The Journey to Help 2: What If Getting Help Is Part of the Problem?
Suppose an older student has finally decided they want help with their substance use. Good. The hard part is over, right? They are given a number to call. There may be an appointment next week, transportation to arrange, an assessment, another appointment and a plan to follow afterward. They also have to keep doing this while everything else in life continues. Apparently deciding to get help was only the opening level.
None of those steps is unreasonable. Health services need information and ways to connect people with appropriate care. The problem becomes clearer when we look at the whole journey from the person's side. Getting help requires someone to start, organize, remember, tolerate uncertainty and keep going. It may require discussing something they would rather hide. If the first attempt is disappointing, trying again requires another decision.
Now add the actual substance-use problem. The person may not believe their use has become serious. What they are using may provide an immediate reward, relief or escape, while the possible benefits of treatment seem distant. Motivation may also change from one moment to another. Research into adolescent treatment shows that engagement, self-regulation and motivation can matter, but the mechanisms are complex and the evidence does not support reducing treatment success to one trait such as willpower (3).
This is why wanting help and successfully getting help are not the same thing. We encounter smaller versions of that gap everywhere. Someone can genuinely intend to begin an assignment tonight and discover much later that the document remains impressively blank. You can know a difficult conversation needs to happen and still decide that reorganizing a drawer suddenly deserves immediate attention. Those examples are not addiction. They simply reveal something ordinary about humans: intention does not automatically create action.
That should make us cautious about a common judgment: “If they really wanted to change, they would.” Wanting change can matter greatly without being enough to make every next step happen. Recognition, immediate rewards, stress, fear, confidence, relationships and the demands of the treatment system can all enter the picture. Research on adolescents seeking substance-use treatment finds barriers at several of these levels (1).
A well-designed community program therefore cannot simply wait at the finish line. It can try to reduce the distance to help. Adults may help young people make the first connection. Services can be designed so adolescents understand what happens next. Youth-friendly and flexible services can make participation easier. Depending on adults for some of this at age twelve or thirteen is not a failure of independence. It is part of being young.
When you investigate a substance-use service, therefore, don't stop when you find its phone number. Follow the journey. Where does someone begin? What must happen next? Who helps when one of those steps becomes difficult? That tells you much more about community safety than knowing that somewhere in town there is a building with a counsellor inside.
References
For post 2 : James, P.D., Nash, M. and Comiskey, C.M. (2024), Barriers and Enablers for Adolescents Accessing Substance-Use Treatment: A Systematic Review and Narrative Synthesis. Int J Mental Health Nurs, 33: 1687-1710. https://doi.org/10.1111/inm.13378
Gov’t of Canada, PHAC site YSUPP: https://www.canada.ca/content/dam/hc-sc/documents/services/substance-use/canadian-drugs-substances-strategy/youth-substance-use-prevention-program/youth_substance_use_prevention_program.pdf?utm
Meisel SN, Pielech M, Magill M, Sawyer K, Miranda R Jr.Mechanisms of Behavior Change in Adolescent Substance Use Treatment: A Systematic Review of Treatment Mediators and Recommendations for Advancing Future Research. Clin Psychol (New York). 2024 Jun;31(2):154-173. doi: 10.1037/cps0000089. Epub 2022 May 12. PMID: 38883554; PMCID: PMC11178260. https://pubmed.ncbi.nlm.nih.gov/38883554/
Cole VT, Richmond-Rakerd LS, Bierce LF, Norotsky RL, Peiris ST, Hussong AM. Peer connectedness and substance use in adolescence: A systematic review and meta-analysis. Psychol Addict Behav. 2024 Feb;38(1):19-35. doi: 10.1037/adb0000914. Epub 2023 Mar 27. PMID: 36972090. https://pubmed.ncbi.nlm.nih.gov/36972090/
Rose ID, Lesesne CA, Sun J, Johns MM, Zhang X, Hertz M. The Relationship of School Connectedness to Adolescents' Engagement in Co-Occurring Health Risks: A Meta-Analytic Review. J Sch Nurs. 2024 Feb;40(1):58-73. doi: 10.1177/10598405221096802. Epub 2022 Apr 28. PMID: 35477342.) https://pubmed.ncbi.nlm.nih.gov/35477342/
Weatherson KA, O'Neill M, Lau EY, Qian W, Leatherdale ST, Faulkner GEJ. The Protective Effects of School Connectedness on Substance Use and Physical Activity. J Adolesc Health. 2018 Dec;63(6):724-731. doi: 10.1016/j.jadohealth.2018.07.002. Epub 2018 Sep 28. PMID: 30269908. https://pubmed.ncbi.nlm.nih.gov/30269908/
Chae J, Kim H. Effectiveness of School-Based Resilience Interventions on Adolescent Tobacco, Alcohol, and Illicit Substance Use: A Meta-Analysis. J Sch Health. 2026 Apr;96(4):e70137. doi: 10.1111/josh.70137. PMID: 41812678; PMCID: PMC12978879. https://pubmed.ncbi.nlm.nih.gov/41812678/
