Mental Health and Substance Abuse Problems: The Teenage Years


Growing up involves being more observant and aware of yourself and the people around you – as an older teen, you already have a good understanding of what it takes to be a good friend and have begun to judge when you or a friend needs help.  Recognizing the difference between common and normal issues for people your age from more serious problems is a skill that will continue to improve as you become a young adult.

What will you notice if you or a friend is having a problem?

The basic rule of thumb is that if you notice changes in yourself or your friend that are significantly different from how you or they used to act, think or feel, you might want to consider the possibility that you or they are struggling with something that might be serious.  Remember that you don’t need to be a trained mental health professional to recognize or do something when you’re concerned about yourself or your friend.

Problems with the way you feel

Ups and downs in life are normal and common; anxiety and stress come with everyday challenges.  Disappointment, frustration and anger come when things go wrong, sadness comes with loss or being hurt. However, when you notice that a friend feels these emotions nearly all day, every day, they can’t “snap out of it” no matter what you do, and they feel like they don’t care about themselves, or the things and people that used to give them pleasure, they might have a more serious emotional condition. Read more about depression and/or anxiety.

Problems with the way you think

When a person is struggling with an emotional disorder, they may have negative and defeating thoughts about themselves and about life. Examples of this might be thoughts like, “I hate myself – I’m worthless, “I’m ugly and undesirable, “no one likes me, “I suck.” Though it is common to have doubts about yourself as you go through your teens, most of the time these doubts are balanced out by positive thoughts about yourself.  You’ll notice that a friend who is struggling with an emotional disorder can’t balance these self-critical thoughts with more soothing or positive thoughts.

In rare situations, when people are suffering from certain mental health problems they can also have trouble with disturbing thoughts they can’t get rid of (like not being able to stop worrying about getting sick if I touch a doorknob) or sometimes even trouble organizing thoughts (so someone’s speech may be really confusing or disorganized). These kinds of problems might reflect a serious mental health problem. It would be important to seek help if something like this happens.

Problems with the way you behave

Emotional disorders can cause a person to behave differently than they used to.  A person who’s struggling might stop taking care of themselves – they don’t care how they look and their hygiene habits change.  If your friend is struggling with difficult emotions, they might push you away, try to be left alone or suddenly start hanging hang out with a different group of friends.  A person with emotional difficulties could start taking risks they would never take before such as doing drugs, having unprotected sex or driving recklessly.  And finally, if you have a friend who is struggling with substance abuse issues, they may behave like they are drunk or high: inappropriate or out of it.

Problems with the way you communicate

One good way to notice that a friend is having difficulties is to notice a change in their use of social media. If a friend posts photos that show very inappropriate images or doing things that are dangerous, they might need help.  If a friend texts or posts all night for days on end, you might be concerned that they have a mood or substance use disorder that has changed their sleep patterns. Posts of dark poetry or quotes, disturbing songs or videos, and using hashtags that are connected to worrisome trends can be warning signs of emotional distress. Using sad, distressed emoticons or emoticons of guns and knives can be reasons to ask your friend if they’re OK.

If the content of a friend’s texts is about death, harming themselves or suicide, you should get help immediately. Call 911, or help get them to the nearest emergency room, or text START to 741-741 or call 1-800-724-TALK (8255).

Therapy is not an easy way out

Lots of people have the impression that therapy is for people who give up too easily or who are self-absorbed and just want to wallow in their problems. This is not the case at all – though therapy can be very rewarding and is always focused on you (as the client or patient), it’s usually difficult and not always comfortable. When you first start working with a therapist, it can be difficult to open up about your problems, and even when you start to feel better, it can be challenging to practice new ways of coping with your feelings and behaviors.

Getting help doesn’t mean you’re not smart enough to figure out your own problems

You can be a very sensitive, bright and emotionally aware person and still not be able to solve your own emotional problems.  Just as you would not expect yourself to know how to set your own leg if it were broken, or fix your car if it were dead (unless you are a surgeon or auto mechanic!), similarly, you shouldn’t expect to be able to sort through difficult or strong emotions without help and support.

Therapy should be a confidential experience

Before you agree to work with a therapist, it is good to discuss your ideas and expectations about what information will remain private between you and them, and what can be shared with others, especially your parents or caretakers if they are paying for your insurance or your treatment.  Most issues about confidentiality can be worked out – one exception is that therapists expect to be able to share any information that has to do with your safety or the safety of others.

Therapy should be a safe experience

Your therapist is a professional who will hear very personal information about your life and feelings – in order to get the most out of the work you’re doing, it is important for you to feel safe.  What does that mean?  That your therapist will respect your boundaries and behave like a therapist at all times.  A therapist is not your friend and is not in any way supposed to cross a physical boundary (like giving you a hug, or pat on the knee) as part of your therapy.   If you feel confused about what a therapist is or is not allowed to do with a patient, talk to an adult whom you trust about your concerns.

Therapy should be a helpful experience

Therapy is supposed to help you understand your difficulties, help you figure out ways to cope with problems on your own, and offer support as you do this.  Your therapist is not there to always agree with your perspective or accept just anything you say – at times, they’re bound to make you angry, frustrated or defensive.  As long as you feel like you’re making progress and/or feeling better, your therapy is working for you. However, if after a few sessions you feel like your counselor is not a good fit for you, it is OK to be honest about it – therapy is supposed to be helpful for you and your feelings should be respected.  And actually, there is research evidence that one of the most important considerations for making therapy helpful is your comfort with the therapist!

Get Help Now

If you or someone you know needs to talk to someone right now, text, call, or chat 988 for a free confidential conversation with a trained counselor 24/7. 

You can also contact the Crisis Text Line by texting HOME to 741-741.

If this is a medical emergency or if there is immediate danger of harm, call 911 and explain that you need support for a mental health crisis.