A few months ago a young man (early 20's) came into a shop I sometimes hang out at. "What brought you to town?" "Recovery." He'd been in town for 3 weeks, and sober for 3 weeks and 1 day.
I asked him, "People usually know when their problems when substances started, when did it start for you?"
When he was in 3rd grade his teacher thought he was disruptive. They put him on some kind of medication for "ADHD". He told his parents in 9th grade that he was going to kill himself if they didn't take him off the pills. Soon after discontinuing his "ADHD" medications was when he started experimenting with self-medicating... Tobacco, alcohol, etc.
His latest bender was on alcohol & laughing gas (nitrous oxide [0], for the euphoria).
[0] https://en.wikipedia.org/wiki/Nitrous_oxide#Recreational_use
After a bit I told him, "I bet you're exhausted."
"YEAH!"
"Recovery" is good for getting people to feel like failures, so I thought it'd be helpful for putting a different 'frame' on his last 15 years. I told him that he doesn't actually have a substance abuse problem, he's just been exhausted this whole time, and didn't know what to do to help improve his energy levels. I gave a few suggestions for keeping his energy levels up.
Saw him three or four more times over the next 2-3 months, and he was doing much better. I saw him last 2 days before he returned to where he came from. I think he's got a chance this time.