Teens at Muir Wood enjoy game night

Co-Occurring Mental Health Disorders

A Double-Edged Sword That Requires Comprehensive Treatment


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 teen’s reasons for abusing drugs could be radically different than another person’s reasons for following an addictive path.

For some teens, substance misuse often develops 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
  • Depression
  • 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 teens. 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 teens, 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.