The idea that someone will change only when they find their rock bottom is inaccurate and dangerous. This thinking wastes valuable time—time in which a teen could be benefiting from early prevention and treatment. Concerning behaviors are likely to worsen and, without treatment, a teenager’s mental health and substance use can become more complicated and difficult to treat, or even lead to death in some cases. And once they finally do enter treatment, care can be more complicated, time intensive and costly.

The idea of rock bottom is based on the assumption that people will change once they’ve reached the lowest part of their disease. The concept is a mining metaphor. It describes miners mining out the entire supply of the precious resource they’ve been extracting and finally hitting the worthless bedrock below.

When Can Teens Really Change?

Relating this metaphor to mental health conditions has been soundly disproven by the most up-to-date research, which shows that people are able to change at any point when they are provided the right conditions to do so (Miller, 2013). This means that absolutely no wait is necessary to begin counseling to support teens in making healthy changes. In fact, you don’t even need to wait until they are ready to go. Good therapists can help teens with their readiness for change. As a therapist who works with young people, I love having these conversations because within one or two sessions with me even extremely resistant teenagers are able to start thinking about which healthy changes they are interested in making for themselves.

There is no need to use up valuable resources like supportive friends and family, housing, education, youth, good health or finances. When left intact, these protective factors create a better prognosis for recovery. We know that any substance use by teens increases their chances of developing a substance use disorder (Dennis, 2002). Teen brains are much more susceptible to addiction than adult brains. Given this and the fact that teens can make changes at any point in their progression into addiction, I have seen the most success in cases when families and caring adults took action as soon as they caught a whiff of a concern.

Cancer and House Fires

Which brings me to more helpful metaphors. Instead of rock bottom, let’s start using the metaphors of cancer treatment or saving a house that’s on fire. When someone is diagnosed with cancer, do we expect them to wait until the cancer has spread to their surrounding organs before we begin to provide help? Similarly, when a house is on fire, is it better to put it out a few seconds after at the first whiff of smoke or wait until the fire is at the peak of its blaze before calling for help?

For example, I helped a high school student quit vaping and avoid hitting his rock bottom when his mother gave me a call within the first few weeks of the school year. She’d gotten a call from his school after they found his vape pen in his backpack. Although the school’s protocol wasn’t to send students to therapy on their first drug offense, this student’s mother called to begin treatment because she didn’t want her son to become one more casualty in the vaping epidemic.

Who Could Benefit From Early Prevention or Treatment?

According to the 2018 National Survey on Drug Use and Health, about 1 in 26 adolescents (946,000 adolescents) needed substance treatment in 2018. Only 10 percent of those adolescents got treatment when they needed it. That same year about 1 in 7 young adults (5.2 million young adults) needed substance use treatment. Only 20 percent of those young adults got timely treatment.

The American Academy of Pediatrics (AAP) recommends pediatricians screen for substance use in children starting at 9 years of age. The AAP also recommends universal depression screenings starting at age 12.  Just like with house fires or cancer, prevention, early detection and intervention are key. Doctors aren’t waiting, and there are many teens and parents who refuse to wait for rock bottom.

What Should I Be Looking For?

Here are some “first whiffs” vigilant adults or teens themselves have noticed that have indicated they could benefit from early intervention and recovery:

  • Someone in the teen’s family is struggling with a health or mental health concern, so the teen enters treatment to make sure they get help, too, if they need it
  • A family has a history of mental health or substance use, so they ask for an assessment
  • Teens who experience discrimination, bullying or rejection
  • Teens who are sad, isolating themselves or speaking vaguely about death (for example, talking about not wanting to wake up)
  • Death of a loved one or friend
  • Finding evidence of substances or paraphernalia in a teen’s room
  • Parental conflicts
  • Feeling removed or disengaged from life
  • Teens who struggle to open up to others, even parents or loved ones
  • Teens who are transitioning to independent living and need additional support as they do this
  • Teens who are interested in finding or struggling to find genuine friendships
  • Teens who can’t verbalize why, but ask to see a counselor “just to talk”
  • Teens who have lost interest in sports or hobbies they previously loved
  • Teens struggling with grades or who want to make sure they stay on track with school gains they have made

Prevention and Beyond

Early detection and intervention allow teens to stay engaged in school, at home with family and surrounded by supportive friends. This gives teens the best environment in which to learn valuable knowledge and skills they can immediately put to use in their everyday lives. Best of all, they can take with them into adulthood these insights, some of which may even give them an advantage over peers who have never struggled with and overcome similar issues.

Miller, W.R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd Ed.). New York, NY: Guilford Press

Dennis, M.; Babor, T.F.; Roebuck, C.; and Donaldson, J. Changing the focus: The case for recognizing and treating cannabis use disorders. Addiction 97:(s1):4–15, 2002.

Don’t wait for your teen to hit rock bottom. I can help get them on the path to early recovery. With more than 15 years of experience as a clinical social worker, I specialize in adolescent substance use, anxiety, depression, trauma, grief and loss and the full spectrum of adolescent behavioral health. Contact me below to get your child and your family on the path to healing.

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