Muir Wood therapist, David Laing
Muir Wood Adolescent and Family Services is a Joint Commission-accredited mental health and substance use disorder treatment provider located in Petaluma, California. We provide integrated evidence-based care including psychiatry, psychotherapy, experiential therapy, wellness services, and milieu therapy for adolescents and teens, and their family members.

Comorbidity

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.

Life History

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:

  • Aggressiveness
  • Impulsivity
  • Hostility
  • 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:

  • Depression
  • Anxiety
  • 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.

Deepening Misery

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.

Finding Relief

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:

  • Hike
  • Paint
  • Work with animals
  • Write

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:

  • Heroin
  • Vicodin
  • OxyContin
  • Morphine

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.


Further Reading

Co-Occurring Disorders

Dual Diagnosis Treatment