In this episode of Beyond Substance, hosts Dean Babcock and Jodi Miller focus on adolescence, substance use, and the role treatment and medications can play when young people struggle. Dean speaks with Dr. Alexander Thomas, an addiction psychiatrist and program director, about when medication should be considered for adolescents, why opioid use requires earlier medical intervention, and why integrated treatment for co-occurring mental health conditions matters. Jodi interviews Spencer Medcalf, a person in long-term recovery who began using substances as a teenager, about early warning signs, stigma, gaps in adolescent services, and what helped him move from despair to a life he values. Together, these conversations offer clear guidance for families, clinicians, and communities, with compassion for what young people and caregivers carry. Segment 1: Professional Interview Summary (Dean + Dr. Alexander Thomas) Dean’s conversation with Dr. Alexander Thomas centers on the realities of treating adolescent substance use disorders with clinical precision and caution. Dr. Thomas explains that substance use often begins in the teen years, yet research, treatment systems, and public dialogue frequently focus on adults. He emphasizes that medication decisions depend first on the substance involved. For adolescents using opioids, he recommends bringing medication into treatment early because of overdose risk and the strength of evidence supporting medication for opioid use disorder. Dr. Thomas outlines a practical framework for decision-making. For many substances, especially when severity is mild or moderate, clinicians should start with therapy and psychosocial interventions, including individual therapy, family involvement, and environmental changes. Medication becomes more appropriate when risk and severity increase, when therapy alone has not been sufficient, and when a reliable system exists to support adherence. He also stresses that adolescents metabolize medications differently than adults, and many medications used in adults have limited evidence in youth, which increases the need for careful risk-benefit justification. Segment 2: Personal Story Summary (Jodi + Spencer Medcalf) Jodi’s interview with Spencer Medcalf reveals what adolescent substance use can look like from the inside, long before a young person has the language to describe what they are feeling. Spencer describes a childhood with an early sense of stability, followed by a sudden rupture when he discovered his mother intoxicated and later learned it was the day she filed for divorce. That moment marked a shift in his foundation, and by his mid-teens, he began using alcohol and marijuana, then escalated quickly into opioids and benzodiazepines. TakeawaysAdolescent substance use often begins earlier than adults expect, and treatment systems still lag behind that reality.Medication for teens requires careful clinical judgment, limited youth-specific evidence means risk-benefit decisions must be individualized.Opioid use disorder in adolescents warrants early medical involvement due to overdose risk and the effectiveness of medication-based treatment.Integrated care matters, treating substance use and co-occurring mental health conditions together improves outcomes and reduces suffering.Families can influence recovery by changing what they control, communication patterns, supervision systems, and the environments a teen moves through.Episode Hashtags #BeyondSubstance, #RecoveryIsPossible, #AdolescentSubstanceUse, #TeenMentalHealth, #YouthRecovery, #SubstanceUseDisorder, #AddictionRecovery, #MedicationAssistedTreatment, #OpioidUseDisorder, #Naltrexone, #Buprenorphine, #Methadone, #CoOccurringDisorders, #IntegratedCare, #FamilySupport, #TraumaInformedCare, #SuicidePrevention, #HarmReduction, #ShawnPNeal, #AdvoCast Podcast Information: Hosted by: Dean Babcock & Jodi MillerExecutive Producer: Shawn P NealAudio Engineer: Shawn P NealMixed at: AdvoCast Studio236
