Your teen is using and the harder you push, the worse it gets. A psychologist explains why pressure backfires and what to do instead.
When the Hammer Stops Working
By the time most parents reach out to me, they have already tried the obvious things. They have grounded the teenager. Taken away the phone. Threatened to send them to rehab. Driven them to AA. Read books on tough love. Tried bribing. Tried pleading.
Whatever they tried, it did not work. The use continued. The lying continued. The grades dropped further. The relationship with their child got worse, not better.
And the parent, exhausted and scared, calls me with a version of the same question: “My teen is out of control. What do I do?”
The honest answer is uncomfortable: you have probably been doing the things that look like they should work, but make the situation worse. Not because you are a bad parent, because the playbook you inherited about what to do when a kid is “out of control” was wrong.
Why Pressure Backfires With Teens
I see this every week. A parent walks in with the assumption that if they just push harder, more rules, more consequences, more confrontation, the teen will eventually break and stop using. That is not what happens.
When you create too much stress, two things happen at once:
One, the teen relapses or escalates. They do not yet have the coping skills to handle the emotions they have been suppressing with substances. The substance is doing a job, managing anxiety, anger, depression, social pain. Take it away through pressure, and you are stripping their coping mechanism without giving them anything to replace it with. They will go back to it, often using more.
Two, communication shuts down. The moment a teen feels lectured, criticized, or trapped, the conversation ends. They will tell you what you want to hear. They will sneak out and use anyway. They will go further underground. The relationship that you actually need in order to help them gets damaged in the process.
Pressure feels like action. It is not. It is the opposite of action, it is the thing that prevents the work from happening.
What “Out of Control” Usually Looks Like
When parents call me describing an out-of-control teen, the picture is usually some combination of:
- Daily marijuana use, sometimes vape carts of unknown strength
- Weekend drinking that has escalated to weeknights
- Xanax or other prescription medications used recreationally
- Cocaine use in school environments, yes, including high school
- A car accident, an arrest, a hospitalization, a school suspension
- Grades collapsing despite a teen who used to be a strong student
- Friend groups that have shifted toward heavier users
- Lying, sneaking, hiding, the loss of trust that scares parents most
The common thread is not the specific substance. It is that the consequences have stopped working as a deterrent. The teen knows what they are risking and is using anyway. That is the signal that something underneath needs treatment.
What Is Actually Driving the Use
Adolescent substance use is rarely random. The substance is almost always doing a job. When a teen is using compulsively despite escalating consequences, you are usually looking at one of these underlying issues:
- Anxiety that has not been recognized or treated. Alcohol shuts down racing thoughts; marijuana slows everything down. Both feel like relief.
- Depression, often masked by irritability and withdrawal rather than the textbook sadness.
- ADHD that was missed or inadequately treated. Stimulants self-medicate the focus problem; cannabis takes the edge off the agitation.
- Trauma, sometimes from events the parent does not know about, bullying, an assault, a betrayal in a friendship, an early sexual experience the teen has not processed.
- Family conflict that the teen sees as their fault, or that they are using substances to escape from.
- Academic pressure in achievement-oriented families where success is expected and any cracks are hidden until they cannot be hidden anymore.
The substance is not the disease. The substance is the symptom of an emotional disorder that has not been addressed. This is why traditional rehab, which often treats the substance use in isolation and demands abstinence as a precondition, fails so many adolescents. It treats the wrong thing.
What to Do Instead
Stop using stop-using as the precondition
The single most important shift: stop telling your teen they have to stop using before they can get help. Demanding that someone stop using before they can come to therapy is like telling someone who is depressed that they have to stop being depressed before they can see a therapist. It does not make sense, and it prevents people from getting into treatment in the first place.
In our practice, we will see a young person whether they are using or not. They can come in any time. We start the work where they actually are.
Engage them, do not lecture them
What young people respond to is not pressure. It is being heard. Even when they are doing something they should not be doing, especially when they are doing something they should not be doing, they want someone to acknowledge what they are getting out of it before telling them why they should stop.
When I meet a new teen patient, I do not start with a list of warnings. I start with: “You must be getting something from this. So what is it? Tell me.” The kids will tell you. “I feel more relaxed.” “I do not obsess so much.” “My friends are doing it.” “It makes the noise stop.”
Once they are telling you what the substance is doing for them, you have a real clinical lead. Now we know what we are actually working on. We do not need to take away the substance until we have given them something else that can do that job.
Treat the substance use and the underlying issue at the same time
Treating one before the other does not work. If a teen is using opioids because they are angry and have no other way to manage it, addressing only the substance use without addressing the anger means we are taking away their coping tool without replacing it. They will relapse.
The opposite, treating only the underlying issue and ignoring the use, also does not work. The substance use becomes its own disorder over time. It needs direct attention.
We treat both. Simultaneously. Sometimes that means coordinating with a psychiatrist for medication. Sometimes it means cognitive behavioral therapy to change patterns of thinking that lead to the use. Sometimes it means involving the whole family. Always it is both, at once.
Pace it carefully
You cannot make up for years of avoidance in three weeks. Young people who have been suppressing emotions with substances for two years do not have the coping skills to suddenly handle those emotions raw. We move at a pace they can sustain. One step in the right direction, then the next step, then the next.
A teen who reduces marijuana use from daily to weekends has done significant work. A teen who switches from street-bought vape carts to a regulated dispensary product has reduced medical risk substantially. A teen who learns to handle anxiety with cognitive techniques 30% of the time is on a trajectory. None of these are total abstinence. All of them are progress, and all of them lead somewhere.
What to Say When Your Teen Refuses Treatment
Most parents I work with started with this: their teen refused to come to treatment. They got through that wall the same way: they reframed the ask.
Instead of: “You need therapy. You are getting treatment.” Try: “I just want you to get an evaluation. Let’s just see what a professional has to say.”
An evaluation is a one-time meeting. It does not commit them to anything. Most teens will agree to that. And once they meet with us and feel heard, once they realize we are not there to lecture them or strong-arm them into stopping, they typically choose to continue.
Read more on this approach: how to talk to your teen about drug use.
When Outpatient Is Not Enough
I should be honest about the cases where outpatient therapy is not the right level of care. There are situations where a young person needs more than one to two hours per week:
- Acute suicidal or homicidal ideation
- Daily use of physically addictive substances (alcohol, benzodiazepines, opioids) at levels where stopping requires medical detox
- Drug-induced psychosis
- An unsafe home environment
- Use that has not responded to outpatient treatment over a sustained period
For those situations there are intensive outpatient programs (IOP), partial hospitalization (PHP), residential treatment, and inpatient hospitalization. We refer up the chain when needed and we move quickly when behavior becomes dangerous. But for most adolescents, even most adolescents who feel out of control to their parents, outpatient is the right place to start. It keeps them in their real life, where the coping skills actually have to work.
What Parents Need to Hear
If you are reading this and your teen is out of control, here is what I would say to you on the phone:
Your child is not lost. Their brain is still developing, still plastic. The window for real change is wider at 16 than it will be at 36. A teenager who learns to manage anxiety without alcohol now carries that skill forward into college, into early career, into the rest of their life. You are not too late.
But the way you approach the next few months matters. The harder you push, the further they pull away. The more space you create for honest conversation, about what is actually happening for them, not what you wish was happening, the better the outcome.
The work is slow. It is uncomfortable. It involves accepting that your teen will probably continue to use for a while as we work on the underlying issues. That is hard for parents to sit with. But it is what works.
If you are ready to talk, schedule a consultation. We can see your teen by Zoom or in person at our Princeton office, and we are licensed across NY, NJ, PA, CT, and most PSYPACT states. Call (212) 944-8444.
