Dana first noticed it over winter break. Her son Eli, twenty, had come home from his second year of college quieter than usual. He slept through the afternoons and stayed up through the night. He'd stopped answering his friends' texts. Twice she caught him standing at the window, watching the street, and when she asked what he was looking at, he said "nothing" in a voice that made her stomach drop. She knew he'd been smoking weed at school. She'd told herself it was a phase. Now she couldn't tell what she was looking at: stress, a rough semester, the substance, something else, or all of it knotted together.
If you've stood where Dana was standing, with a young person you love who just doesn't seem like themselves, this is written for you. It won't tell you what's wrong, because nobody can do that from the kitchen. It will help you notice what matters, and think about what to do next.
Why It's So Hard to Tell What You're Seeing
Sleeping late, pulling away, snapping at dinner: most of it is ordinary growing up. When substance use is also in the picture, it gets harder, because the same behaviors can come from several places at once. The person might be using more because they feel awful. They might feel awful because of the using. Or something else might be going on underneath that neither of you has a name for yet.
A short video on Kids in the House featuring Kenneth Duckworth, MD, medical director of the National Alliance on Mental Illness, makes a point that's easy to miss: in his telling, drug use is a significant factor in the onset of psychosis in teens, and most teens don't realize it. He also says that no one can pin down exactly how much risk comes with marijuana or hallucinogens, and that many casual users have a brief experience and go back to normal, while some keep having experiences they can't switch off. His advice to young people is to delay use for as long as they can.
That mix of uncertainty and caution is honest. It also explains why "wait and see" can feel so uncomfortable.
What the National Institute of Mental Health Says to Watch For
The National Institute of Mental Health (NIMH) publishes a plain-language guide to psychosis. It notes that psychosis often begins in young adulthood, in a person's late teens to mid-20s, though it can happen earlier or later. It also says a person will often show changes in behavior before psychosis develops.
The changes it lists include:
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Suspiciousness or paranoia
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Trouble thinking clearly
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Withdrawing socially and spending a lot more time alone
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A decline in self-care
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Disrupted sleep
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A sudden drop in grades or job performance
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Emotional disruption, anxiety, low motivation, or reduced overall functioning
NIMH also lists misuse of alcohol or drugs among the possible causes of psychosis, alongside things like sleep deprivation and some prescription medications. It adds that a condition like schizophrenia is typically diagnosed only after those other causes have been ruled out.
Two things are worth taking from that. First, a cluster of changes that persists or gets stronger deserves attention, not just a single bad week. Second, nobody should be diagnosed by a parent's checklist. Seeing some of these signs doesn't mean your child has a serious condition. It means it's time to ask a professional.
A Familiar Scenario: What Dana Did
Dana's first instinct was to confront Eli about the weed. It went badly. He got defensive, she got scared, and he left the room. What worked better, a few days later, was a quieter conversation on a drive, when nobody had to look at anybody.
She didn't open with the substance. She opened with what she'd seen. "You've seemed far away lately, and I'm worried about how you're sleeping. I'm not here to punish you. I'd like to understand." Eli didn't say much. But he said he'd been hearing things he wasn't sure about, and that it scared him. Dana kept her voice steady, thanked him for telling her, and called his doctor the next morning.
How to Talk When You're Frightened
A few approaches tend to help:
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Pick a calm, private moment, not an argument
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Describe what you've noticed without labeling it
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Ask open questions and leave room for silence
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Tell them you're on their side, whatever the answer turns out to be
When It May Be More Than a Rough Patch
Sometimes the right next step is a conversation with a family doctor or a mental health professional. Sometimes, when substance use and emotional struggles are tangled together and home isn't enough, it's a more structured level of care.
Programs that treat both at once are often described as dual diagnosis care. Sunflower Recovery Center in Osawatomie, Kansas, near Kansas City, offers a dual diagnosis residential program that treats substance use alongside mental health conditions or trauma. Its 60-day co-ed program combines individual, group and family therapy with options such as yoga, gym sessions, art and music therapy and cooking classes. That kind of setting won't suit every family, but knowing it exists can help you ask better questions.
If You're Worried About Safety
If your child seems confused, is hearing or seeing things that aren't there, or says anything about harming themselves or others, don't wait. In the US, call or text 988, the Suicide and Crisis Lifeline, or call 911 in a life-threatening situation. The NAMI HelpLine can also connect families with local programs.
What Changed for Dana
Eli's doctor referred him on to a specialist. It took weeks, not days, and there were hard evenings in between. Months later, Eli was sleeping at night again. They weren't finished, and they both knew it. But the window at the end of the hall was just a window, and when he stood there, she let herself think he was only looking out.
Sources
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National Institute of Mental Health. Understanding psychosis (NIH Publication No. 23-MH-8110). https://www.nimh.nih.gov/health/publications/understanding-psychosis
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Duckworth, K. Psychosis and drug links [video and transcript]. Kids in the House. https://www.kidsinthehouse.com/special-needs/mental-health-disabilities/psychosis-and-drug-links
