For very different reasons, both adults and other youths may make a teen coming from treatment feel unwelcome and alone. Those feelings can send youths back to drugs or drink, which is why some in treatment change schools, several counselors said. Social media makes even that "clean slate" harder to count on.
Kids often exaggerate a teen's challenge when they talk about him with friends and family. "Someone can go into rehab because he was smoking marijuana, but by the time it circulates around school and the internet, it was a stabbing," Markisich said.
The best way for a community to help lost teens find their way back, he said, is to be supportive. "Guilt and shame can fuel substance abuse. Don't enable, but help them and love them." Youths, he said, will latch on to those who give them support and direction, who mentor and lead, who offer hope.
Narasimhan called addiction "a very powerful force." It takes a lot of support to overcome. Sometimes drug abuse is an ill-conceived attempt to self-medicate, an unwitting cover up to abuse or illnesses like anxiety and depression. In relapse, those issues remain, she said. And events, including bullying, can precipitate a slip.
A person's journey is his own, as is the decision to share it, she said. "Addiction is a medical issue. You don't have to let anyone at school know you're seeing a therapist, a doctor or were in a hospital." She encourages patients to let her talk to school administrators, to explain not the details of the diagnosis, but to see a student is given proper support. Beyond that, a family decides who knows what.
Find a different trail
Addiction is a disease, but it doesn't happen instantly. Neither does fixing it, said Amara Durham, director of marketing for the nonprofit treatment program Caron Texas in Dallas. The longer someone stays in treatment, the greater the likelihood of maintaining sobriety.
Caron Texas is a 12-step program that encourages those who emerge from treatment to continue the steps, "to do 90 meetings in 90 days. Find a place where one is comfortable and confident and get a network to help support them," she said.
Besides new friends, addicts often need new places and even new paths to get there, if old routes were part of the addiction or scoring the drug. "If you don't have a plan," she said, "it's easy to slip into an old habit."
If it takes a while to make new friends, she tells her young patients to be alone at school, then find sober friends for after school or through the 12-step programs. Some things can't be compromised.
The people who close ranks and won't accept a youth who's had troubles will eventually come around, she predicted, if they see a real change. Broken trust takes time to rebuild. One of the best ways to do that, she noted, is to help others struggling with the same issues.
Durham, too, believes recovery is a private matter, the person doing it the one who decides how much to share.
Hope is most important to recovery, the vehicle one rides out of the wilderness.
The road home
On the day Josh first visited home in April of 2012, after 120 days in rehab, he helped his mother find the drug paraphernalia he had hidden in his room. It was, she said, "a great moment." He is in phase 3 of 5 of the treatment program, an "oldcomer" helping newcomers learn the ropes.
He contemplates the future with yearning, but fear, too. "It's hard to think about what I will do besides drugs; it was such a big part of my life. … I'm not cocky about getting better. I know it's going to be hard."
He wrestles with what he calls social anxiety and said it was easier to get friends when he was using. That's a problem.
But he's willing to leave the past where it is and move on. He's learning to help others. He's learned that speaking up is hard, but not impossible.
Before, he said, he ignored God and spirituality. Now, he thinks they will carry him where he hopes to go.
So Josh Stauffer has reached, yet again, a fork in the road. Once more, it's leading him uphill. This time, his legs are longer, his back a little straighter, his resolve and sense of direction his own.
The lost boy is heading home.
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