MIAMI – Co-occurrence of mental health and substance use disorders is a substantial problem among American adolescents, Jorielle R. Brown, Ph.D., said at the annual conference of the American Society of Addiction Medicine.
Many teenagers go untreated for mental health disorders, even though about half of all lifetime mental illness begins by age 14, and some turn to illicit drugs to self-medicate, she said.
Mood disorders top the list of co-occurring disorders (CODs). For example, a major depressive episode is reported by 14% of adolescents with substance use disorders, especially in the older age range. In certain populations, the prevalence is even higher. For example, mood and anxiety disorders are the leading co-occurring mental health conditions in incarcerated youths with a substance use disorder, affecting nearly 33% of these teenagers.
Among 12- to 17-year-olds who report having used illicit drugs in the past year, 32% also have mental health problems, according to 2005 data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Those adolescents who reported a major depressive episode in the past year also were more likely to report illicit drug use in the past year, as well as daily cigarette use and heavy alcohol use in the past month.
Physicians can intervene early and make a difference, Dr. Brown said. For example, there is a need to identify the “diagnostic orphans.” These are the teenagers who meet only one or two criteria for alcohol dependence and none for abuse, but who will later develop a more serious problem. Screening can identify these patients, she said.
“Engagement is critical with adolescents,” Dr. Brown said. “You want them to stay in contact with you so treatment can later take place.”
When working with teenagers, address specific, real-life problems early in treatment; plan for cognitive and functional impairments; and use support systems to maintain and extend treatment effectiveness. “With our youth, we often have to be very creative in finding their support system if their family is not there,” said Dr. Brown, a public health advisor at SAMHSA's Co-Occurring Center for Excellence.
Early identification of adolescents at risk may reduce the number of referrals from the juvenile justice system, Dr. Brown said. The fact that criminal justice is the leading source of adolescent referrals for addiction treatment is “very depressing for me,” she continued. “COD is not addressed until someone does something criminal. We see [it] in schools, but we don't do anything until they steal something or hurt someone.”
Another reason that physicians should screen for CODs is that “treatment works. And the earlier the treatment, the better the outcomes,” Dr. Brown said. Use of medications also must be part of a comprehensive treatment plan that includes nonbiologic interventions, she added.
Although there is paucity of data on medications for COD in adolescents, fluoxetine, for example, appears promising for the treatment of depression with co-occurring alcohol use, Dr. Brown said. In addition, case reports indicate that bupropion might benefit patients with both attention-deficit/hyperactivity disorder and drug dependence. Medications to treat alcohol-related cravings, such as naltrexone, also have been effective in adolescent case reports, she said.
For more information, call SAMHSA's Center for Substance Abuse Treatment National Helpline at 800-662-4357 or visit www.samhsa.gov