Many parents feel uncertain and ill-prepared when their child has completed inpatient or outpatient addiction treatment. You probably have many questions about how to best support your teen’s recovery and you may be feeling extra pressure.
We put this guide together to answer those questions. We want to give parents hope that they can find tools and supports to make their families stronger, and deal with the complex and challenging situations that parents and children experience during the days, months and years after treatment.
Unfortunately, there is very little scientific evidence for parents on how to best support their child’s recovery. All of the information you’ll find here, however, is based on well-established behavioral principles, clinical experience and related research.
Keep in mind that each parent, child and family is unique. You’ll need to take into account your family’s strengths and weaknesses, the severity of your child’s substance use and the presence of co-occurring disorders. Most families will benefit from support and other professional help after their teen finishes treatment, including family therapy.
Sometimes the situation is complex and requires the help of a skilled professional who can help you learn about the options that are best for your family. Please note that the information you’ll find here does not take the place of a health professional whom you should collaborate with to help your teen manage his or her addiction.
We hope this guide will help you figure out what might best support your recovery journey together.
This material is the copyrighted work of The Treatment Research Institute and Partnership for Drug-Free Kids. All rights reserved. Limited use and reproduction of this document is permitted for personal purposes only. Development of this tool was funded through grant #P50-DA02784 from the National Institute on Drug Abuse.
Our natural tendency is to notice when something goes wrong and to try and correct it, often by implementing restrictions, or providing negative feedback, both of which can be punishing. It is much more difficult to notice when something goes right and reward it, but emphasizing the positive is very important. Positive reinforcement may be especially important with substance-abusing adolescents who are defiant, resistant to authority or have low self-esteem. Punishment often appears to be immediately effective, because it often results in the adolescent immediately stopping undesirable behavior. Unfortunately, in the long run, controlling behavior by punishing it is often ineffective and can have negative side effects including making the adolescent more secretive about the behavior and damaging your relationship with your child. If you are going to use negative consequences for rule-breaking, you should always use them in combination with positive reinforcement for following rules. There should be much more opportunity for positive reinforcement than there is for punishment – the general guideline is at least five positives for every negative.
“Emphasizing the positive is very important, and may be especially important with substance-abusing adolescents who are defiant, resistant to authority or have low self-esteem.”http://continuingcare.drugfree.org/category/reinforcing-the-message/#197save this answer
It is essential that you communicate the message that you expect your child to stay completely abstinent from drugs and alcohol following addiction treatment. Make it clear that abstinence is the household rule.
This means that taking prescription drugs that are not prescribed or in a way that is inconsistent with a physician’s orders is also against the rules. Conveying a strong and clear expectation about abstinence, is your best bet for decreasing the chances your child will relapse.
This is important because adolescent alcohol and drug use is not only illegal, but it also has negative effects on brain development, and research shows that the brain continues to develop until the mid-20s.
“Conveying a strong and clear expectation about abstinence, is your best bet for decreasing the chances your child will relapse.”http://continuingcare.drugfree.org/category/reinforcing-the-message/#193save this answer
First, you have to be sure whether your child is abstinent. The best way to do this is to involve a health care provider who is well-informed about adolescent substance use and drug testing. Ideally, drug testing occurs two to three times a week and your child does not know in advance when the test will occur. Random scheduling is important so that your child is not able to prepare by stopping drug use prior to the test.
The testing schedule can be reduced over time as your child demonstrates continuing abstinence. Because drug tests won’t pick up all substances your child might be using, don’t ignore other signs that your child is using.
Second, you and your child must have a pre-determined understanding of what consequences will occur if a drug test comes out positive and what rewards or reinforcements there will be for staying abstinent.
The rules for behavior – and the consequences for breaking the rules – need to be clear as well. Rules must be set out in advance — not decided upon when something unpleasant happens. You may want to even write up contract. Figure out what things really matter to your child. Create rewards and consequences based on what your child values.
Positive reinforcement is saying and doing something “nice” for your child in response to positive behavior and can encourage healthy constructive changes. Consider providing a reward as soon as possible after your child has abstained from substances or followed other rules you have created beforehand. What rewards are effective varies for every person and may include things as simple as receiving praise, having accomplishments acknowledged or earning privileges. For some, earning extra driving or cell phone privileges may be important; for others having their favorite meal or getting extra time with friends is most valued.
Sometimes NOT mentioning drugs, addiction or recovery all day long can be a welcome and pleasant reward to both you and your teen. Also, a big hug, a smile or an ‘I love you’ can go a long way.” - Paul Kusiak, parent
When rules are violated, it can help to place restrictions on things or activities of value to your child. Parents should also think through with a health care professional what they should do if they discover that their child is using drugs or alcohol. For example, a parent should avoid yelling at the child, or trying to have a discussion while the child is drunk or high.
Restrictions and other negative consequences should not be too severe or long lasting. Take away the cell phone, but let the teen earn it back within a week – two at the longest. If you keep taking things away for the rest of the month, by the end of the month there might be nothing left to take away.
Use negative consequences sparingly. The emphasis should be on noticing and rewarding your child when he or she does something positive.
Note: Focusing on the positive doesn’t mean that your teen should have free access to everything he or she wants. If you have an agreement that your child can earn extra cell minutes by going to his or her aftercare program, it’s okay not to give those unless he earns them. With holding privileges is not the same as punishing.
“Reward positive behavior by acknowledging or praising it and sometimes giving added privileges or things that matter most.”http://continuingcare.drugfree.org/category/reinforcing-the-message/#195save this answer
Although you need to clearly communicate a message of abstinence, there is always the chance that relapse will occur.
Teens are typically prone to testing boundaries, impulsive behavior and poor decision-making. We now know that these behaviors are related to the areas of the developing brain associated with impulsivity and cognitive control. This may make it much harder for teens to meet a goal of abstinence than it is for individuals who develop substance use disorders in adulthood. Research shows that nearly one-third of adolescents who have completed a 28-day program use a substance again within the first three months.
“Although you need to clearly communicate a message of abstinence, there is always the chance that relapse will occur.”
Recovery from a substance use disorder is more than abstinence. Recovery is about improving one’s quality of life, being emotionally and physically healthy, succeeding in school or work, having healthy relationships, having a healthy social life, and living drug-free.http://continuingcare.drugfree.org/category/reinforcing-the-message/#199save this answer
A full relapse is the process of returning to problematic substance use seen before treatment, whereas a slip (which is far more common) is a specific drug use episode.http://continuingcare.drugfree.org/category/reinforcing-the-message/#201save this answer
It is not your fault if a slip or relapse occurs. Although a return to drug use can be frustrating for you and your child, it is important to remember that it does not need to lead to a full relapse and your child can pick up again in the recovery process. However, this does not mean that parents should not be concerned or should tell to their child that occasional use is acceptable. Motivation to stay abstinent may be low in adolescents and that can be especially frustrating for parents who feel their child should want to stay sober. It is essential that you, as the parent, indicate that you do not want your child to be using any alcohol or drugs.
“It is essential that you indicate that you do not want your child to be using any alcohol or drugs.”
Reality check: How many times have some of us tried to diet, exercise or quit smoking? It isn’t always one and done. Our teens didn’t get so deep into the deep dark woods of their substance use overnight. Seldom is there one straight path out of those woods – from chaos to clarity. When the entire family practices self-care, this time of relapse can pass without panic and drama. Lessons can be learned, and recovery moves forward again.” - Paul Kusiak, parent