, 1999, p 171).

The therapist must encourage the family to help the alcoholic end the dance by realizing they cannot control and enable the drinking and that only when they reach out for help outside the family system may they be led into the stage of transition.

Stage 2: Transition Stage

The transition stage is a complex ebb and flow during which the alcoholic works through no longer drinking, and the family struggles with the transition of living through the end of the drinking to the beginning of abstinence.

The environment within the family at the end of drinking is made up three distinct variables:

  • Increasingly out-of-control environment
  • Tightening defenses to prevent or forestall systems collapse
  • A last ditch attempt to maintain denial and all core beliefs

The therapist has a multitude of functions in the beginning stage of transition. The therapist must help guide the alcoholic to realize the loss of self-control with their drinking and, with this understanding, help the alcoholic realize that they must reach out to outside help (ie, AA) to have any realistic chance to stay sober.

In the meantime, the therapist has to help the family—who has been dealing with supporting the drinker’s world that is now beginning to crack and crumble—realize their need for help (ie, Al-Anon) in handling how the denial, core beliefs, and out of control behavior made them, as much as the alcoholic, a prisoner of the drinking.

The therapist is a guide to help find sobriety, and a place to go for information when life is a bundle of confusion. “Are you going to meetings?” “How are you feeling?” “Take it one day at a time, first things first, and set priorities” are statements repeated by the therapist until the client can recite them for themselves.

As the family begins to move from drinking to abstinence and to the later half of the transition stage, Brown describes four focal points the family must be aware of:

  • To focus intensely on staying dry
  • To stabilize the out-of-control environment
  • To allow the family support system to collapse and remain collapsed
  • To focus on the individual within the family

The therapist, after seeing that the family is stable enough and has lifeboats in place (AA & Al-Anon), can begin to investigate underlying feelings that may be triggers or causes of past and current drinking relapses. The therapist must also be attentive to how children in the family are being cared for and if they are handling the changes to the family structure.

Forward movement is the key and the best way to help clients reach for and know when is the right time for the family to move to the next stage: Early Recovery. In reality, this may take years based to severity of the past drinking.

Stage 3: Early Recovery

The main difference between the transition stage and the early recovery stage is a general lessening of the physical cravings and psychological impulses for alcohol. The therapist must always look for potential relapse signs, but this factor lessens as time moves forward.

An item the therapist must address in the early recovery stage is continual support within the alcoholic’s family to stay focused on their own recovery. By this stage co-alcoholics, if they are not getting support of their own, may become weary of the lack of attention from the alcoholic who is busy trying to gain support (AA) to stay sober. The co-alcoholic may have been the controller of the drinker and now has to live with decisions of the family being completed by committee. It is imperative that the therapist is able to construct support for both the alcoholic and the co-alcoholic; each has issues that must be addressed so that recovery can continue.

As recovery moves forward, hidden and latent issues that fostered drinking or was created by the trauma of the drinking environment may need individual attention. Not only does the therapist become the guide for the family, but also the provider of information in this stage.

The therapist must:

  • Continue to teach abstinent behaviors and thinking;
  • Keep families in close contact with 12-step programs and help them work on the steps;
  • Keep focus on individual recovery, seeking outside supports for the family;
  • Maintain attention for the children in the recovering family; and
  • Keep a continual eye on potential issues, such as the onset of depression, emotional problems, sleep problems, fear, and/or helplessness.

Stage 4: Ongoing Recovery

This final stage is relatively stable in comparison to the earlier three stages. This is because recovery is now solid, and attention can be turned back to the couple and the family.

The family focus lies in the area of staying on task (sobriety) and committed to recovery, and building up the structure of the family after it had been torn down in the earlier stages. The family had reached for outside help (AA, Al-Non, therapy) and now, after finding themselves and actually liking what they see in the mirror, it is time to do the following:

  • Heal the emotional separation issues
  • Look in-depth at what damage had been done to the family due to drinking
  • Study the underlying causes of the drinking behavior

The ongoing recovery stage is a time for the creation of healthy relational dependence within the family and the understanding that recovery is a process, not an outcome (Brown, 1999).

The therapist’s main functions in this stage are:

  • Make sure family is continuing abstinent behavior
  • Expand the family’s alcoholic and co-alcoholic identities
  • Ensure that everyone maintains programs of recovery (work the 12-steps and internalize 12-step principles)
  • Focus on the couple and family issues
  • Explore spirituality issues and past childhood and adult traumas

 Final Thoughts

As I constructed this article, I was struck in many ways how involved and complex the role of the therapists is during an alcohol recovery process. It is more than being a listening ear in the background; it is a juggling act of many aspects of recovery.

The therapist is one step ahead of the family—guiding the family and the drinker to realize the importance of changing behavior; all the while wondering if what they are trying to accomplish will actually work.

The family and the drinker must come to a point in their lives that only when heartfelt change is ingrained will real change occur in the family. In truth, the magic of recovery is with the drinker and the family, not the therapist.

Steve Greenman Traverse City Counselor
Steve Greenman, MA, LPC, NCC | Thoughtful Experience

Steve Greenman, MA, LPC, NCC is a counselor at Mental Wellness Counseling in Traverse City, MI. He specializes in helping families dealing with complex family situations, addictions, and transitions. Steve is also helping clients through the Intensive Recover Program, which helps with recovery treatment, alcohol treatment, and other addictions treatment. Contact Steve at 231-714-0282 Ext. 701

Dependency: Are We Enabling?

Dependency: Are We Enabling?

By Steve Greenman, MA, LPC, NCC

“At the bottom of every person’s dependency, there is always pain, discovering the pain and healing it is an essential step in ending dependency.”  Chris Prentiss, The Alcoholism and Addiction Cure

Do you have a love one struggling with emotional/physical pain using an unhealthy dependency (alcohol, pornography, gambling, drugs legal or illegal) to cope, escape or numb?

How helpless do you feel?

During my stay as a clinical therapist at a 28 day substance treatment center I had more than one client suggest the drugs/alcohol filled a void which nothing in the past ever had. One client shared to me his use of Heroin was best described as: “A hug from God”.

How do you combat a hug from God?

One has to remember you cannot save a person using a dependency, change can only come from the person themselves willing to make the effort.  We can very easily if  we are not careful become a part of the problem rather than the solution. It may be how we act out (anger, frustration, helplessness) which creates more division in the family than the person actually involved in the numbing/avoidance behavior.

Sherry Collier from her website – “Creative Path to Growth” in an article entitled   “Compassion versus Co-dependency: Caring without Enabling”  lists questions to ask yourself to determine if one is acting out of compassion or in a place of co-dependency:

  • Ask yourself what is your motive?  Am I trying to rescue someone else?
  • Are we able to walk along side someone or do we need to have to fix the problem?
  • Am I trying to “fix” someone else so as to not look at my own issues?
  • Am I exhausted – physically and emotionally drained?  Do I feel taken advantage of?
  • Are you creating safe solid boundaries for yourself and the rest of the family?

This can be very difficult questions to ask when were dealing with a loved one but the soul inside the one combating dependency is not only struggling with the outside world but also within side of themselves. We need to be able to understand the best way of supporting our loved one. There comes a time when we may need to reach out to others such as professional counselors, close friends who may have been in your shoes before for not just for our loved one but for ourselves as well.


by Portia Nelson


I walk down the street.
There is a deep hole in the sidewalk
I fall in.
I am lost … I am helpless.
It isn’t my fault.
It takes me forever to find a way out.


I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place
but, it isn’t my fault.
It still takes a long time to get out.


I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in … it’s a habit.
my eyes are open
I know where I am.
It is my fault.
I get out immediately.


I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.


I walk down another street.

It may be time for not only our loved one but ourselves to find our way back home.

And so it goes

HEAD SHOT WITH DESCRIPTION GREENMANSteve Greenman, MA, LPC, NCC is a counselor at Mental Wellness Counseling in Traverse City, MI. He specializes in helping families dealing with complex family situations, addictions, and transitions. Steve is also helping clients through the Intensive Recover Program, which helps with recovery treatment, alcohol treatment, and other addictions treatment.