Substance Use Treatment with Teens: Mindfulness and the Power of Relationship

In my work with adolescents who are navigating substance use, I integrate a mindfulness-based approach called MBSAT (Mindfulness-Based Substance Abuse Treatment), developed by Dr. Sam Himelstein in the Bay Area. MBSAT is a trauma-informed, mindfulness-centered curriculum designed specifically for teens, many of whom are involved in the juvenile justice or child welfare systems. It emphasizes the development of emotional awareness, impulse control, and value-driven decision-making.

The MBSAT program is typically delivered over 8-12 weeks, but is flexible and can be adapted to individual therapy or longer-term formats. It’s used across a range of settings including schools, outpatient clinics, juvenile detention centers, and residential treatment programs. I use it in individual therapy with teens in the Bay Area who are juvenile justice impacted and often struggling with depression, anxiety, and substance use.

At the heart of MBSAT is a simple yet powerful practice: the pause. In moments of overwhelm, teens learn to pause, observe their internal experience, and choose how they want to respond. That space—between impulse and action—is where meaningful change begins. For teens whose behaviors have been pathologized or punished, this moment of choice can be transformative. They begin to see that they are not their mistakes. They have agency. They can learn to regulate their nervous systems, relate to their feelings with compassion, and live in alignment with what matters most to them.

What makes MBSAT effective is that it meets teens where they are. It doesn’t tell them what not to do—it shows them how to be with discomfort, how to ride out cravings, and how to make decisions that support their values. It speaks their language and gives them concrete tools for self-reflection and growth. In a world of dopamine-driven screens and easy access to potent dispensary drugs like cannabis and nicotine, teens need these tools more than ever.

Why MBSAT Works:

• Neuroscience Support: Mindfulness practices strengthen parts of the brain responsible for executive functioning, emotional regulation, and impulse control—all still developing in adolescence.

• Trauma-Informed Approach: Many teens in substance use counseling have experienced complex trauma. MBSAT fosters a respectful, safe environment that supports healing.

• Accessible and Engaging: With relatable content and interactive activities, the curriculum engages teens in a way traditional talk therapy sometimes doesn’t.

• Empowerment Over Punishment: MBSAT shifts the narrative from control and compliance to growth and self-trust.

  
  

As a therapist, I believe healing happens in relationship. My work with teens is grounded in connection, curiosity, and a deep respect for their lived experience. The adolescents I work with are incredibly insightful and resilient. MBSAT gives them a framework to access that wisdom more consistently, and to build skills they can carry with them into adulthood. Whether your teen is facing challenges related to substance use, anxiety, or school-related stress, mindfulness-based therapy can be a powerful part of the healing journey. 

If you’re a parent wondering how to open up a conversation with your teen about substances, here are a few suggestions grounded in the MBSAT philosophy:

• Lead with curiosity, not judgment: Ask open-ended questions like, “What’s it like for you when you’re feeling stressed or overwhelmed?” or “What do you notice in your body or mind when you feel the urge to use?”

• Normalize discomfort: Let your teen know it’s okay to feel anxious, sad, or numb—those feelings are part of being human. The goal isn’t to get rid of them, but to learn how to relate to them differently.

• Introduce the idea of the pause: Share the concept that we all have a moment of choice before we act. You might say, “Sometimes, taking one deep breath can give us just enough space to make a different decision.”

• Validate their experience: Even if you don’t agree with their choices, acknowledge their perspective. You might say, “It makes sense that you’d want to escape when things feel so intense.”

• Model mindfulness in your own life: Practice pausing before reacting, and name it when you do. Teens learn more from what we model than what we say.

• Focus on values, not just behavior: Rather than asking “Why did you do that?”, try asking “What do you care about, and how do you want to live?”

These conversations can be hard—but they’re worth having. When teens feel seen and respected, they’re more likely to open up, reflect, and grow. And when parents approach substance use with compassion and curiosity, it becomes an opportunity for connection, not conflict.

If your or your child is struggling with substance use please know that you are not alone. Big Life Change Therapy can provide dedicated support for your entire family through this challenging time. Contact us to learn more about our services for teens and their families.