Youth and Co-Occurring Disorders

Millions struggle with substance abuse disorders and up to 60% of addicts also have at least one co-occurring mental disorder. Although the connection between these two psychological phenomena is not fully understood, some experts believe that mental health disorders can play a contributing role in addiction and vice versa. Not only are adolescents and children with mental health disorders more likely to abuse drugs than others their age, but researchers have also uncovered evidence that early drug abuse may contribute to an increased risk of developing psychiatric disorders.

Diagnosis of Co-Occurring Disorders

Sometimes referred to as dual disorders or dual diagnosis, doctors diagnose patients with co-occurring disorders when they show symptoms of both a substance abuse disorder and one or more psychiatric conditions. Many psychiatric patients first present symptoms in adolescence or young adulthood, so it should come as no surprise that teenagers and young adults are frequently diagnosed with dual disorders.

Diagnosing Substance Use Disorders

A doctor might diagnose his or her patient with a substance use disorder if the patient’s drug or alcohol use interferes with normal functioning or social relationships. The patient may also receive an official diagnosis of substance use disorder if his or her drug or alcohol use creates new medical conditions, worsens existing conditions, or places the patient in dangerous situations.
Some patients diagnosed with a substance use disorder, even adolescents and young adults, also suffer from drug or alcohol dependence. This diagnosis covers both physiological dependence and psychological dependence. Symptoms may be most obvious when patients attempt to stop using their substances of choice without adequate medical care.

Diagnosing Mental Health Disorders

Mental health disorders range substantially in severity and effect. The most common psychiatric conditions found in substance abusers are mood disorders and psychiatric disorders but psychiatric patients with any severe mental illness are more likely to abuse drugs or alcohol than those with only mild symptoms.

The Problem with Dual Diagnosis

Symptoms of addiction are often confused with symptoms of mental illness, which can substantially complicate things for diagnosing physicians. Many mentally ill people who are not receiving the treatment they need to turn to drugs or alcohol as a means of self-medicating, as well. People with co-occurring disorders tend to experience a worsening of mental health symptoms while receiving drug or alcohol treatment or to appear resistant to otherwise effective treatments.

Depression and Substance Use Disorder

Research has shown that there may be a link between addiction and major depressive episodes. One study of adolescents with no prior substance use showed that one or more major depressive disorders in the previous year increased participants’ chances of using drugs or alcohol for the first time.
The results of the study were definitive: youth who had major depressive episodes were at twice as much risk of starting to use drugs or alcohol as those who remained psychologically healthy during the first year of the study. More than 29% of participants who initiated drug or alcohol use had experienced at least one depressive episode, while only 14.5% of participants who initiated substance use did not report an episode of depression.
Depressed adolescents and young adults often turn to drugs or alcohol in an attempt to elevate their moods and feel more animated. Conventional addiction treatment, which focuses only on treating the addiction and not the underlying mental health problem that contributed to it, are often ineffective because they do not provide relief from these patients’ depressive symptoms. Treating youth with co-occurring depression and substance use disorders often requires counseling sessions with an experienced psychologist and anti-depressant medications in addition to addiction treatment.

ADHD and Substance Use Disorder

Children, adolescents, and young adults with attention-deficit hyperactivity disorder (ADHD) are also more likely than their peers to develop a substance use disorder. Experts have three main theories for why this might be the case.
First, patients with ADHD suffer from symptoms like impulsivity and poor judgment that can contribute to an increased risk of substance abuse. Second, there may be a genetic link between the two disorders that leave adolescents with ADHD more vulnerable. Finally, as with depression, youth with ADHD may use drugs or alcohol in an attempt to self-medicate if they do not receive adequate psychological care.
Research has shown that children who receive ADHD treatment at a younger age are less likely to develop substance use disorders than those who only begin treatment in adolescence or later in life. The situation is further complicated by the prevalence of other co-existing mental health disorders like anxiety and depression that often come along with ADHD.
The situation is also complicated by the fact that the first-line pharmaceutical medications used in treating ADHD in children and adolescents are prone to misuse. Parents and doctors need to monitor young patients’ medication use closely. Adolescents with ADHD who have already developed a substance use disorder can benefit substantially from dual diagnosis treatment.

Anxiety and Substance Use Disorder

Teens and young adults who suffer from anxiety disorders often use alcohol or illicit drugs in an attempt to self-medicate. It’s common for socially anxious youth to start out drinking or using drugs like marijuana to calm down before social situations they feel might trigger anxiety attacks. Occasional recreational use soon escalates to daily drug use and, eventually, dependence. Over time, drug or alcohol use may start to make anxiety symptoms worse.
Post-traumatic stress disorder (PTSD), another category of anxiety disorders, can also leave teens and young adults at higher risk of developing substance use disorders. Unfortunately, the symptoms of PTSD and other anxiety disorders make addiction harder to treat. When patients experience anxiety symptoms, it predisposes them to relapse.
As with ADHD, some medications used to treat severe anxiety disorders have the potential for abuse. They can also create dangerous drug interactions when taken with alcohol or illegal substances. Doctors whose patients struggle with dual disorders often prescribe lower doses of medications or choose medications that do not create adverse reactions with illicit drugs.
Treatment for co-occurring substance abuse and anxiety disorders often focuses on therapy and support groups in addition to or instead of medication. Cognitive-behavioral therapy (CBT) shows particular promise for teens with anxiety disorders. CBT helps patients identify, understand, and alter their negative thought or behavioral patterns, and patients typically begin to see results in just three to four months.

Bipolar Disorder and Substance Use Disorder

There is a strong correlation between bipolar disorder and substance abuse. In fact, bipolar disorder has the highest association with substance abuse of all major substance abuse disorders. In adolescents, the onset of substance use disorder typically precedes the diagnosis of bipolar disorder with the results of one study showing that over 60% of patients were diagnosed with a substance abuse disorder before bipolar disorder.
As with treating comorbid ADHD and substance use disorder, treating bipolar patients with addiction problems is complicated by the fact that many people struggle with other co-occurring mental and physical health problems or polysubstance dependence disorders. Poor treatment adherence can also be a problem in this group, so parents should closely monitor their children’s medication use and adherence to other treatment guidelines. It may be more appropriate in some cases to seek inpatient treatment.

Psychosis and Substance Use Disorder

Psychotic disorders include severe forms of mental illness such as schizophrenia and schizoaffective disorder. These mental health problems are typically diagnosed in young adulthood between the ages of 16 and 30, but even adolescents and young adults at risk for psychosis who have not yet experienced their first psychotic episodes are at higher risk of developing substance abuse disorders.
Between 13 and 51% of adolescents and young adults seeking treatment for their first psychotic episodes have a co-occurring substance use disorder. Part of the problem lies in the delay in diagnosis typical of this category of mental illnesses. Young patients are often overwhelmed or confused by their symptoms and do not seek treatment immediately.
The median delay in diagnosis is around one year. During this period, it is common for patients to use drugs or alcohol in an attempt to self-medicate. Ensuring an early diagnosis is the best way to encourage adolescents and young adults experiencing psychosis to get the help they need instead of turning to drugs and alcohol. Those with existing co-occurring conditions should always seek help from a qualified dual diagnosis treatment facility.

The Bottom Line

No matter what type of mental health disorder a young patient is struggling with, it’s critical to identify this when looking at addiction treatment. Not only do addicts with underlying mental disorders tend to present with more severe symptoms at intake that requires a more comprehensive treatment program, but they also respond better statistically to treatment programs designed for patients with dual diagnoses.
At Canadian Addiction Rehab we recognize that without specialized treatment, mentally ill recovering addicts are less likely to complete their rehabilitation programs successfully and more likely to relapse after their release. With psychiatric integrated treatment, abstinence rates for young adults with mental illnesses approach those of healthy young adults without mental health issues.
Effective treatment programs for youth with dual disorders typically include a range of therapeutic and medical interventions. Patients can expect to receive help with medical detox, attend personal, group, and family therapy sessions with a licensed counselor, have routine appointments with trained psychiatrists and receive other forms of psychological care in addition to their addiction treatment.