Exhausted,
When we were having all kinds of SA issues with difficult child when he was in 10th grade, we were told by the guidance counselor as well as other professionals that most of the time, you can't "wait" for someone to want to change, particularly if they are your minor children, that sending them away for wilderness, rehab, etc. has to be sort of mandated, either by the parents or by the courts. I'm certain there's plenty of evidence to support that, as well as common sense. In our case, though, our difficult child was SO stubborn, SO resistant, that there was nothing effective we could do until he was finally ready. Luckily, the psychiatrist we had was excellent. The psychiatrist was always excellent, it's just that we wasted our time and money initially because difficult child wasn't receptive. Once difficult child was receptive, things moved along with psychiatrist. I really had given up on difficult child before that point because he was just so combative and skeptical. It was as though he was taken over by an alien - that's how much he changed because of drugs.
I cannot think of anything that husband and I did that enabled difficult child to become receptive, other than continue to encourage him and hold our ground. When he became 18 and was no longer a minor, we just told him what we wouldn't stand for in our home. husband and I were completely united on that front, but with psychiatrist's help, we put it in a loving, supportive way, rather than in a "get the heck out of our house you bum" way that I was ready to express! The adoption issue was a complication, and he needed to work on that, too. Currently, as far as any parent with a kid in college in another state can know, it has worked out, but I maintain we were all lucky, because plenty of people have done exactly what we did, and are still waiting for their difficult child's to get the message. Plus, I'm always sure the other shoe is going to drop and we will be back to square one. I bolt up out of bed sweating in the middle of the night many, many times - even now.