Mental Illness and Co-occurring Substance Abuse Disorders
By Dr. Ramesh Vemuri

Childhood is a critical time for the development of life skills and the failure to treat co-occurring disorders early has devastating long-term social consequences.   Almost half of all youth receiving mental health services in the United States have been diagnosed with a co-occurring disorder.  Youth with behavioral disorders (i.e., conduct disorder, attention deficit disorder) are more likely to develop substance abuse disorders than youth with anxiety or depressive disorders, who are still two to four times more likely than their peers without mental disorders to develop substance abuse disorders.

    One out of every 8 adolescents with a mental illness has a co-occurring substance abuse problem.  Various explanations have been offered to explain substance use by people who have mental disorders. Many professionals believe that youth “self-medicate” with drugs or alcohol in order to relieve emotional states such as anxiety and depression. This may be especially true of youth with mood disorders. Some researchers attribute drug use to sensation-seeking, risk-taking, and impulsive behavior that are usually associated with the disruptive disorders or disorders such as conduct disorders and ADHD. (Risk-taking behavior is also characteristic of adolescence in general.) Finally, some professionals point to the role that stress plays in bringing on both addiction and symptoms of mental illness in many vulnerable individuals. Studies have suggested that the mental disorder preceded the addictive disorder in over 80% of cases where there are co-occurring disorders, particularly those that develop during adolescence.

     Regardless of the reasons why people with mental disorders use substances, youth with severe mental illness and substance abuse often experience more negative outcomes—such as higher rates of hospitalization, incarceration, school drop out, etc.   They also tend to drop out of traditional outpatient treatments more often, use more services, and cost more to serve than individuals with single disorders. In fact, youth with co-occurring disorders have worse outcomes than youth with substance abuse problems alone.  Untreated, this youth with co-occurring disorders have high rates of suicide, medical problems, truancy, academic problems, legal involvement, difficulty functioning in school or work, and tend to have poor peer and family relations.

     Research shows that integrated mental health and addiction treatment programs that are specifically designed for people with co-occurring disorders are most effective. For youth, services should be comprehensive and integrate academic, legal, health, recreational/social and treatment services.    A team of professionals including psychiatrists, school psychologists and social workers, and specialists who are trained to assess and treat children with co-occurring disorders are essential and integral to recovery.  These services must be designed to match the needs of the child’s developmental stage.

   Often, those adolescents with co-occurring substance abuse and mental health disorders receive treatment from two separate agencies that focus on either the mental health issues or the substance abuse issues. Sometimes, the adolescent is excluded from both treatment approaches because of the complication of the second disorder.  Often the focus on just one primary disorder results in poor treatment outcomes.  Integrated treatment is superior to sequential or parallel treatment (treatment provided by two different agencies or treatment providers). 

     Effective interventions must be related to the school, peer, and family systems where adolescents routinely socialize and receive reinforcement for their behavior. Treatment options that show the best evidence of effectiveness are those that provide extensive outreach to engage and motivate the individual and also include behavioral therapies, intensive case management, cognitive-behavioral skills training, family-oriented therapies, and Multi-systemic Therapy

Youth Service Bureau
101 South Jefferson St.
Woodstock, IL 60098
815-338-7360