The Pro’s & Con’s of Forcing a Minor into Treatment

ElpiNikki seeks guidance on the situation with their teen son whose troublesome use of marijuana derivatives is causing more and more agitation, conflict and consequences. The family would like to keep their son at home, without access to substances, until he agrees to treatment. They feel the situation is urgent and that it's important to take advantage of the remaining year of his being a minor and at home.

"There is a question at the end…

My husband and I have just confirmed that our smart, curious, loving, 16.75-year-old son is addicted to cannabis in its various forms but mostly high potency wax and carts. His use has gone largely undetected by us because when we caught him a few times early in freshman year, he crafted very skilful ways of hiding it. Although he keeps managing to catch up on his schoolwork and come in around curfew, he is starting to be forgetful and can't keep track of anything, and is often short tempered and disrespectful. He may be using something else but its unidentified as of yet.

For the past year or so he has been increasingly irritable, unpredictable, abrasive, and sometimes becomes so angry he is destructive to his room. He is also engaging in risky behaviors when he's out with friends (friends that are constantly changing and not for the better). He is a new driver and is engaging in risky behavior behind the wheel.

He LOVES and LIVES to drive. He loves driving and he loves the freedom and social clout and access it affords him.

Two weeks ago we confronted him with the irrefutable proof of the cannabis use. Although we initially thought we could help him by limiting his opportunities to smoke and access to it as well as providing him education through a virtual program for teens with SUDs, we now know it’s way past that.

It's been five days since he lost control of himself so badly that he was taken by ambulance to the ER where he continued to be out of control until the next morning. At that time, he was compliant and willing to say anything to go home.

Now we are all home having purged the house of everything we could find and not allowing him to leave to get more while we wait for a program that doesn't seem to exist right now. Virtual will be a waste of time although it would be better than doing nothing while we wait for face to face partial or ideally inpatient.

Please provide feedback on our plan which is to get him sober enough, long enough, to get him to agree to go to an inpatient dual diagnosis treatment program. We are trying to incentivise him to abstain long enough to clear his head by not allowing him to drive until he is clean (as verified through home drugs screens conducted in my husband’s view so no planted urine.)

We also won't allow him to replace the bedroom door he kicked in until we are sure he is clean. We won't allow friends in or him out until we know he is clean.

Please provide feedback on anything you have tried that works to help get a minor to treatment.

Also please provide feedback on forced inpatient treatment for minors. We want to make the most of the next fourteen months. Thank you."

Thank you for this good summary of your son’s cannabis use and the behaviors that have you worried.

The incident where he ended up in the ER sounds terrifying. I gather your son lost control and beat down a door. Please visit Module 2 on Safety. If you didn’t answer the exercises on safety, please do so. The questions guide you quickly through 7 key steps to designing a safety plan.

You are anxious to know next steps. The first is to take a deep breath. While your son is indeed close to the age of emancipation, this is not of top importance when considering treatment, etc. 

You may be at the start of something that will take time to resolve (cannabis) and manage (behavioral issues). They may or may not be linked, and as you suggest, your son may be trying new drugs, though the hospital didn’t find any other drugs, I assume.

We can force them into treatment, but we can't usually force them to stay there

The advantage of his age is that your authority may make him feel compelled to follow your instructions. However, it's important to know that only psychiatric hospitals and some teenage programs (by default hours from a road) are “locked.” Substance use and mental health treatment are overwhelmingly voluntary in the US; you can walk out at anytime.

Whether you strong-arm him into treatment or he walks in voluntarily, the outcomes are about the same. Check out this recent post we wrote and scroll down to the section entitled: "We’re not seeing results despite CRAFT and treatment".

At Allies, we prefer to see a little zoom in their step as they walk through that door to treatment, rather than anger and resentment, so we aim to teach you how to recognize, and build on some spark of nascent motivation. All of this ideally means that your Loved One will more willingly agree to treatment.

Motivation is the key to change

Your son is exhibiting several kinds of extreme behaviors (risk taking, lashing out), but I would caution you away from accepting hard and fast diagnoses given while your son was at the hospital. He has not been properly evaluated.

It can take 30 days for cannabis to be out of the body’s system. This means your son’s urine tests won’t help you manage the day-to-day.  Your son could still be positive for cannabis after weeks of non use. Drug testing isn’t a good guide in your case.

As you are new to the site, I’d like to make two other points we’ve made before in blog posts, before responding to your question about treatment.

1. A good percentage of teens who use drugs tend to mature out of the drug use, as life gets their attention. 

2. Addressing a Loved One’s addiction is a marathon, not a sprint. Watch how much you spend — your treatment budget may need to be spread out over several years: several treatment episodes may be needed. It will also be essential for you to find the support that will allow you to hang on, and even thrive, despite a Loved One’s journey through addiction.

What would treatment look like for your teenager? Where does inpatient fit in?

You've expressed that you would like your son to get intense treatment, in a program that is competent in both addiction and mental illness, and away from home. I don’t blame you. All this disturbing information about you son must feel like it just appeared out of nowhere. It must be rocking your foundation. I would be asking myself if I was qualified to handle what might come next.

So, your wish: out the door if possible. I see that your are in Massachusetts. There is a two-week program at McLean Hospital that takes a surprising number of insurances, even some medicaid plans.

Here are some programs at McLean to look into (I only feel comfortable referring programs whose services I have personally experienced or have trustworthy, recent recommendations for):

• Alcohol, Drug, and Addiction Partial Hospital Program

"This comprehensive day treatment program provides individual and group therapy. The program is designed for individuals who are in need of structured addiction treatment but are able to manage their symptoms without 24-hour care. Our treatment focuses on various therapy models including relapse prevention therapy and integrated group therapy, a novel approach developed at McLean."   www.mcleanhospital.org/treatment/addiction-partial-hospital-program

(Your son’s age makes him negotiable into either an adult, young adult, or teen program… I would look at all of these.)

Consider something like the 3East program at McLean's that teaches dialectical behavioral therapy (DBT), which helps teach the skills a person needs to get through strong emotions, and reduces self harm, drug use, or other hurtful behaviors.

• 3East: Adolescent DBT Programs

"McLean’s adolescent dialectical behavior therapy programs, collectively known as 3East, provide specialized care for teens and young adults who require treatment for depression, anxiety, post-traumatic stress disorder (PTSD), and emerging borderline personality disorder. The programs in the 3East continuum are specifically designed to accommodate patients in different phases of the treatment and recovery process, from highly focused residential treatment to outpatient care. We have intensive treatment tracks for both boys and girls, and our day program (partial hospital) and outpatient program are coed."  www.mcleanhospital.org/treatment/3east 

A close family member of mine did very well in this program.

Sometimes more "failed treatment episodes" are required for insurance to cover treatment

You might encounter a problem with your son not qualifying for insurance or for admission, since he has received so little treatment and inpatient is the highest level of treatment intensity. He might need to amass more “failed” treatment episodes to meet the criteria for admission.  Make sure you are getting reimbursed. The McLean program is short stay, two weeks typically. The families I have talked to say the staff is excellent, but two weeks is a drop in the bucket.

For the longer term, the options are all costly, but here is a non-exhaustive list of what could follow the 2-week stay at McLean’s:

• look at behavioral boarding schools, or private prep schools (I had a good experience with Vermont Academy – we are happy to refer when we feel we know the place well enough).

• There are also more substance-focused long-term programs for “emerging adults.” You’ll find a myriad of advertising for them online. I’m afraid this takes money money money, which is out of reach for many. Again, push on insurance to pay for some or all. Our members report some success in getting insurance to pay.

You should be looking to put together 12 to 18 months of residential treatment. We welcome ideas from our membership about programs other members may know, and have availed themselves of, for their Loved One.

Alternatively, what happens if your son stays home?

Even if your son stays at home and does outpatient or virtual recovery supports, the question remains the same for you, the family member: how do I get him into treatment? The "how" is in the eLearning center.

The work your son would do in a dual-diagnosis program could be done in the community, with your motivated (and informed, through our modules) family holding down a safe and sober home front. This could work better, be easier for you to "sell", may be more clinically appropriate than inpatient, and would not disrupt your son’s school life.

Your son is keeping up with his schoolwork. He must be in 12^th grade? He is doing well enough in school that you JUST found out he is using cannabis. Yes, the manner in which he is taking cannabis is slightly more worrisome, for this is how tolerance builds quickly, and suggests a certain sophistication in use. The irritability you describe can be a side effect of the cannabis, or, as you may be thinking, could be the addition (or subtraction, by this I mean withdrawal) of a different cannabis product, or another drug.

So you could consider community treatments, after a short period of inpatient like what is offered at McLean's. This can work well, especially when home life is CRAFTy, recovery oriented, and safe for everyone.

As we mentioned earlier: your son is young. Many older “emerging adults” simply mature out of problem substance use. ¹ 
 

One of the best regarded evidence-based community treatments is Adolescent Community Reinforcement Approach (ACRA) (Look at SAMHSA.gov —see Our Treatment Finding Methodology here— and see if  ACRA is being supported through grants to local clinics in your area).

Go to SAMHSA's government site and look for grant archives. I looked at initiatives that served young people and easily found two examples that may fit, one is in Cambridge. The SAMHSA grants provide paid services that may not be covered by insurance. See the addendum below this post for two examples of the types of grants you can locate and look into.^2,3

The driving and the use of a car sound like a fine choice of rewards for your son. He LOVES to drive. I remember that feeling too, at 16. It is so adult! Can you meter out the use of the car rather than having a blanket rule (that may be seen as punishment)? Using and taking away rewards is described in Modules 5 and 6.

Lastly, I agree with your choice to leave the broken door broken. It will be a reminder to him of what happened and of why he lost the right to a closed door, for now.

There are a number of families on this site who are dealing with the bumpy, drug and alcohol transition of kids your son’s age or slightly older. Thank you for writing in.

^{1 The Cannabis Youth Treatment (CYT): Main Findings from Two Randomized Trials, Dennis M., Ph.D., Godley S.H., Rh.D. et al., Journal of Substance Abuse Treatment, vol. 27,  issue 3, p197-213, October 01, 2004.}