Co-Occurring Disorders in Teens: A Double-Edged Sword That Requires Comprehensive Treatment
For some teens, addictions develop due to an underlying mental health issue. In a desperate quest to find relief, these teens attempt to medicate their own illnesses using the only tools they can find: drugs and/or alcohol.
When a teen develops a substance abuse problem, the first question a parent might ask is: “Why?” Answering this question can be difficult, as teens are individuals and one person’s reasons for abusing drugs could be radically different than another person’s reasons for following an addictive path. However, for some teens, addictions develop due to an underlying mental health issue. In a desperate quest to find relief, these teens attempt to medicate their own illnesses using the only tools they can find: drugs and/or alcohol.
Other teens develop mental illnesses as a result of the brain damage they endure due to drug abuse, but the mental illnesses they have can serve to lock the addictions in place and make it difficult for the teen to stop abusing substances. The problem is complex, and it can be hard for parents to even think about, but teens who have co-occurring disorders like this can get better. They’ll just need access to specialized programs in order to reach their goals.
A Common Problem
Among teens who have an addiction issue, mental health concerns aren’t uncommon. In a study of the issue, published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers found that 82 percent of teens who entered a treatment program for addiction also met the criteria for a mental health disorder. Some teens may have obtained a diagnosis of a mental illness in the past, so they may not have been surprised to learn that their mental illnesses were playing a role in the development of an addiction. Other teens, however, may have had no idea about their mental health status before they went into treatment for their addictions.
Teens could have almost any type of mental illness co-occurring with their addiction, but there are some specific diagnoses that seem to be more common in teens who have addictions. In one study of the issue, published in the Journal of Substance Abuse Treatment, researchers found that these particular mental illnesses were commonly at play in teens with addictions:
- Attention deficit hyperactivity disorder (ADHD)
- Conduct disorder
- Adjustment disorder
- Bipolar disorder
- substance abuse
Drugs of Abuse
Almost any drug could be a target of substance abuse for teens with a dual diagnosis issue. Some teens with ADHD, for example, begin taking very high dosages of their mental illness medications in the hopes of feeling euphoria and a sense of power. Teens with conduct disorder might lean on depressants like alcohol, as these drugs allow them to feel calm and quiet, at least for a while. Teens with depression might rely on opiates like heroin, as they find it difficult to experience joy in life, and these drugs seem to provide a gateway to happiness they can’t experience in any other way.
In general, however, teens with a dual diagnosis issue tend to abuse the same types of drugs as teens who don’t have mental illnesses. For example, Medscape reports that marijuana is the drug most frequently abused by adolescents, and 15 percent of the teens who abuse marijuana also qualify for a diagnosis of major depression. These teens may not differ from their peers in terms of the drugs they use, but the way in which they use those drugs, and the consequences of that drug use, could be vastly different.
Understanding the Association
As mentioned, some teens use drugs of abuse as a form of medication for the mental health issues they already have. These teens might be well aware of the effects of the drugs they take, and they may develop sophisticated dosing schedules that allow them to feel well even on days in which they’d normally be suffering. There is some evidence, however, that suggests that some teens develop co-occurring addictions due to genetic factors.
People with this condition don’t produce enough of a specific chemical that allows them to feel happy and at peace. Drugs of addiction do produce this chemical, and as a result, people who have bipolar disorder may experience a greater effect from drugs and alcohol. Just as people who’ve been walking in the desert for months would experience extreme joy at finding a glass of water, and that joy would be unmatched by people who have been living at home and who have access to water 24/7, people with bipolar disorder might be hardwired to enjoy drugs just a bit more. It’s easy to see how addictions might follow.
For example, according to research quoted by the National Institute on Drug Abuse, marijuana has been linked to the onset of schizophrenia in people who are already predisposed to the disease. The exact link is unclear, and researchers are even now parsing the evidence and attempting to determine how this drug could “turn on” a latent signal of schizophrenia, but it is clear that there is a link between the two conditions. Perhaps minor cell damage plays a role, and scientists haven’t yet found the specific cause of that cell damage. Similar studies are ongoing, attempting to determine how minor cell damage could play a role in the development of mental illness.
It is known, however, that the brain is wiring and rewiring during adolescence. The two hemispheres of the brain break their connections and reform them, and drug abuse could interfere with this process. Teens could develop tiny changes in their genetic codes, and their wiring processes might not be performed with precision, and this could lead to ongoing mental illness later in life. The addiction may have started this process.
The Effects of Co-Occurring Disorders
Abusing drugs or alcohol could make an underlying mental illness much worse. Teens who are depressed, for example, might feel a burst of euphoria due to drug or alcohol abuse, and this might make their blue feelings seem to disappear for a time, but when the substances wear off, those depressed feelings are still in place. In addition, abusive drugs tend to play on the same chemicals used by the brain to identify pleasure. As the drug abuse wears on, the brain may adjust by producing fewer natural pleasure chemicals. A modified brain like this is even less capable of experiencing joy, making the original depression so much worse.
Measuring the impact of this is difficult, but according to a study in the Journal of the American Academy of Child and Adolescent Psychiatry, teens with depression who abused drugs were likely to attempt suicide, while teens with depression who didn’t use drugs tended to simply talk about committing suicide. Both groups were suffering, of course, but those who abused drugs and had dual diagnosis issues just had more severe symptoms. The same could be said of almost any other mental illness. Once drugs enter the picture, healing is more difficult to achieve.
In addition, teens who are medicating their mental illnesses with drugs or alcohol aren’t really learning how to keep their disorders under control. They’re not coming up with techniques they can use to soothe their concerns and they’re not learning how to live a productive life when a mental illness is at play. These are the sorts of lessons they’ll need to master in order to handle their lives as adults, and they’ll need to start learning those lessons now. Without using drugs as a crutch, these teens could build the life skills they’ll need in the future.
Teens who abuse drugs and alcohol may anger their parents, and teens like this might also be subject to law enforcement action. Being yelled at by parents on a regular basis can make a teen feel yet more isolated, alone and misunderstood. The teen might feel as though he/she is using a reasonable approach to handle a terrible problem, and yelling might just make the teen feel so much worse. Being arrested can also be devastating for a teen, making educational and career options all the more difficult to come by. These episodes could push a teen back into substance use and misuse, as life has just become so much harder to live.
What Parents Can Do
Parents of teens with known mental illnesses can work to develop clear and open levels of communication, reminding teens to work with their doctors and therapists when their symptoms begin to overwhelm. Some teens may resist these discussions, and if so, therapists and doctors might be able to deliver the news in a way that is more palatable for the teen in need. Since some mental illnesses tend to run in families, these sorts of discussions might also be appropriate for teens who don’t have mental illnesses now, but who are likely to develop these types of issues in the future if they’ve inherited the susceptibility from their parents. Some parents find that discussing their own struggles with mental health is helpful, as teens will know what to watch for and when to ask for help, before a dual diagnosis situation begins.
Parents of teens who already have co-occurring disorders may also benefit from clear communication styles, but there are specific techniques that might help them to reach through to their children.
The National Alliance on Mental Illness suggests that parents:
- Avoid using if/then statements, such as: “If you loved me, then you’d stop.”
- Establish consequences for drug and alcohol abuse. It can be tempting to make allowances due to mental illness, but this approach rarely helps the teen in the long run.
- Use words of love and understanding.
- Remind the teen that recovery is possible.
Parents of these teens should also work hard to find an appropriate program that can offer real help. These programs might market their services using phrases such as, “co-occurring treatment” or “dual diagnosis program.” These programs might keep licensed therapists on site who can provide medications, unlike counselors who might be able to teach valuable lessons but who might not be able to prescribe medications. Recovery can be slow, and teens might need to lean on their family members for extra support as they learn how deal with these issues, but patient parents can see their children recover bit by bit and enter adulthood with healthy bodies and strong minds. All of the hard work will then be well worth it.
At Muir Wood, we offer a comprehensive dual diagnosis program for adolescent boys. We’re nestled in beautiful Northern California, and we utilize the nature around us to help our clients. Therapeutic hiking programs, camping trips and other experience-based therapies can awaken the inner strength of teen boys, and our strong therapy can help these teens learn how to build a stronger, more satisfying life. Please download our admissions packet to find out more, or call us to schedule an intake appointment.
Comorbidity: A merger of Mental Illness and Addiction
Teens who suffer from addiction may also be suffering from mental illness. In such cases both issues need to be treated.
An addiction can leave a teen feeling amazingly out of control. Thoughts of drugs pass across the teen’s mind all day, and the night might be filled with dreams of alcohol-infused binges. Just getting out of bed and starting on the day might be hard for a teen like this, unless the promise of some sort of substance looms in the future. Parents of a child like this might wonder why the abuse began, and they might be desperate to make it stop. Sometimes, that means dealing with a child’s mental illness.
When a person has both an addiction and a mental illness, it’s known in the medical world as a “comorbidity.”
Knowing a little more about how this issue develops, and what sorts of treatments tend to help, can ensure that parents get the right kind of care for their children, when a comorbidity is in play.
A Common Condition
Much of the research done on comorbidity has been conducted on adults, and the results of that work are startling. For example, in the National Co-Morbidity Study, 78 percent of men addicted to alcohol were found to have a mental illness as well. Studies like this seem to suggest that almost everyone who has some sort of addiction issue also has a mental health concern that’s lurking just below the surface, waiting to lash out. Since studies like this have demonstrated such a strong link between adult addictions and mental illness, many adult addiction treatment programs offer therapies that can assist with a mental health concern.
Parsing the issue in teens is more complicated, however, as teens often don’t fit into tidy diagnostic profiles. For example, in order to be diagnosed with a specific mental illness like depression, a client must demonstrate severe dysfunction that impacts that person’s ability to function in the world. A teen might find it hard to meet that standard, as that person’s parents might handle some of the child’s activities of daily living. Since the teen isn’t responsible for as much, the dysfunction isn’t as severe and the formal diagnosis might not apply. Similarly, a formal diagnosis of addiction relies on a longstanding pattern of behavior that might not yet be in place in a young person. That teen might have an abuse issue, per the medical guidelines, but not an addiction.
As a result, finding statistics regarding teen comorbidity is difficult, but it’s clear that there are many teens who deal with both addictions and mental illnesses on a regular basis, and often, those issues develop after years of dysfunction.
In an article about the progression of comorbidity in teens, published in the journal Science and Practice Perspectives, researchers suggest that teens who have this issue have spent much of their childhood laboring under the “difficult” label.
These are children who might grow up displaying undesirable traits such as:
- Refusal to take direction
- Inability to deal with frustration
They might be placed in classrooms with other children who also struggle with behavior and mental health, and they might feel as though they’re not quite smart enough or cheerful enough to succeed. As they age, children like this might become yet more hostile and difficult to reach, steeped in unusual thoughts and behaviors, and their peers might begin to entice them with substances of abuse. There’s little reason for a child like this to refuse, since life seems so difficult and unrewarding.
It’s likely that the parents of a child like this are aware that something is amiss, but they might struggle with finding a solution. The child doesn’t seem open to suggestions, and the parents might feel as though all the options they’ve tried have simply made the situation worse.
When it comes to comorbidity in teens, according to an article in Alcohol Research & Health, there are a few mental illnesses that seem most likely to stand behind a substance abuse problem.
The researchers name these conditions in particular:
- Conduct disorder
- Attention deficit hyperactivity disorder
Other researchers have found a link between adolescent-onset schizophrenia and substance use and abuse. These mental health conditions can intertwine and interconnect with substance abuse in different ways, but often, the mental illness is in place before the addiction begins, according to an article in The Journal of Clinical Psychiatry. This seems to suggest that teens turn to drugs in the hopes of making their mental illnesses fade, but unfortunately, drugs tend to make a problem like this so much worse.
Substances of abuse can seem like good options in the fight against mental illness, as they tend to bring about a burst of good feelings through complex chemical reactions. Sometimes, the chemicals drugs augment are the same chemicals that stand behind a teen’s mental illness. Someone with depression, for example, might have feelings of sadness due to low production of the brain chemical dopamine. Without this chemical, people just can’t find the joy in daily life. Substances like heroin can flood the brain with dopamine, and they can bring about feelings a depressed teen has been missing for quite some time.
As an addiction continues, the same drugs that once brought relief can enhance the damage that lies beneath a mental illness. Teens with depression may feel even lower pits of despair when they are sober, as their brain cells may refuse to produce dopamine unless drugs are involved. The sadness a teen like this felt prior to the addiction might pale in comparison to the depression a teen feels now.
Some drugs can also produce the same kinds of symptoms that are associated with the primary mental illness. Teens who have schizophrenia, for example, might see terrifying visions from time to time, and they might hear voices others can’t detect. If these teens take in a hallucinogenic drug like marijuana, they might push themselves into a psychotic period of hallucination. The drug might seem soothing, but it can be damaging.
Teens with comorbidity are often looking for relief in all the wrong places.
They do need assistance in order to soothe their distress, but that’s not the kind of help they’re likely to get from a bolt of alcohol or from a hit of illicit drugs. Often, the best help they can get comes in the form of therapy.
Programs that offer this therapy often use the words “dual diagnosis” to describe the work they do. Unlike other addiction therapy programs that might work to help teens to curb their cravings, a dual diagnosis program attempts to infuse the therapies provided with discussions of how mental illnesses work. The illness works like an addiction trigger, so it’s vital to get it handled.
Individual therapies might play a role, but group therapies might also be vital for adolescents. Here, they can work on specific skills regarding impulse control, emotional regulation and communication, and they can learn from the other members of the class. In a study in the journal Group, researchers found that this form of treatment was quite helpful for teens, as those who completed the program showed a significant improvement in their ability to control their behaviors and behave appropriately.
Some teens do need medication management in order to heal, but that treatment simply must be administered by a mental health professional in concert with addiction treatment, as some medications used to treat mental illness can become targets of abuse by young people. Teens with attention deficit hyperactivity disorder, for example, are sometimes provided with stimulant medications in treatment. While studies quoted by the National Institute on Drug Abuse suggest that medications like this aren’t associated with an increased risk of addiction, teens with free access might be tempted to sell their drugs or otherwise get into trouble. In the early stages of therapy, it’s vital to ensure that teens have close monitoring.
If your son needs help, we hope you’ll consider Muir Wood. We provide comprehensive dual diagnosis care for adolescent boys, using evidence-based treatment models that are provided by a staff of trained and dedicated professionals. Your son will have individualized therapy, along with group therapy, education, equine-assisted therapy and adventure therapy. We can even include your family in our treatment plans. We hope you’ll download our parent’s packet to find out more, or call us with your questions.
Dual Diagnosis Treatment: Comprehensive Programs for Teens With Drug Addictions and Mental Health Issues
Some teens who abuse drugs or alcohol have mental illnesses separate from their addiction issues. Teens like this, who are sometimes described as having a “dual diagnosis” or a “co-occurring illness,” can get better, but they might need specialized programs made just for them.
Addictions are technically considered a form of mental illness, as people who have addictions are unable to control their behavior when it comes to drugs and/or alcohol. Some teens who abuse drugs or alcohol have mental illnesses separate from their addiction issues. Teens like this, who are sometimes described as having a “dual diagnosis” or a “co-occurring illness,” can get better, but they might need specialized programs made just for them.
What Is a Dual Diagnosis, and How Is It Found?
In the Treatment Episode Data Set, researchers found that 27.7 percent of teens who enrolled in an addiction treatment program also had a psychiatric disorder. Researchers relied on treatment facilities to provide this information, however, and this could allow some teens to fall through the cracks. While some teens know they have mental health issues, and they’ll readily discuss their concerns when they begin their addiction treatment programs, other teens have never seen a mental health professional in the past and they have no idea that they have a disorder. If these teens are asked to describe their health, they may say that they’ve not had a problem in the past. They have no reason to think differently.
Screening tools for mental health can sometimes allow therapists to spot areas of concern at the beginning of an addiction treatment program. Not all facilities offer this kind of assessment, however, and teens with real behavioral problems might be lumped in with other teens who don’t have mental health abnormalities. In addition, an addiction issue can make diagnosing another disorder difficult, if not impossible.
Teens on drugs may exhibit many of the signs that are typically attributed to mental illness, and it can be hard for therapists to parse the source for the signs the teen displays.
Licensed mental health professionals are aware of the importance of identifying mental illness that lies beneath an addiction, and these people may work hard to find the warning signs in their clients. They may provide assessments at multiple times, when the teen arrives for detox and when detox is complete, for example, and they may ask family members and close friends for their opinions on the teen’s behavior. By spending time sleuthing, these experts may be able to peek past the veil of addiction and spot signs of a problem that others would be apt to miss.
What Is Integrated Treatment?
Since addictions and mental illnesses can look so much alike, causing many of the same symptoms and the same levels of intense distress, therapists once thought it best to treat the addiction first. If the mental health issue remained when the addiction care was complete, therapy would shift focus. Now, experts believe that providing integrated treatment that addresses both the addiction and the mental illness at the same time is the most effective way to care for a dual diagnosis issue. The results of this approach can be dramatic. For example, the National Alliance on Mental Illness reports that suicide attempts and psychotic episodes “decrease rapidly” when people are provided with integrated care. This seems to indicate that this kind of care provides people with a level of relief they may not attain via another treatment method.
Standard addiction treatment programs tend to be skills based, encouraging people to think of an addiction as the most important problem they need to solve at the moment.Therapy discussions all center on the addiction, and sometimes, the person’s past or preferences don’t even enter the picture. The idea is to help the person live in the now, dealing with the large and immediate problem, and then move forward with life. According to the National Institute on Drug Abuse, people with co-occurring conditions often have symptoms that are more severe and persistent than people who have just one problem at a time. A skill-based program that is time-limited might not be the best way to help these people to improve.
Dual Diagnosis Therapy
In an integrated program, a person will have access to a therapist and the two will work together to help address the addiction. This also happens in standard addiction programs, however, the therapy techniques used in these sessions might differ quite a bit. For example, people with conduct disorders or personality disorders may balk at traditional therapies that require them to push against uncomfortable topics. They may clam up or push back, and the therapy may grind to a halt as a result. Therapists may tweak their approaches, allowing people to form a relationship with their therapist before they’re asked to make changes in their lives. The therapy may move slowly, but it won’t be so uncomfortable that the person stops.
Family therapy might also be important in teen integrated treatment programs. Family therapy may help to address:
- Conduct disorders
- Behavioral problems
- Peer pressure
- Family attitudes
- Aggression or violence
- Poor communication
In an article in the journal Addiction Science and Clinical Practice, the author suggests that teens who develop addictions have a long history of “difficult temperament.” These teens are likely to be aggressive, impulsive and frustrated. They’re also likely to experience neglect or abuse. Placing a child in a home like this when addiction therapy is complete could lead to disaster, as all the original triggers for the addiction are still in place. Family therapy can help break the destructive habits all the members of the group have developed, and together, they can develop an environment in which the teen feels safe, nurtured and able to live without substances. Teens might also obtain vital help for their mental illnesses in this model, and the family might be better equipped to help the teen live with that mental illness in adulthood.
Treatment for Specific Mental Illnesses
Some diagnoses merit specialized care, and when that care is provided, the teen might be better able to both participate in therapy and stay enrolled in the treatment program. For example, teens with co-occurring addiction and attention deficit hyperactivity disorder may be using their addictions to keep their symptoms of arousal lowered and under control. When the drugs are gone, these teens may be wild, unable to concentrate and more likely to be disruptive. Therapies that allow these teens to use their bodies, by walking, squeezing a ball, painting, dancing or playing musical instruments could allow these teens a creative outlet for their energies, and this could help them to remain focused on recovery. In a study in the Journal of Substance Abuse Treatment, researchers found that these techniques could decrease arousal and allow people to both learn about their conditions and stay in treatment. Where these teens with behavioral problems might have been ejected from traditional programs, integrated treatment programs work to incorporate the teen’s mental health needs into all aspects of care provided.
People who co-occurring depression and addiction might also need additional therapies. These people might find it too difficult to talk one on one in a counseling session; they may be buried deep inside their thoughts, and all the images they see when they close their eyes are negative and sad. Breaking past this wall of depression can be difficult, but integrated treatment programs might use novel approaches that could help.
These programs might ask teens to:
- Work with animals
This places a bit of distance between the person and the therapist, allowing the person to express deep feelings without having to say them aloud, but these techniques can also give clients a glimpse of joy. They’ll be doing something enjoyable and rewarding, if just for a few hours, and this might provide the kind of motivation people need to keep working and healing.
Teens who have anxiety concerns might also benefit from specialized therapies in which they’re asked to face their fears step by step in a controlled environment in which the therapist is firmly in charge. These exposure therapies are designed to help people to become acclimated to the situations that cause them to feel intense stress and distress, and in time, people who go through this kind of therapy may be able to handle their memories and anxieties without feeling a need to abuse substances. In a study of the issue, in the Journal of Psychoactive Drugs, researchers found that adults who were given this kind of therapy for anxiety had reductions in drug use, as well as improvements in overall mental health. The same might be true of adolescents.
The Role of Medications
Some addictive drugs cause such intense damage within the brain that replacement medications are needed in order to keep cravings under control. This kind of damage is often associated with very high levels of drug use, and according to the Substance Abuse and Mental Health Administration, teens with dual diagnosis issues might fall into this category, as those who entered treatment for co-occurring disorders were likely to report daily use of the substances they abused. Medications might help to reduce the incidence of behavioral problems, allowing teens to feel calm and comfortable while their treatment programs move forward.
These medications are especially appropriate for teens who abuse opiates or opioids, including:
Not all dual diagnosis treatment programs require medications, however, and some teens are able to get better without taking any drugs at all. It’s a personal decision, made in consultation with the teen’s medical staff, the teen and the teen’s family.
Some mental health issues are also best treated with medications. Schizophrenia, for example, is responsive to medication management and teens with this condition may need to stay on these pharmaceutical therapies for the rest of their lives. The work might begin in their dual diagnosis program, providing the teen with the understanding that the illness is best addressed through prescriptions, not street drugs. Medications might also be used to assist teens with co-occurring depression, anxiety or irritability, smoothing the chemistry and allowing the teen to feel comfortable while the treatment moves forward.
How We Can Help
At Muir Wood, we know that mental illnesses can stand in the way of a full recovery from addictions. We offer a robust integrated treatment program for adolescent boys, and we offer our clients neuropsych testing at admission, to help identify any mental health deficits that may be in place. The testing is painless, requiring no needles or body scans, and it can help us to develop a clear understanding of the mental health issues at play in a teen who comes to us for help. By combining this testing with traditional mental health screening, we can ensure that we develop a comprehensive dual diagnosis program for our clients. If you’d like to know more, please download our admissions packet or just give us a call.