Teen drug and alcohol treatment in Texas: where to start and who pays

If you need help now: call 911 in an emergency. In a mental health or substance use crisis, call or text 988, any time. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open 24/7 for treatment referrals. Texas teens and parents can also call the Texas Youth Helpline, 1-800-989-6884, free and confidential, 24/7.

The short version

1. Notice the signs, and talk with your teen calmly. One sign alone may mean nothing. Several at once, or sudden ones, are worth acting on.
2. Get an assessment. Your teen's doctor, or a licensed substance use program, can screen your teen and tell you what level of care fits.
3. Find out who pays. Call the number on the insurance card. With Medicaid or CHIP, call the health plan. With no insurance, call 2-1-1 and ask for the OSAR (Outreach, Screening, Assessment and Referral) program near you.
4. Pick a program that treats teens, apart from adults, and brings in the family.
5. Stay involved. Treatment works better with family taking part, and it often takes more than one try.

Signs to watch for

SAMHSA, the federal substance use agency, lists these signs that a child may be drinking or using drugs:

• Mood changes: temper flare-ups, irritability, getting defensive.
• School problems: falling grades, skipping class, discipline.
• Breaking family rules, and switching to new friends they don't want you to meet.
• A "nothing matters" attitude: a sloppy appearance, low energy, losing interest in things they used to like.
• Finding alcohol or drugs in their room or backpack, or smelling alcohol on their breath.
• Physical or mental changes: memory lapses, poor concentration, bloodshot eyes, poor coordination, slurred speech.
• Social media posts about drinking or drug use.

Some of these are normal growing pains. SAMHSA says a problem is more likely when several signs show up at once, appear suddenly, or are extreme. NIDA, the National Institute on Drug Abuse, says any teen drug use, even "experimenting", is cause for concern, and that it's best addressed early. Vaping is often where it starts; our guide to teen vaping help in Texas covers that.

Getting an assessment

An assessment is a set of questions (sometimes with a drug test) that shows whether your teen has a substance use disorder and how much care they need. Places to start:

Where	What they can do
Your teen's pediatrician or family doctor	Screen with a standard questionnaire, give brief advice on the spot, or refer to treatment. NIDA calls yearly checkups a chance to ask every teen about drug use. With Medicaid, Texas Health Steps checkups are yearly from age 3 through 20 and include a mental health screening.
A licensed substance use program	Do a full assessment and recommend a level of care. In Texas, a program that treats substance use needs an HHSC chemical dependency treatment facility license.
Your local OSAR	HHSC's Outreach, Screening, Assessment and Referral programs screen people and point them to treatment, including state-funded care. Call 2-1-1 to find yours.
The school counselor	Can tell you what help the school has and help plan treatment around class. Ask what gets written down before you share details.
A licensed counselor	A licensed chemical dependency counselor (LCDC) or other licensed therapist can assess and treat. See how to choose a therapist in Texas.

Ask whoever does the assessment to explain the result, and to check for depression, anxiety, ADHD or trauma too. NIDA says treating these along with substance use is part of effective care.

Levels of care for teens

Most teens are treated while living at home. The level depends on how severe the problem is, how safe your teen is at home, and what's been tried before.

Level	What it is	Often a fit when
Outpatient counseling	Individual, family or group sessions, usually once or twice a week	Use is early or mild, and your teen is keeping up at school.
Intensive outpatient (IOP)	Several sessions a week, often after school. SAMHSA cites a minimum of 6 hours a week for teens (9 for adults).	Weekly counseling isn't enough, but your teen is safe at home.
Partial hospitalization (PHP)	Treatment most of the day, several days a week; your teen still sleeps at home	Your teen needs daily structure, or is stepping down from residential care.
Residential	Your teen lives at the program. In HHSC's youth programs, intensive residential means at least 45 hours of services a week, supportive residential at least 21, and teens keep going to school.	Use is severe, home isn't safe or stable, or lower levels haven't worked.
Withdrawal care (detox)	Medical care to stop using safely	Your teen could have dangerous withdrawal, for example from alcohol, opioids or sedatives. Ask a doctor.

Texas licensing rules for programs that serve teens 13 through 17 say teens must be kept separate from adults, the program must involve the family (or write down why it can't), and residential programs must arrange access to school within three school days when treatment is expected to last more than 14 days. For how the levels compare, read IOP vs PHP vs weekly therapy, and for what they cost, what IOP and PHP cost in Texas.

What good teen treatment looks like

NIDA's research-based principles for treating teens include:

• Family is part of it. Family therapy and parent involvement help teens stay in treatment and do better.
• Talk therapy works. Behavioral therapies, such as family-based therapy, cognitive behavioral therapy and motivational approaches, are effective for teens.
• It treats the whole teen: school, friends, family and mental health, not just the drug.
• It lasts long enough, with a plan for what comes next. Relapse is a reason to adjust treatment, not proof it failed.
• It's monitored. Programs check for drug use during treatment, so the plan can change if it isn't working.

Texas Medicaid and CHIP

Medicaid for children and teens is called Texas Health Steps. It's the Texas name for EPSDT, Medicaid's benefit for everyone under 21. Federal law requires it to cover the care needed to correct or improve a physical or mental health condition, substance use disorders included, even when the service isn't otherwise in the state's Medicaid plan. The health plan decides what's medically necessary case by case, and often requires prior authorization for intensive care.

• What's covered: Texas Medicaid's substance use benefit includes assessment, outpatient counseling, withdrawal care, residential treatment and medication-assisted treatment, delivered by licensed programs.
• Limits: HHSC's parity summary describes caps on residential stays in the adult Medicaid program. For members under 21, ask the plan to review what's medically necessary under Texas Health Steps.
• Use the plan's network. Call the member services or behavioral health number on your child's plan card and ask for in-network programs that treat teens.

CHIP covers mental health and substance use care for children in families that earn too much for Medicaid. Since July 1, 2022, CHIP has charged no co-pays for mental health and substance use office visits or residential treatment. Ask your CHIP plan which levels of care it covers and which need approval first.

Not enrolled? Apply at YourTexasBenefits.com or by calling 2-1-1 (step by step: how to apply for Texas Medicaid or CHIP). If your child doesn't qualify for Medicaid, the state checks CHIP automatically. Our guide to using insurance in Texas covers changing plans and who to call when care is hard to get, and the Texas insurance pages show which programs list each Medicaid health plan.

Private insurance

Most teens are covered as dependents on a parent's plan. Under the federal parity law, if a plan covers substance use care, its copays, visit limits and approval rules can't be stricter than for medical care.

• Screening is free. Marketplace plans and most other plans must cover alcohol, tobacco and drug use assessments for adolescents with no copay, when you use an in-network provider.
• Call before you start. Ask: Is this program in network? Do IOP, PHP or residential need prior authorization? What will we owe per day? Is behavioral health managed by a separate company (a carve-out)?
• Privacy: the plan may mail an explanation of benefits to the policyholder. If your teen is getting care on their own, ask the program how billing works.
• If the plan says no, ask for the reason and the criteria in writing and appeal. The Texas Department of Insurance Help Line is 800-252-3439.

No insurance

HHSC funds youth treatment programs for Texas residents 13 to 17 with a substance use disorder, at outpatient and residential levels. Young adults 18 to 21 can be admitted when their needs are like a younger teen's. Eligibility depends on income, and some families pay part of the cost. Contact a program directly or start with your local OSAR (call 2-1-1). SAMHSA's helpline, 1-800-662-4357, can also refer you to state-funded care.

Consent and privacy for minors in Texas

Texas law lets teens agree to some substance use care on their own. That changes who signs, and who can see the records.

The rule	What it says
Family Code 32.003	A minor can consent to examination and treatment for drug or chemical addiction or dependency by a licensed physician.
Family Code 32.004	A minor can consent to counseling for chemical addiction or dependency from a licensed or certified physician, psychologist, counselor or social worker. The professional may tell the parents, with or without the teen's consent. A parent who didn't consent isn't required to pay for that counseling.
Health and Safety Code 462.022	A treatment facility can admit a minor at a parent's or guardian's request, or at the minor's own request without a parent's consent if the minor is 16 or older.
42 CFR Part 2 (federal)	Many addiction programs fall under this federal confidentiality rule. When a minor may legally consent to treatment alone, only the minor can sign a release of their records, even to a parent. When state law requires a parent's consent, a release needs both the teen's and the parent's signatures.

In practice, most programs want a parent involved, and teen programs must try to involve the family. Ask the program, in writing, what it will tell you and what it will keep private. Teens often open up more when they know the rules.

School rules in Texas

• Drugs or alcohol at school. Under Texas Education Code 37.006, possessing, using or being under the influence of marijuana, a controlled substance or alcohol at school, within 300 feet of school property or at a school event leads to removal to a disciplinary alternative education program (DAEP).
• Vapes at school. Since the 2025 law HB 6, a first offense for having or using an e-cigarette can mean DAEP or at least 10 school days of in-school suspension. Selling or sharing vapes, or a repeat offense, means DAEP. Details are in our teen vaping guide.
• Treatment records stay private. A Part 2 program needs written consent to share anything with the school, such as an attendance letter. Share only what the school needs.

Each district's Student Code of Conduct has the details. If your teen is in treatment, ask the campus behavior coordinator what options your district uses.

Finding a teen program

1. Search Cima Find Care. Search Texas programs by level of care and insurance, or browse the Texas directory by city, for example IOPs in Houston or outpatient programs in Dallas. Our search doesn't filter by age yet. On a program's page, look under "Who they list": programs that report a program for adolescents to SAMHSA's FindTreatment.gov show "Adolescents" there.
2. Check SAMHSA's FindTreatment.gov, which lets you narrow results by age group, payment and services.
3. Call and ask: What ages do you serve? Are teen groups separate from adults? How do you involve parents? How do you work around school? Do you take our Medicaid, CHIP or private plan? Are you licensed by HHSC? How soon can my teen start?

Cima Find Care listings show each program's state license and when it was checked (how listings work), but confirm it yourself on HHSC's license search. More plain-language guides are on our guides page.

In a crisis

• Possible overdose (won't wake up, slow or no breathing, blue lips): call 911. If you have naloxone (Narcan), give it; the FDA approved Narcan nasal spray for sale without a prescription in 2023, so you can keep it at home.
• Thoughts of suicide or a mental health crisis: call or text 988. Your county's local mental health authority also runs a 24/7 crisis line; HHSC's directory lists each one.
• Swallowed something, or a child got into e-liquid: call Poison Help, 1-800-222-1222.
• Your teen needs to talk to someone: the Texas Youth Helpline, 1-800-989-6884, is free and confidential and isn't connected to police or CPS.

Worried about more than drinking, drugs or vaping? Read when to get help for your teenager and how to find a teen counselor in Texas.

Checking what a plan will pay? See does insurance cover rehab?

Questions parents ask

Does Medicaid cover rehab for teens in Texas?

Yes, when it's medically necessary. Texas Medicaid's substance use benefit includes outpatient treatment, withdrawal care and residential treatment, and for members under 21, Texas Health Steps must cover medically necessary care. The health plan usually requires prior authorization for residential treatment. Call the number on your child's plan card.

Can my teen get drug counseling in Texas without my permission?

Yes. Texas Family Code 32.004 lets a minor consent to counseling for chemical addiction or dependency. The counselor may tell you, with or without your teen's consent, but federal confidentiality rules can limit what an addiction program shares, so ask the program about its policy.

Can I make my teen go to treatment?

Texas law lets a treatment facility admit a minor at a parent's or guardian's request. Treatment works best when your teen takes part willingly, so ask the program how it builds motivation. NIDA notes that family pressure can help teens enter and stay in treatment.

What if my child is 18, 19 or 20?

At 18 they consent for themselves, and you'll need their written permission to see records. Medicaid's Texas Health Steps benefit still applies through age 20, and HHSC's youth programs can admit young adults up to 21 whose needs are like a younger teen's.

Will treatment go on my teen's school record?

Not from the program without consent. Many addiction programs need written permission to share anything with a school. School discipline for drugs or vapes on campus is separate, and it follows the district's Student Code of Conduct.

Sources

• SAMHSA: Talk. They Hear You, How to Tell If Your Child Is Drinking Alcohol or Using Other Drugs
• NIDA: Principles of Adolescent Substance Use Disorder Treatment and Treatment settings
• NIDA: Screening for substance use in the pediatric and adolescent medicine setting
• SAMHSA: Clinical Issues in Intensive Outpatient Treatment for Substance Use Disorders (advisory based on TIP 47)
• TMHP: Texas Medicaid Provider Procedures Manual, Children's Services Handbook (Texas Health Steps checkups)
• Texas HHSC: Youth substance use treatment services
• Texas HHSC: Chemical Dependency Treatment Facilities
• 26 Texas Administrative Code 564.905: Additional requirements for adolescent programs
• CMS: EPSDT, A Guide for States
• TMHP: Substance use disorder benefits to change for Texas Medicaid, January 1, 2019
• Texas HHSC: Texas Medicaid and CHIP Reference Guide, 15th edition
• Texas HHSC: Summary of Texas parity findings (adult residential limits; CHIP co-pays ended July 1, 2022)
• HealthCare.gov: Preventive care benefits for children and Mental health and substance abuse coverage
• Texas Department of Insurance: Coverage and parity for mental health and substance use services
• Texas Family Code chapter 32 (sections 32.003 and 32.004)
• Texas Health and Safety Code chapter 462 (section 462.022)
• 42 CFR 2.14: Minor patients
• Texas Education Code chapter 37 (section 37.006) and TEA: Report required by House Bill 6 (2025)
• FDA: FDA approves first over-the-counter naloxone nasal spray
• Texas HHSC: Mental health crisis services and Local mental health authority directory
• Texas DFPS: Texas Youth Helpline
• SAMHSA: National Helpline and 988 Suicide & Crisis Lifeline