Every day – and at all hours of the night – teenagers across the country are sending messages while under the influence of drugs or alcohol.

While many of them are just out having fun and sending silly or impassioned (and regrettable) drunk-texts to an ex-boyfriend or a friend, hundreds of thousands of them are sending out messages because they feel that they are at risk of harming themselves or someone they care about. In some cases, they already have.

But with the guarantee of anonymity on both ends, trained counselors on call at Crisis Text Line are able to support millions of young people in crises who find themselves facing some of their toughest, darkest, and most dangerous moments.

Helping High-Risk Texters

Initially, the line was created to help "high-risk" texters dealing with depression who were considering suicide, or already halfway there (think, they're holding pills, they're on a ledge, they have a razor blade), but it quickly became a resource for young people – and now, adults – everywhere dealing with a number of issues, many of them either caused by drugs and alcohol, or by others using those substances to self-medicate.

Since texting is generally the preferred means of communication for most folks under the age of 30, the messaging method allows for a certain level of privacy for whoever is texting in by removing the need to speak out loud or identify themselves.

"The text venue also allows for the safety and anonymity that people need to feel comfortable reaching out for help and support," said Leora Fulvio, a California-based psychotherapist. "In their core of crises, young people tend to feel both alone and isolated. Reaching out to either family members, parents or peers can feel or actually be unsafe and potentially more damaging."

She added that having someone who can assess imminent danger and act on it can "potentially save thousands of lives from suicide, accidental overdose or drug addiction each year."

Once a message is sent to Crisis Text Line's number, 741-741, with the word "START," words within that message are instantly analyzed and marked up in the queue for response depending on the level of urgency.

While two-thirds of their nearly 24.5 million messages processed are directly related to depression and suicide, there are a significant number related to drug and alcohol abuse. Sometimes, those two go hand in hand.

Some examples of these initial texts are as follows:

  • "I keep thinking about using meth and jumping from somewhere up high"
  • "I've turned to drugs and drinking to escape from my pain."
  • "I don't see a way out of this bad place I'm in."

And a conversation might look like this:

  • Texter: I would like to die. My friend is being taken away from me and put into therapy, far away. He was my reason to live.
  • CC: Are you able to stay safe tonight?
  • Texter: I'm drunk, I've already taken pills…. I don't want to die, really…. can you send help? I don't want to tell my parents….
  • CC: The ambulance is on its way…. keep talking to me so we can try and help you deal with this while you wait…
  • Texter: OK I'm here
  • CC: You shared a lot with me…thank you for trusting me and taking a risk…stay with me….
  • Texter: Thank you….

Helping in the Aftermath of Substance Use

Crisis Text Line data shows an active suicide attempt is more than twice as likely to occur in a substance use conversation than any other, and many teens know that if they say they want to kill themselves, a friend, family member, or therapist is inclined to call 911 or the police. For this reason, their counselors work quickly to determine whether they are high risk – if they have a plan, any intentions, where they are, what they're holding – or if things are just really hard in the moment and they want to escape. Regardless, their objective is to keep the conversation going until the texter feels some relief, or to contact local emergency services to intervene and keep them safe until they get there.

Dion Metzger, a psychiatrist who works with adolescents in private practice in Georgia and previously worked with young adults in student health at Emory University, says that in her experience, teens who abuse alcohol and drugs consistently describe "severe depressive symptoms the day after use" that consist of feelings of loneliness, guilt and shame.

"They sometimes only find comfort in using or drinking again and isolate themselves" she said. "This tool gives them an outlet to express their feelings and may even lessen the likelihood of them turning to the substance for instant mood relief."

To be sure, it is meant as a temporary solution to a much larger problem. About 25% of the conversations end up with a national referral for help to a larger, national organization where they can find out more information about what they're dealing with, and about 4% get a more a localized referral to a doctor or support group (like a local AA chapter). But the main line of support is that one conversation, sent entirely through text messaging, that can last for up to an hour.

Many volunteer crisis counselors like Mark Trainer – who is in recovery from addiction himself – have found certain commonalities in all of the texters beyond just the substance abuse problem at hand, such as lack of self-compassion and low self-esteem.

"Many are desperate to find value in their existence. They have lost sight of their inherent value," he said. "They feel hopeless and experience suicidal ideation, and in many cases, guilt is a cause."

He added that texters often communicate that they no longer want to hurt or be a burden to others, and believe that things would be better if they could "simply disappear or cease their existence."

Outside of active rescues, notes Director of Training Michelle Kuchuk, the kind of emotional support they provide increases resiliency for their texters in future situations. Usually, substance abuse issues are a symptom of a larger issue. So, rather than focus on their current drinking or drugging, the counselor will focus on rapport-building and empathetic active-listening – specifically, on the thoughts, emotions, and feelings behind the substance use.

"Many substance abuse issues are secondary to something more that is going on in their lives, so we're creating a safe place to talk about their feelings when they seem urgent," she said. "It's like a pressure valve. Pressure can build and finally explode if no one loosens the valve. The pressure valve is the texter's life, and a conversation loosens the valve and releases a little steam."

Because there is still so much stigma and shame around substance abuse, says Kuchuk, it often goes unreported.

"One of the most impactful points for texters is that they feel less alone," Kuchuk said. "Ideally, these text conversations will help young people on the other end build coping skills to help deal with anxiety and stress."

DeAnn MacCloskey, a licensed mental health counselor in Orlando, Florida who specializes in working with teens, says that sometimes it's easier for teens to text her about something they are going through, rather than say it out loud, especially when it's something they "shouldn't be doing or are ashamed of."

"I had a client who had started smoking marijuana and was so nervous to talk about it, because she was worried that I was going to be disappointed in her, the way she was disappointed in herself," Dr. MacCloskey explains.

"I asked her if it would be easier to text it to her, and she said 'yes,' opening to lines of communication to be able to deal with the issue."

At the end of the day, all tools in recovery are in place to help save a life. To be sure, anxiety and stress, both directly and indirectly, affect substance abuse, and while the textline is not intended as a tool to maintain long-term sobriety or mental health care, it's proving to be an effective first step.

Images Courtesy of iStock