Young Adults in Los Angeles Need More Than a Short Recovery Window
I got sober in 1988 at the age of 19, close to death. Legally I was an adult. In almost every practical sense, I had no idea how to live successfully as one. Recovery gave me my life back, but it took time.
That experience is part of why the newly released data on young adults hits me so hard. SAMHSA estimates that 24.5% of young adults ages 18 to 25 in Los Angeles County had a substance use disorder in the past year. Almost one in four. The same estimates show that 32.8% experienced mental health issues and 12.5% experienced both.
The latest report on Los Angeles County's publicly funded substance use disorder treatment system makes it more sobering. Among treatment admissions, 58% involved reported mental health issues, 44.1% involved homelessness, and 69.4% involved unemployment. It also shows that 41.8% began using their primary substance between ages 12 and 17, and 72.5% had received treatment before.
What do these numbers actually tell us? To me, they describe the symptoms. They do not by themselves explain the underlying causes and conditions that brought a young person there, or why another episode of stabilization may not lead to lasting recovery.
The following are some thoughts about what may be happening underneath the numbers:
The sequence can begin years before the SUD diagnosis: The CDC's 2023 national survey of high school students found that 76.1% reported at least one adverse childhood experience and 18.5% reported four or more. Dr. Nadine Burke Harris does a great job in The Deepest Well of explaining how toxic stress can become biologically embedded. ACEs explain part of the vulnerability, but not all of it. Genetics, environment, generational trauma, and the emerging research on epigenetic effects add other layers that we are still learning to understand.
Self-medication can become part of the progression: I have seen young people who were first prescribed medication for mental health issues begin taking it outside of how or what was prescribed. Sometimes it becomes a way to self-medicate. Then cost or access can change, and the person shifts to illicit substances. This is not everyone's path, but it is a path I have seen.
SAMHSA's 2025 national survey counted 978,000 young adults who misused prescription stimulants, 582,000 who misused tranquilizers or sedatives, and 733,000 who misused prescription opioids. These categories overlap, but those are still sobering numbers.
The consequences can compound quickly: Once illicit substance use becomes chronic and acute, mental health issues can escalate. Then the consequences can metastasize into justice involvement, institutionalization, homelessness, lost relationships, and falling away from school or work. Those consequences further exacerbate both the SUD and the co-occurring mental health issues.
The adolescent brain is still developing through all of this: NIDA notes that the circuits responsible for judgment and self-inhibition are still maturing and that substance exposure can interfere with cognitive development and important social milestones. A young person can be derailed from the successful completion of that development by both the SUD and the negative environmental factors surrounding it.
Even the best clinicians need time: During early stabilization, it can be very difficult to understand whether the co-occurring mental health issues predated the SUD, were caused or intensified by illicit substance use, or will be pervasive into recovery, for how long, and to what extent. SAMHSA's guidance on co-occurring disorders recommends observing symptoms over time and reevaluating them as recovery progresses.
Our publicly funded system is too focused on fragmented, short-term fixes: The 2025 NSDUH found that among young adults ages 18 to 25 with both SUD and mental health issues, 43.9% received neither substance use nor mental health treatment in the past year. Only 9.9% received both.
Those numbers are symptoms. They are not as helpful if we treat each one separately and do not holistically address the underlying causes and conditions bringing them about. Too much focus on the symptoms is also emblematic of the holes in our publicly funded behavioral health system.
A brief treatment episode here. A mental health appointment there. Temporary housing someplace else. A justice response when it all spills over. The young person is living one interconnected condition, while the help is too often delivered as a series of fragmented, short-term fixes.
Stabilization is the beginning. Lasting healing requires enough continuity to address the immediate crisis, the underlying causes and conditions, and the hard work of learning how to live.
I have heard a line in 12-Step rooms that captures the progression: substances taught me how to fly and then took away the sky. What first feels like freedom eventually makes the world smaller and smaller.
Recovery has its own ancient story. Joseph Campbell called the larger pattern the hero's journey. Robert Bly explored a related passage through initiation in Iron John. I also think of a phoenix rising from the ashes. A person enters the unknown, faces trials, accepts guidance, and returns changed. In recovery, the return is service. We help the next person.
Learning not to pick up a drink or a drug is only the beginning. A young adult may still need to learn how to show up, keep a commitment, tell the truth, regulate emotion, repair relationships, work, and ask for help before acting on another destructive impulse. None of that happens in thirty, sixty, or ninety days.
Over ten years at Awakening Recovery, I have watched men and women arrive after several attempts to stabilize. Some know the language of recovery very well. Consistently living by those principles once the immediate crisis passes is a much deeper process.
Philosophically, a process like Awakening Recovery treats recovery as something practiced. We often say that you act your way into right thinking. Through a holistic, peer-mentoring-driven process, people uncover, discover, and discard the thinking and behavior that sustained their addiction. In the 12-Step tradition, substance addiction is understood as a three-fold disease of mind, body, and spirit, with the goal of a spiritual awakening and a sustainable new way of living. A community of people with lived experience carries that work day to day, paired with integrated and care-coordinated clinical support that is aligned around the person.
One size does not fit all in recovery. Clinical treatment, appropriate medication, safe housing, peer support, family healing, work, and spiritual growth may all be part of the path. The mixture will be different for each person. What remains constant is the need for enough time, structure, and community for new thinking to become new behavior.
The NSDUH shows us the symptoms and the gaps left by a system too often built around fragmented, short-term fixes. The underlying causes tell us what sustainable recovery must address: enough time to rebuild mind, body, and spirit within a lived-experience community, with coordinated clinical support woven in. The hero's journey reminds us that being lost does not have to be the end of the story. It is never too late to begin the return.
