Co-Occurring Disorders and Treatment for Adolescents and Young Adults
In a perfect treatment world, professionals would have only one disorder at a time to deal with. Problem is, health disorders don’t always play fair.
“Co-occurring disorders compound the difficulty of treatment.”
Co-occurring mental and emotional problems can occur in adolescents and young adults if their intrapersonal growth is not yet ready to deal with social/environmental demands. Essentially, what happens is such external demands overly tax or exceed current coping abilities, which can lead to substance-use or self-medication, and ultimately substance abuse. On the other hand, drug and/or alcohol use may well precede and actually be the factor that unleashes the presentation of various mental and emotional disorders.
This population of impaired individuals has traditionally presented greater difficulty in treatment engagement, had higher rates of treatment dropout, the focus of a disproportionate use of expensive services, and greater problematic physical-mental-emotional health disorder symptom experience.2
“Houston, we have a problem,”
Apollo 13 Moon Flight, Astronaut Jack Swigert
By definition, a co-occurring disorder is one where there is an addiction to some kind of substance and the presentation of a mental and/or emotional illness. In some cases, the addiction pre-dates the mental illness, while in others the mental illness was there first.5 The addiction can be to drugs, alcohol or even various addictive medicines. The mental or emotional illnesses can include various depressive disorders (bipolar, SAD, etc.), conduct disorder (CD), oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADD), anxiety (panic, social, etc.), and post-traumatic stress disorder (PTSD).3, 4
And the treatment conundrum for this problematic situation will be which do you treat first, or can they be treated simultaneously? Of the most common CODs, is it alcoholism first, or depression? Is it anorexia or cocaine dependence? Prescription-drug dependence or anxiety? PTSD or heroin addiction? Or, is there a way to treat both and see success on both fronts.5
“Which comes first, the chicken or the egg?”
Plutarch, The Symposiacs, 1st Century
Treatment for CODs
It is not by chance that adolescence and young adulthood is the time for the “perfect storm” for such co-occurring disorder emergence. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), such a confluence is likely due, at least in part, to the fact that so much is going on developmentally within a very short period of time and having to prematurely come up against developmentally-unique psychosocial stressors, such as the initiation of independent living and educational/vocational transitions. Turns out, adolescents and young adults are especially vulnerable to the presentation of both SUD and COD.
Bergman’s studies concluded that while further research is needed, especially in important clinical subgroups (co-occurring CODs without SUD), with the right treatments, dual-diagnosis patients can simultaneously improve on all disorder fronts. The treatments that proved to be most effective in Bergman’s studies emphasized “high-quality, multi-disciplinary, psychiatrically integrated residential SUD treatment.” Patients of clinicians without SUD-treatment experience, or the presence of typical residential conditions, focusing only on COD manifestations, did not fare as well to conventional outpatient-type services. Study results suggest that parents consider referral to residential programs that integrate evidence-based psychosocial and psychopharmacological intervention.1
“Living with both a mental health disorder and substance abuse or addiction is a deadly combination.”
American Addiction Centers
Two previous studies showed promise for non-pharmacological treatment options for COD and SUD. These studies demonstrated promising results regarding long-term effectiveness and support. The first study showed that cognitive behavioral therapy and motivational enhancement therapy (CBT/MET) can reduce both mental health symptoms and substance use in young people with co-occurring disorders two years after treatment. The second study found that those young people with co-occurring disorders who had high rates of participation in a 12-step program (AA, NA, etc.) had higher levels of abstinence from alcohol and drugs years later.2
The stance of the American Addiction Centers is that patients participate in intensive medical and therapeutic intervention and care for both disorders at the same time. Comprehensive care that begins in detox and continues long after treatment in aftercare is the most effective way to build a new life in recovery from co-occurring disorders.5
The kind of program recommended by the American Addiction Center is an “integrated” treatment program, one that offers all the medical, therapeutic, and holistic resources necessary to help patients heal physically, mentally, emotionally and spiritually. The specifics of any treatment plan must be integrated to meet the unique needs of the patient involved.5
1 “Young Adults with Co-occurring Disorders,” Brandon Bergman, Center for Substance Abuse Treatment, 2015.
2 “Treating Young People with Co-occurring Disorders: What Works,” J.R. Cornelius, F.W. Chi, 2014.
3 “Co-occurring Disorders,” Youth.
4 “Depressive Disorders,” and “Anxiety Disorders,” National Institute of Mental Health.
5 “Co-occurring Disorders Treatment Guide,” American Addiction Centers, 2015.