When Substance Use and Mental Health Collide

This commentary is co-authored by Harold S. Koplewicz, MD, president of the Child Mind Institute, and Fred Muench, PhD, president of Center on Addiction.

Getting help for a young person with a mental health disorder or a substance problem is hard. It’s even harder when these disorders occur in the same person. These “co-occurring” mental health and substance use disorders (often referred to as comorbid disorders or dual diagnosis) are common. One in five young people struggle with a mental health disorder like ADHD, anxiety disorders, depression and millions of adolescents and young adults misuse alcohol, illegal drugs or prescription medications. Studies show there is a 30% to 65% overlap between these two groups.

Often, when a mental health disorder goes untreated, a young person will attempt to self-medicate — using substances to relax, fit in socially, numb emotional pain, or relieve anxiety. Studies show that ADHD, anxiety disorders, post-traumatic stress disorder and depression all increase risk of drug use and dependence in adolescents. At the same time, substance use poses a serious risk for developing mental health symptoms including psychosis, depression and manic or unusually irritable mood states.

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Self-medication may be understandable, but adolescents and young adults are usually loathe to admit it. When young people are referred for help for a mental health disorder, they can be reluctant to talk about substance use. Similarly, young people being evaluated for substance use problems will often avoid discussing emotional or behavioral problems.

This lack of information can make it hard to get an accurate diagnosis. Furthermore, substance use and mental health symptoms mimic one another, confusing diagnosis for professionals without expertise in mental health and addictions. Treatment often depends on the luck of the draw; if a family seeks out a substance use professional without mental health expertise, that side of the equation can go unaddressed. Similarly, mental health professionals without substance use knowledge may miss troubling signs or promising avenues for treatment.

In our new guide to substance use and mental health disorders in adolescents and young adults, Center on Addiction and the Child Mind Institute recommend integrated care in situations where young people are suspected to have co-occurring disorders. Thorough evaluation, diagnosis and treatment planning for these cases requires a professional with expertise in both mental health and addiction.

Parental education and empowerment is a crucial component to improving outcomes. Parents are the first responders and key to noticing changes in thoughts and behavior, helping youth start treatment and supporting ongoing recovery. Their involvement sets the stage for success. Here are a few tips for how families can help young people get better:

• It is critical for clinicians to talk with family members, teachers and other providers to get a full picture, and for family members to connect with clinicians.
• Even if your child refuses treatment, consider healthy alternatives (sports, music lessons, yoga) to begin the process of integrating healthy alternatives into their lives.
• Quality treatment addresses both mental health and substance use treatment simultaneously.
• A comprehensive treatment plan includes evidence-based therapy approaches, medications, family involvement, connection with positive social activities and is age and gender appropriate.
• Continuing care and relapse prevention are vital, including through mutual and peer support.
• Family involvement results in better outcomes for both children and parents.
• The family consists of any supportive individuals including parents, grandparents, older siblings, trusted friends, or other caregivers
• Support includes family counseling and ongoing community engagement.
• Knowing signs of relapse for both substance use and mental health help families intervene early.