When a teen is facing both a mental health concern and a substance use disorder — a situation known as dual diagnosis — the path to healing can feel complicated and overwhelming. But with the right support, teens can learn to manage both conditions and move toward lasting recovery.
At ETHOS, therapist Sarah Notebaert explains that dual diagnosis means “someone is struggling with both mental health — something like anxiety, depression, or trauma — in tandem with a substance use disorder at the same time.”
Parents often ask which came first: the mental health issues or the substance use. But, as Notebaert notes, what truly matters is treating the whole person, not trying to separate one issue from the other.
“Substance use can worsen mental health, and when your mental health isn’t in a good place, it often leads people to reach for substances,” she says. “We’re addressing the foundation while developing new coping skills. Treating both together leads to better outcomes.”
How One Problem Fuels the Other
When substance use and emotional distress overlap, they often reinforce one another. Withdrawal can mimic or intensify symptoms of depression or anxiety, while disrupted sleep and maladaptive coping patterns make recovery harder to achieve and sustain.
“Using substances to deal with emotional pain is just masking it — it’s not addressing it,” Notebaert explains. “What was once the solution becomes the problem.”
By helping teens recognize these cycles, treatment opens the door to understanding what’s really driving their behaviors — and to learning ways to meet their needs without self-harm or avoidance.
Beyond Anxiety and Depression: Co-Occurring Challenges
While anxiety and depression are common in dual diagnosis, ETHOS clinicians also see teens navigating trauma, obsessive-compulsive symptoms, disordered eating, and self-harm — all of which can serve as attempts to manage or escape overwhelming emotions.
“Self-harm, for example, can be a way for teens to try to regain control or release tension when emotions feel unmanageable,” says Notebaert. “In many ways, it functions similarly to substance use — it provides temporary relief but ultimately deepens distress.”
At ETHOS, the focus isn’t on labeling or punishing the behavior but on understanding its function.
“We help teens build insight and compassion for themselves,” Notebaert adds. “We explore how the behavior has been protective — and how to replace it with something more adaptive and compassionate.”
Treating the Whole Teen
ETHOS’s adolescent programs are designed specifically to address dual diagnosis by integrating both mental health and substance use treatment.
“People don’t exist in a vacuum,” says Notebaert. “If we’re only working on abstinence without addressing loneliness, shame, or grief, the risk of relapse is higher. The goal is to help teens build a life worth living.”
Groups at ETHOS are intentionally integrated, bringing together teens who are navigating mental health challenges, substance use, or both. This approach reflects the reality that these issues rarely exist in isolation — and that healing happens in connection.
While some parents initially worry about “exposure,” the blended model has been shown to foster empathy, reduce stigma, and help teens recognize shared experiences beneath different behaviors. By learning alongside one another, teens begin to see that while their struggles may look different on the surface, the underlying pain is often the same.
“That shared experience can be both healing and preventative,” Notebaert explains. “It helps teens realize that their challenges are not unique or shameful — they’re human.”
Why Early Help Matters
It’s common for families to hope their teen will “grow out of it,” but waiting often allows harmful patterns to deepen.
“These aren’t things that time heals,” Notebaert cautions. “Ignoring the problem can isolate your teen and increase shame. Early intervention provides a safe space to learn coping tools and connect with others who understand.”
When teens begin to identify what’s happening beneath the surface — the emotions and needs that fuel their behavior — substances lose their power.
“Connection is the healing part,” says Notebaert. “Once we learn to regulate emotions and tolerate discomfort, we realize we’re capable of managing what once felt impossible.”
Finding Hope and Healing at ETHOS
At ETHOS Treatment LLC, we believe in meeting teens where they are — with empathy, curiosity, and evidence-based care. Our integrated treatment model helps adolescents and their families navigate dual diagnosis with both structure and compassion.
If you’re concerned that your teen may be struggling with both emotional distress and substance use, know that help is available — and that recovery is possible.
Learn more about ETHOS’s adolescent Substance Use Disorder and adolescent Mental Health programs, or reach out today to schedule a consultation.
About Ethos Treatment
Ethos Treatment LLC is a behavioral healthcare provider accredited by The Joint Commission to treat mental health conditions and substance use disorders. Licensed clinicians lead Intensive Outpatient Programs in Pennsylvania via telehealth and at seven locations: Broomall, Collegeville, Jenkintown, Philadelphia, Plymouth Meeting, West Chester and Wyomissing. Ethos accepts most insurance.
MD, Alex Moxam is a graduate of Sidney Kimmel Medical College and completed his adult psychiatry residency at the University of Pennsylvania. Subsequently, he pursued a fellowship in child and adolescent psychiatry at the Children’s Hospital of Pennsylvania.
Using a holistic approach and emphasizing shared decision-making, Dr. Moxam engages with clients to initiate and optimize medication regimens. His goal is to decrease problematic symptoms and enhance the overall quality of life for those under his care. Dr. Moxam’s expertise spans both adult and child psychiatry, reflecting his commitment to providing personalized and effective care.
