Young Adult Addiction Treatment

An 18-year-old is legally an adult and, in most other ways, is not one yet. That gap is why programs run young adult tracks, why parents are often the ones reading this page, and why the first thing a family needs to understand is that consent now belongs to the person in treatment.

This page covers why 18 to 25 is treated as its own group, how college and career interruption are handled, what the evidence says about treatment at this age, what a young adult track actually contains, how a parent stays involved with an adult child, the life-skills and vocational side, what aftercare looks like at this age, and how coverage on a parent’s plan works. Our page on addiction treatment covers the clinical ground beneath it.

Why this age group is treated separately

Two reasons, and neither is about maturity as a character judgment.

The first is practical. A person in this age band is often mid-education, mid-first-job or between both, usually without their own health coverage, and frequently living at home. Those facts change what treatment has to plan around: a semester, a lease, a driver’s license, a parent who is paying.

The second is clinical, and it is about the peer group. Programs separate age cohorts because a room of people in their twenties works differently from a mixed room, and a young adult surrounded by people thirty years older tends to conclude that none of this is about them.

Federal reporting carries findings about which treatment approaches have support with people at this end of the age range, and this page sets them out further down. Ask a program which of them are part of what it offers. Our levels of care page explains the steps a young adult would move through.

College, career interruption and coming back

The fear driving most delay at this age is that treatment ends the course or the job. Handle that fear directly, because it is usually smaller than it looks.

Get the facts before the decision. Ask the school what a medical leave of absence involves, what the deadlines are, and what happens to credits, housing and financial aid. Ask an employer, or an employment lawyer, what leave is available. Then decide with real numbers rather than assumed ones.

The argument for going now is that a semester is recoverable and the alternative often is not. Well-supported scientific evidence shows that treatment for substance use disorders, including inpatient, residential and outpatient care, is cost-effective compared with no treatment [3].

Plan the return at the same time as the departure. A young adult going back into exactly the same term, the same house and the same group with no plan is being set a harder task than the treatment itself was. Our page on what the rehab process is like sets out the shape of a stay.

What the evidence says about treatment at this age

Be careful with generalizations about what this age group uses. What is worth knowing is which approaches have support for the patterns that do turn up.

Federal reporting describes contingency management as giving tangible rewards to individuals to support positive behavior change, and says it has been found effective in treating substance use disorders [3]. Voucher-based reinforcement, compared in clinical studies with traditional treatment regimens, is associated with longer treatment engagement, longer periods of abstinence and greater improvements in personal function [3]. There is a specific finding for this cohort: contingency management improves outcomes for young adults with marijuana dependence when included with motivational enhancement therapy and cognitive behavioral therapy [3].

Motivational enhancement therapy is worth understanding for the same reason. Federal reporting describes it as a counseling approach that uses motivational interviewing techniques to help someone resolve any uncertainties they have about stopping, working by promoting empathy, developing awareness of the discrepancy between a person’s goals and their behavior, and avoiding argument and confrontation [3]. Anyone who has argued with a 20-year-old about their drinking will recognize why that last clause is in there.

Where more than one substance is involved, or where alcohol is being used daily, the assessment matters more than the label. In severe alcohol dependence, seizures, delirium tremens, and dysregulation of body temperature, pulse and blood pressure are outcomes that can lead to fatal consequences [4]. The same chapter puts sedative withdrawal on the same side of that line, contrasting it with uncomplicated opioid withdrawal, which it says is not life-threatening [4]. Federal guidance says that for alcohol, sedative-hypnotic and opioid withdrawal, hospitalization or some form of 24-hour medical care is generally the preferred setting [4].

If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.

What a young adult track actually contains

Ask the question specifically, because “we treat young adults” and “we run a young adult track” are different claims.

A track usually means a separate group programming stream with an age-matched cohort, and often a different balance between clinical work and the practical business of building an adult life. Promises Brazos Valley’s own page states that specialized tracks for young adults and professionals provide focused environments to help clients step away from triggers and focus on lasting change [7]. That is the campus’s own description, and it is the kind of sentence to ask any program to give you.

The same page describes the campus as catering to adults and young adults in College Station, specializing in inpatient and outpatient rehabilitation for people experiencing substance use or co-occurring mental health disorders, and says the facility has beds available and is currently accepting clients [7]. Its range of care is described as medically monitored detoxification, residential treatment and flexible options including a partial hospitalization program and an intensive outpatient program [7]. The same page’s treatment cards carry those and run on to aftercare planning, with inpatient mental health rehab published beside them [7].

Three questions are worth asking about any track. How many people are in the age-matched group, and how often does it run? What is different in the programming, rather than in the brochure? And does the track continue at the step-down levels, or does the cohort dissolve after residential care. Our medical detox page covers the first stage and inpatient rehab the second.

Family involvement with an adult child

This is the hardest adjustment for parents, and getting it right early avoids months of friction.

Your son or daughter is an adult and their records are theirs. Substance use disorder records may be used or disclosed only as federal regulation permits, limited to the information necessary for the purpose, and that applies whether or not the person asking already has the information [1]. Those rules turn on the records rather than on who pays the bill [1].

If they want you informed, that runs on a consent they sign. It must name the patient, identify who may make the disclosure, describe the information, state the right to revoke it in writing and how, and carry an expiration date or event [2]. A program cannot act on a consent that has expired or been revoked [2]. Ask for it to be sorted at admission, and accept a narrow one gracefully.

What you are entitled to do regardless is take part in the family work. Federal reporting states that family counseling in substance use disorder treatment is positively associated with increased treatment engagement and retention rates, treatment cost effectiveness, and improved outcomes for individual clients and their families [5], and that family involvement at any level can motivate a person facing addiction to receive or continue treatment [5]. That is the lever that still exists when the information does not.

Life skills and the vocational side

At this age, treatment that only addresses substance use leaves the hard part undone.

The things that go wrong after discharge are usually ordinary: no routine, no money, no plan for the daytime, and a social life built entirely around one activity. Ask what a program does about those, and ask for specifics rather than a philosophy.

Useful things to ask about include help returning to study, employment support, budgeting, and structured daytime activity after the program ends. Ask who provides them, whether they run during treatment or after, and what they cost.

And ask about the co-occurring side, because it is common at this age and shapes everything else. Federal reporting says people with a substance use disorder and a co-occurring mental disorder who received cognitive behavioral therapy had significantly improved outcomes on measures of substance use and mental health symptoms compared with those who did not [3]. Our page on types of therapy explains the methods.

Aftercare, sober living and peer community

Aftercare matters more at this age than at any other, because a young adult usually goes back into the environment where the use started.

Federal protocol treats the handover as part of the work. Fostering a patient’s entry into treatment means preparing them by stressing the importance of following through with the complete continuum of care, and where someone has a pattern of completing detoxification and then not engaging in treatment, a written treatment contract may encourage entrance into that continuum; it is not legally binding, is signed voluntarily when the person is stable enough, and commits them to a continuing care plan with details and contacts established before detoxification finishes [6].

Sober living is worth asking about honestly rather than romantically. The questions are who runs it, what the rules are, what it costs, how long a stay usually is, and what happens if someone uses. Ask them before the discharge date, not after.

Peer community is the other half, and for this age group it is often decisive. A young adult who leaves treatment with no one their own age to spend a Friday with is being asked to do something very difficult. Ask what alumni or peer arrangements exist and whether they are age-matched. Our facility directory lists our campuses by state.

Paying for treatment on a parent’s plan

This is often the whole answer at this age, and the rule is more generous than families expect.

If a parent’s health plan covers dependents, a young adult can usually be added and stay on it until they turn 26 [8]. On a job-based plan that generally holds even if they married, had or adopted a child, started or left school, live away from the parent’s home, are not claimed as a tax dependent, or turned down an offer of job-based coverage [8]. On a parent’s Marketplace plan, coverage can run through December 31 of the year they turn 26, or the age permitted in the state [8]. Some states and plans have different rules, so check with the employer or the plan [8].

What the plan must cover is set separately. All Marketplace plans cover mental health and substance use services as essential health benefits, including behavioral health treatment such as psychotherapy and counseling, mental and behavioral health inpatient services, and substance use disorder treatment [9]. Marketplace plans cannot deny coverage or charge more for a pre-existing condition including a substance use disorder, and Marketplace plans cannot put yearly or lifetime dollar limits on an essential health benefit [9].

One caution about privacy. A claim on a parent’s plan tells the policyholder that care happened, which is a real consideration for a young adult weighing whether to use the family plan at all. That is a conversation to have before admission rather than after the explanation of benefits arrives. Our pages on insurance coverage for rehab and what rehab costs cover the arithmetic.

Frequently Asked Questions

Sources

1. Legal Information Institute. 42 CFR § 2.13 — Confidentiality restrictions and safeguards. Cornell Law School. https://www.law.cornell.edu/cfr/text/42/2.13
2. Legal Information Institute. 42 CFR § 2.31 — Consent requirements. Cornell Law School. https://www.law.cornell.edu/cfr/text/42/2.31
3. Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health — Chapter 4: Early Intervention, Treatment, and Management of Substance Use Disorders. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK424859/
4. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Treatment Improvement Protocol (TIP) Series, No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
5. Substance Abuse and Mental Health Services Administration. (2020). Substance Use Disorder Treatment and Family Therapy, Chapter 1: Substance Use Disorder Treatment: Working With Families. Treatment Improvement Protocol (TIP) Series, No. 39. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK571084/
6. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Treatment Improvement Protocol (TIP) Series, No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
7. Promises Brazos Valley. Drug and Alcohol Rehab in College Station, Texas. The Recovery Village. https://www.therecoveryvillage.com/locations/promises-brazos-valley/
8. Centers for Medicare & Medicaid Services. How to Get or Stay on a Parent’s Plan. HealthCare.gov. https://www.healthcare.gov/young-adults/children-under-26/
9. Centers for Medicare & Medicaid Services. Mental Health and Substance Abuse Coverage. HealthCare.gov. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.

Author

Kevin Wandler, MD

Chief Medical Officer, The Recovery Village