Substance use disorder (SUD) treatment is a crucial part of the teen behavioral health crisis.

While the rate of youth SUD has held steady after a COVID-19 dip, teens in need of treatment often face several structural barriers to care, including a lack of available providers and access to family therapy.

Treating teens with SUD requires a specialized, more holistic approach to care.

“We’re definitely seeing an increase in substance use,” Dr. Monika Roots, president and chief medical officer of Bend Health, told Behavioral Health Business. “What we see is everything from an increase in vaping, which could include things like CBD, to an increase in cannabis access and some other substances.”

Bend Health is a Madison, Wisconsin-based virtual youth and family behavioral health company. In March, it landed $32 million in funding.

Alcohol is the most commonly abused substance by teens and young adults.

“Underage drinking often begins at an early age,” the Substance Abuse and Mental Health Services Administration (SAMHSA) wrote in a March 2021 report. “Of those who drink underage, 15% began using alcohol before they were 13 years old.”

It takes a village 

Treating SUD in teens comes with its own set of challenges and opportunities.

Studies have shown that family-based therapy is the gold standard for treating youth SUD. But this requires a unique approach to care from providers.

“When we think about substance use, obviously, there are complexities that come up in adolescence,” Roots said. “Usually, there are privacy issues that we can’t share with the caregivers, but we want to be able to address them.”

One of these complexities is from a legal standpoint. Some of the substances a teen uses may be illegal or illegal for the patient based on their age. As a result, many teens are reluctant to share their condition with their families.

But to treat teens, providers stress the importance of working with the whole family.

“The good thing, which is different from adult substance use treatment, is that they have caregivers to support them in the home potentially,” Roots said. “And so we’re focusing on that, and making sure that [caregivers] understand the need for sobriety in the home, being able to support them as well, so that we don’t have situations where maybe a caregiver is using in front of them and asking the teen to be sober.”

A teen’s support ecosystem goes beyond just the home, though. Adolescents spend most of their time at school. Some providers, like Bend, collaborate with schools to support teens in many environments.

One of the essential elements of supporting teens in schools is educating teachers and administrators about these patients’ challenges.

“As we start to collaborate with schools, which we do, it’s about how you can best support this child or teen in the school,” Roots said. “We also ended up teaching the administrators and the teachers a little about what we’re seeing. And so we think that that is a good first step because educating educators on the warning signs and the critical things that they may be seeing every day is a great step towards early identification of prevention.”

Another challenge in the dspace is sometimes the negative perceptions of facility-based care for youth.

Citing the negative experiences of a handful of high-profile celebrities, U.S. lawmakers in May introduced new legislation calling for more oversight and data transparency from institutional youth treatment programs.

Integrated care

At pediatric behavioral health provider Embark, SUD care is combined with its mental health services.

“Our focus is, even though substance use is an issue, that’s not the problem; the underlying problem is the emotional pain. What’s causing that emotional pain?” Embark CEO Alex Stavros told BHB. “And how can we help you feel it, embrace and accept it.”

Chandler, Arizona-based Embark provides a network of outpatient centers and residential programs for mental health treatment for preteens, teens and young adults. Earlier this year, private equity firm Consonance Capital Partners invested in the provider, giving it a controlling stake in the company.

Taking a holistic approach to treating SUD in teens is critical for providers. In SAMHSA’s 2023 National Survey on Drug Use and Health, the agency reported that 13.5% of young adults 18 to 25 had both an SUD and a mental health condition in the past year.

“Usually, you find out that there is a comorbid behavioral health or mental health concern that [a person] has been trying to self-medicate … along the way,” Roots said. “Once you identify that root, you can say, ‘Hey, if I can help your anxiety, and maybe you are a little less anxious in social situations, is there a better way to address that anxiety instead of a substance?’ Because as we know, that substance’s side effects can be very harmful to their mental health.”

While SUD has traditionally fallen in the adult sector of care, providers need to have a different approach to caring for youth.

“Working with youth is very different from working with adults,” Stavros said. “And a lot of what’s happened in the field is we’re just taking what we’ve done in the past, or what we do with adults and trying to do the same thing with you. We need youth specialists to be developing programs that understand development, that understand the youth brain, that understand neurobiology, that understand family systems theory, that understand how to create programs.”