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Addiction and Co-Occurring Disorders in Teenagers

Teenagers experience rapid development and change dramatically as they leave childhood behind and become adults. A big part of that development and change involves trying new things, taking a few risks and riding the ups and downs of teenage life. However, when a young person develops a mental health condition and begins to use drugs and alcohol it can lead to what is known as a co-occurring disorders or a dual diagnosis.  

Young people living with depression, bipolar disorder, anxiety disorders and ADHD are at greater risk of developing a substance use disorder and eventually receiving a dual diagnosis.

The substances most frequently used include alcohol, marijuana, club drugs like GHB, ketamine, Molly and LSD, methamphetamine and inhalants.

Teenagers with co-occurring disorders can experience serious life altering consequences: school failure, jail, homelessness and serious medical problems are some of the negative consequences that can occur. Fortunately, teens receiving a dual diagnosis with appropriate treatment can recover.

How often do young people develop co-occurring disorders and how does the condition develop?

Co-occurring disorders in young people are so common that many mental health professionals and primary care providers now expect to find it and screen teenagers for it when a child shows signs of mental health troubles. Biological and environment factors contribute to the conditionís development, but the disorders also influence each other in complicated ways.

A teenager may not understand why they are depressed or experiencing a lot of anxiety. But, they may learn that when they drink alcohol or take drugs their stress or emotional pain are relieved and they feel better. Unfortunately, this remedy is only temporary and can lead to bigger problems. Over one-half of all lifetime cases of co-occurring disorder diagnoses begin by age 14 and three-fourths by the age of 24.

The use of drugs and alcohol use can also harm normal brain developmentóespecially during adolescenceóand it can increase a teenager's chance of developing some forms of mental illness.

What are the warning signs and how is a co-occurring disorder diagnosed?

Warning signs of a dual diagnosis will include signs of both a mental illness and a substance use disorder. They will be different depending on which type of mental health disorder a person is experiencing and which type of substances are being used.

To recognize a mental illness itís important to learn about the particular mental illness. Depression, bipolar disorder, anxiety disorders and ADHD are most often involved in a dual diagnosis. Each has its own distinct symptoms.

Warning signs of substance use will vary depending on the substances being used and may include:

  • Changes in thinking and emotions. Teens may experience difficulty concentrating, irritability, personality changes, lack of motivation and energy, moodiness, a decline in grades, or feelings of depression or even suicide.
  • Changes in behavior. Giving up activities once enjoyed, taking risks including driving while high and risky sexual behavior, secretive, becoming violent or a victim of violence are signs that a teen may be experiencing a substance use disorder or mental illness.
  • Physical changes. Some common changes include fatigue, red and glazed eyes, nervousness, unexplained changes in appetite and weight, frequent hangovers, or the appearance of physical injuries.

What kind of treatment works?

The best approach to treating a dual diagnosis is to treat both the substance use disorder and the mental health condition at the same time. The first step is a careful assessment that distinguishes the disorders and the relationship between disorders. A mental health professional experienced with substance use disorders is best able to conduct an assessment, make a diagnosis and thoughtfully integrate care for both conditions into a comprehensive treatment plan.

A treatment plan should:

  • Take into account the young personís goals and motivation.
  • Involve the young person in treatment decisions and planning whenever possible.
  • Take into consideration the young personís unique set of strengths and vulnerabilities.
  • Include psychosocial treatments especially cognitive behavioral therapy (CBT),which focuses on the relationships between thoughts, feelings and behaviors.  
  • Consider the use of medication to address the symptoms of mental illness and to reduce cravings for substances.
  • Include peer recovery support groups for young people. Positive peer influence can be powerful. Groups for dual diagnosis recovery are best, but if not available consider one for either condition.
  • Engage the young personís family.

I think my teenager may have a problem with substance use and Iím concerned about their mental health. Where do I begin?

Before you share your concerns with your teen there are some things you can do:

  • Become familiar with symptoms, treatments and resources.
  • Reach out to peopleĖschool psychologist or counselor, clergy, community mental health worker. They can help you identify resources.
  • Depending on the severity of your teenís substance use or mental condition you may need to consider an inpatient program or hospital support. Learn about your options.
  • If possible, both parents should be involved and work as a team to address their teenís issues.

You may need help with your feelings and emotions. Your health is important too. If youíre experiencing guilt, shame, fear, blame, judgments and disappointments, they may become obstacles to effectively helping your child. A therapist or counselor may be able to provide you help.

Some parents find it helpful to speak with a mental health professional experienced in treating teenagers with co-occurring disorders. They can offer valuable advice about how to discuss the situation with your teenager and become a ready resource after your conversation. They would also be capable of assessing both the substance use disorder and mental health concerns.

When beginning treatment, confidentiality is sometimes an issue for teens. Be sure everyone is clear and understands how the issue will be handled. With a clear understanding your teen will feel comfortable being honest and youíll be assured that critical information you need will be shared.

Itís important to remember that you are not alone. Many families with teens face this issue. Help is available and recovery is possible. Your NAMI State Organization and NAMI Affiliate can share information about local resources and NAMI education and support programs; NAMI Basics is designed specifically for parents of adolescents living with a mental illness.

Reviewed by Ken Duckworth, M.D., May 2014

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