Learning that their child is struggling with a substance-use disorder is any parent's nightmare. But, especially if the child is still a minor, that realization is often coupled with another overwhelming question: Where can you turn for help?
It's a question without an easy answer. In Pennsylvania, for instance, there are only eight treatment facilities that accept adolescents, said Jennifer Smith, secretary of the state Department of Drug and Alcohol Programs. Seven are residential programs. One takes only boys referred through the juvenile justice system.
In a state where 5,456 people died of a drug overdose last year, parents and advocates alike say there's a dearth of options for parents trying to help children through addiction, a relapsing disease where early intervention is key. (In New Jersey, just eight of the more than 370 addiction treatment programs listed in a state database indicate that they serve adolescents and children.)
Though the state can help some parents with costs, parents from around the state said navigating the treatment system with a minor child is daunting and often prohibitively expensive. They spoke of spending tens of thousands of dollars to send teenagers to long-term rehab programs, of having to pull children from programs where they seemed to be thriving after their insurance ran out, or of praying that teens in juvenile court cases would be sent to treatment instead of detention.
"A lot of attention is going to the 22- to 38-year-olds, but for the most part, they did not pick up as adults," said Rebecca Bonner, the head of Bridge Way School, the state's only high school for teenagers in recovery. "This is the piece we're missing in our state, and the resources and services for adolescents are virtually nonexistent."
Since Bridge Way opened in 2011, Bonner said, five residential treatment facilities for adolescents around the state have closed, and even intensive outpatient programs that admit teenagers are hard to come by.
Smith said a number of factors contribute to the problem. Treating adolescents means more specialized training and a bigger load of paperwork than most facilities are willing to undertake. There's higher client turnover at facilities that take teenagers, largely because many teens aren't there voluntarily, and so are more likely than adults to leave. Smith said employees at several treatment facilities around the state have been accused of inappropriate conduct with their teenage charges, leading to those institutions' closures.
For parents who don't have private health insurance and ready access to cash, the options are even slimmer. Lisa Geist, who grew up in Kensington but moved to Pottsville to raise her family, first noticed last summer that her daughter Brieze McCabe, then 16, was evasive, withdrawn, even staying out of the house for days at a time. Then she found heroin baggies in her daughter's purse.
Geist had already helped an older daughter with opioid addiction, and knew that private schools and high-end residential treatment programs were out of the question for people of limited means. Officials at the local Children and Youth Services agency, she said, didn't seem to take Brieze's case seriously until she was arrested on drug possession charges.
"It took her getting criminal charges for anyone to even step in," Geist said. "Treatment had to be a punishment."
A judge in Juvenile Court allowed Brieze to attend a treatment facility outside of Pittsburgh that accepted Medicaid. She turned 17 there and seemed to be doing better, Geist said. Her bubbly attitude was back. She was excited to hit her 90th day of sobriety. She told Geist on the phone that she was homesick.
Geist and Brieze's father, Corey McCabe, said they would have wanted their daughter to attend school at a place like Bridge Way, where tuition is covered by grants from the state, after her treatment. But it's a day school in Philadelphia, 2½ hours from home. There was no way to get her there.
In Pottsville, the juvenile justice system offered little support, Geist said. Brieze's juvenile court date — when Geist hoped a judge would sentence her daughter to house arrest or more treatment — kept getting pushed back. Brieze started leaving the house for days at a time again.
The day before she was finally due to appear in court, she fatally overdosed. Toxicology reports showed the drug she overdosed on was fentanyl, the deadly synthetic opioid behind most of the overdose deaths in Pennsylvania.
"She wanted to do right," Geist said. "But she got out of treatment, and there was no supervision, no one to answer to, just me calling Children and Youth, calling juvenile probation, and asking them to put her in another treatment center or something."
Sousan Robinson's 16-year-old son, whose drugs of choice are marijuana and the synthetic cannabinoid K2, was first arrested at age 15 and has been in four juvenile detention centers. When her 14-year-old son also showed signs of substance abuse, she scrambled to persuade her insurer to cover a stay at a well-regarded residential school in California. When the insurance ran out, Robinson had to beg the facility to keep him for a few more days as she scrambled again — to fund his plane ticket home.
"It's debilitating me, emotionally, financially — I maxed out every credit card to try to get them treatment," she said. "People tell you the one or two places [in the area that will treat adolescents], and you'd better hope your insurance covers it."
She's grateful, though, that her younger son has not been in the juvenile justice system. Robinson's sons are biracial, and she's listened with frustration in parenting support groups as white parents speak of children in drug court or their seventh stint in rehab. "Kids of color don't get rehab," she said. "They get jail."
Smith said it's crucial that support for addicted teenagers doesn't end with a residential treatment placement.
"There are so many support services that really have to be initiated for an adolescent," she said. "That has to involve plans for completion of their education — something around what the school district is doing, as well as their involvement in the community."
Parents who are struggling to find treatment options should contact their local single-county authority, the agencies that handle drug and alcohol treatment programs around the state, Smith said. They can also help parents without insurance or with high deductibles fund treatment for their children. "There's not any way to navigate the system on your own," she said. "Even if you have great insurance, and millions of dollars to pay the bills, strictly from a case-management perspective, aside from just getting the adolescent into treatment, there's so much more that goes into ensuring their continued engagement in recovery."
Smith encouraged parents to call the Substance Abuse and Mental Health Services Administration's national helpline for substance abuse treatment: 1-800-662-HELP. (The agency also has a free help sheet available online.) In New Jersey, the 24-hour line for addiction treatment can be reached at 1-844-276-2777.
In parenting groups around the Philadelphia region where mothers such as Robinson go to vent and seek support from others in their shoes, parents of adult children have plenty of sympathy for those with teens.
Lori, who asked that her last name not be used because she fears her 27-year-old son, newly in recovery, will face stigma, said her son started using pills at 14 and graduated to heroin at 19. His recovery has been long and hard, she said, with multiple stints in rehab and jail. But trying to find him treatment before he turned 18, she said, was even harder.
"It is a constant, constant battle to try to find anything for that age group," she said. "When it's young people, and there's so little out there, you just hang on for the ride."