Is Your Teen Struggling with Substance Use and Mental Health?
Your daughter has always been anxious, but lately it's different. She's smoking weed every day now—she says it's the only thing that helps her calm down. Your son's ADHD seems worse than ever, but you also found a vape pen in his backpack. Your teen's depression has been getting worse for months, and now you're noticing that alcohol is disappearing from the house.
Here's what makes this so confusing: you can't tell where one problem ends and another begins. Is the marijuana making your daughter more anxious, or is the anxiety driving the marijuana use? Did the depression lead to drinking, or is the drinking causing the depression?
These aren't just worried-parent questions. Mental health professionals ask these same questions when evaluating teenagers, because the answers change everything about treatment. And here's what most parents don't realize: trying to address just one piece of this puzzle almost never works.
When substance use and mental health struggles show up together—which research suggests happens in roughly one-third (and as high as nearly half) of adolescents and young adults with mental health disorders¹—they feed off each other in ways that make both worse. When a child is facing both substance use and mental health challenges, this is often called having co-occurring conditions or co-occurring disorders. Knowing those terms matters because they can help you advocate for the right care—care that identifies and treats both needs together, not one at a time. Understanding this connection isn't meant to scare you. It's meant to point you toward what actually helps.
Why Does This Get So Tangled?
Sometimes the mental health struggle comes first. A teen with untreated anxiety discovers that alcohol quiets the worried thoughts. A kid with ADHD finds that nicotine helps them focus. The substance seems to solve the problem—at first. But what starts as self-medication becomes its own problem, and over time it can make mental health symptoms worse and complicate recovery.²
Other times, it works the other way. Heavy marijuana use can trigger anxiety or paranoia that wasn't there before. Drinking can deepen depression. The teenage brain is particularly vulnerable to these effects, in part because it is still developing.³
And here's what makes it hardest for parents trying to help: the symptoms can overlap so much that it’s hard to tell what you’re seeing. Irritability, social withdrawal, sleep problems, trouble concentrating—these can all be signs of depression, or anxiety, or substance use, or withdrawal from substances.⁴
This isn't a puzzle you can solve from home. You need professional help to untangle it. But you can recognize when that help is needed.
You know your kid. You're not looking for a generic checklist that could describe any teenager—you're trying to figure out if what you're seeing is serious. Here's what actually matters: duration, intensity and your gut.
When you're seeing significant changes that last more than a couple of weeks and seem to be getting worse rather than better, pay attention. When things start having a real impact on school, friendships, or day-to-day functioning, something bigger is usually happening.⁵ And if something just feels different now—if there's a voice in your head saying “this isn’t right”—trust that instinct. You're probably picking up on real changes even if you can't articulate exactly what they are.
What If You Can't Wait Anymore?
You need to find someone who understands both pieces of this equation. Not a therapist who treats mental health and will minimize the substance use. Not an addiction counselor who’ll push for abstinence without addressing the anxiety driving it. Someone who gets that these issues are tangled together and knows how to treat them that way.⁶
When you call therapists or treatment programs, ask directly: “Do you have experience treating teenagers who are struggling with both substance use and mental health issues?” If they hesitate or say they mostly focus on one or the other, keep looking. Ask follow-up questions: “How do you coordinate care between the mental health and addiction sides?” “Will my teen have one treatment plan that addresses both, or two separate plans?” “Do you require abstinence before treating mental health symptoms?” If they can't give you clear answers, keep looking.
Your teen's pediatrician may know who does this work well in your area. SAMHSA’s treatment locator at findtreatment.gov and Safe Project’s SAFE Locator at safeproject.us/locator can be starting points for finding providers.⁷ Not everyone needs a formal program right away. Many families start with an individual therapist who has experience in co-occurring disorders—directories like Alma and Psychology Today can help you find clinicians with this expertise.
Before the first appointment, have a direct conversation with your teen: “I’m worried about you. I’m not trying to punish you or control you. I just want to understand what’s going on so we can help you feel better.” Then be honest with the evaluator about everything you've observed—the substance use, the mental health symptoms, all of it. Young people sometimes don’t report everything that’s going on, and those experiencing mental health issues may be reluctant to talk about substance use.⁸
The treatment itself has to address both issues at the same time, with providers who actually talk to each other and have a unified plan. Here's where you need to be careful: many facilities advertise that they treat co-occurring disorders, but what they actually mean is they have a psychiatrist who can prescribe medications, or they'll address mental health only after your teen is completely abstinent from substances. That's not integrated care. Real integrated care means both issues are treated simultaneously by a coordinated team. Medication is often part of integrated care—for ADHD, depression, anxiety or other mental health conditions—but the prescriber needs to understand both the mental health and substance use sides to select medications carefully. Treating depression alone doesn't work when marijuana is interfering with the plan. Treating substance use alone doesn't work when your teen keeps going back to the one thing that seemed to help them feel less depressed. A treatment approach that considers all parts of this at the same time is likely to be quicker and better for your child.⁹
Be prepared for this to be harder than it should be. Good treatment for teens dealing with both issues isn't easy to find. Insurance can be a nightmare—different benefits for mental health and substance use, providers who aren't in network, authorizations that take weeks. You may have to make a lot of calls. You may have to fight for what your teen needs. This is exhausting and unfair, but it's also worth it.
What Does Your Teen Need From You?
Professional treatment is essential, but your role matters too. Make home a place that supports recovery rather than sabotages it—keep alcohol and other substances out of your house, help your teen maintain basic routines around sleep and meals, encourage relationships and activities that don't revolve around substance use. Go to family therapy sessions if they’re offered. Stay connected to your teen’s treatment team and understand what the plan is trying to accomplish.¹⁰
And prepare yourself for recovery to be messy. Your teen will have good days and hard days. They may make progress and then slip backward. Relapse—to substance use, to old mental health patterns, or both—is common. It doesn't mean treatment failed. It means your teen needs more support. If it happens, respond with concern rather than punishment and get them back into treatment quickly.¹¹
You also need to take care of yourself through this. Join a parent support group: Al-Anon, SMART Recovery Family & Friends, NAMI family groups, whatever fits your situation. Find a therapist for yourself if you need one. Maintain the parts of your life that aren't about your teen's struggles. This isn't selfish. You're modeling healthy coping for your teen, and you're keeping yourself strong enough to be helpful over the long haul.
You didn't cause this. These problems come from a complicated mix of genetics, brain chemistry, life experiences, and environmental factors that parents don't control. But you can help your teen get through it. With the right treatment from providers who understand both issues, with family support, and with time, teenagers do recover. They learn to manage their mental health without substances. They build lives that work.
If you're seeing signs that worry you, don't wait for things to get worse. Trust your instincts enough to reach out for professional help from someone qualified to evaluate and treat both substance use and mental health. The fact that you're here, seeking information and trying to understand what your teen needs—that's exactly the right instinct and first step.
Need Help Now?
Crisis support: Call or text 988 | Text HOME to 741741
Find treatment:
Partnership to End Addiction: 1-855-378-4373 |
SAFE Locator: safeproject.us/locator
Parent support: drugfree.org | nami.org
REFERENCES:
Scott Hadland, MD, Chief of Adolescent Medicine, Mass General for Children/Harvard Medical School
Fred Muench, PhD, CEO, Clear 30
SOURCES:
Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
Child Mind Institute (Caroline Miller; Sarper Taskiran, MD). Mental Health Disorders and Teen Substance Use. childmind.org/article/mental-health-disorders-and-substance-use/.
Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022; The Harris Project. Know the Signs: Warning Signs of Substance Use. theharrisproject.org.
Substance Abuse and Mental Health Services Administration (SAMHSA). FindTreatment.gov (treatment locator). findtreatment.gov; Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
National Institute on Drug Abuse (NIDA). Co-Occurring Disorders and Health Conditions. nida.nih.gov/research-topics/co-occurring-disorders-health-conditions; National Alliance on Mental Illness (NAMI). Substance Use Disorders. nami.org/co-occurring-conditions/substance-use-disorders/.
Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
Child Mind Institute & Partnership to End Addiction. Substance Use + Mental Health in Teens and Young Adults: Your Guide to Recognizing and Addressing Co-occurring Disorders. (PDF guide), 2022.
