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Teen Angst and Rebellion or Something More?: How does comorbidity with anxiety, depression, and substance use occur in and affect teens?

An Introduction

…about half of people who experience a mental illness will also experience a substance use disorder at some point in their lives and vice versa.

National Institute on Drug Abuse

What you need to know

Comorbidity is defined as having ‘two or more disorders or illnesses occuring in the same person,’ occurring ‘at the same time or one after the other,’ with interactions between the two worsening the effects of both.

National Institute on Drug Abuse

Images of Brain Development in Healthy Children and Teens (Ages 5-20)

PNAS 101:8174–8179, 2004.

In 2018, it was reported that an estimated 9.2 million US adults experienced a simultaneous substance use disorder and mental disorder (“Substance Use Disorders” [National Alliance on Mental Illness]). While there are fewer statistics and studies available about the presence of comorbidity in adolescents, some have suggested that there are also high rates of it in youth populations. After all, it is commonly known that mental disorders often emerge during teenage years (prompted by the great emotional, social, physical, and other changes that teens go through) and additionally, teens are more likely to begin using substances because while the reward-processing aspects of the brain may have already matured, the brain’s rational decision making center (the prefrontal cortex) is still developing (“Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide”).

 Differences in Substance Use preferences based on age.

SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013.

Depression, Anxiety, Behavior Disorders, by Age

Center for Diseases Control and Prevention. “Depression, Anxiety Behavior Disorders, by Age.” Center for Diseases Control and Prevention, U.S. Department of Health & Human Services, www.cdc.gov/childrensmentalhealth/data.html.

Furthermore, as the definition of “comorbidity” suggests, the effects of a mental disorder can exacerbate those of a substance use disorder (and vice-versa). Experiencing a mental health condition like depression or anxiety may prompt people to self-medicate using substances (substances that lower inhibitions, such as alcohol, can help reduce the experiences of anxiety and drugs could give those with depression a temporary reprieve) but dependency on substances can eventually worsen the symptoms of the mental illness. As those who are addicted to substances may be going through effects like withdrawal symptoms, worsening social relationships, relapses, and school failure, their mental health may take a turn for the worse; among other things, substance addiction can be a trigger for conditions like depression.

Substances definitely help me de-stress in social situations. That’s why I initally liked them. And then they helped me with my general anxiety…like in empty voids, especially during times like quarantine, they allow me to just ‘vibe.’

Anonymously Interviewed Peer

With all this in mind, it is additionally no help that there is currently no clear protocol for comorbid disorder treatment in adolescents. A study from Brown University in 2013 reported that out of surveyed mental health treatment providers, while 93% “claimed that they were treating co-occurring disorders in youth,” only 10% “reported using specific treatment protocols for co-occurring concerns in adolescents”  (Lichtenstein, et. al).

Although some treatments have proved slightly better than others, such as Multidimensional Family Therapy (therapy with a focus on family relationships) and Cognitive Behavioral Therapy (which includes goal-centered techniques used to eliminate negative behaviors and thinking patterns–things applicable to both mental disorders like anxiety or depression and substance dependency), most research on comorbid disorder treatment is primarily centered on adults, leaving a problematic lack of solutions for teens (Waldron and Turner).

My Response: What Can We Do?

Given how little information there is out there about the epidemiology and treatment of comorbidity in teenagers as of now, it is safe to say that it is not a very widely discussed topic…therefore, unfortunately, I discovered that there is currently no clear protocol for how we can enact change; since the majority of us are not advanced researchers (yet), there is not much we can do about exploring the efficacy of various comorbidity treatments in youth. Despite all of this, however, some general things we can do to help for now are as follows:

> Get educated and get talking!

> Be there for yourself and your peers.

Get educated and get talking!

“People with Speech Bubbles.” Harvard School of Public Health, The President and Fellows of Harvard College, 23 July 2014, www.hsph.harvard.edu/news/features/do-women-talk-more-than-men/.

Even though comorbidity in youth (especially with anxiety, depression, and substance use in specific) is not very well-researched, we can start talking about the information that we do know; maybe then, with it being more widely discussed and acknowledged as relevant to teens, more research will be conducted on it or, at least, susceptible teens will have more awareness about it. Research says that there is greater stigma around mental health and substance use in youth, so it’s important that we work to break that stigma (Hawkins). So:

  1. Learn what you can about comorbidity (this WordPress or this page from the National Institute on Drug Abuse may be a good starting point)
  2. Start talking about it with your peers when mental health comes up (here’s a general guide to talking about mental health with those in your life provided by the U.S. Department of Health & Human Services)
  3. Push your health curriculum to include its discussion (if it doesn’t already)–my school’s curriculum does not currently include its coverage and nearly all of my peers whom I interviewed agreed that it should be included.

…even if not all teens start substance use with previous disorders, it’s definitely good to know about comorbidity in case it does start happening so they have an explanation and somewhere to work from.

Anonymously Interviewed Peer, in reaction to the “Get educated and get talking” response

Be there for yourself and your peers.

“Peer Relationships at Work Graphic.” Bonusly, Bonusly, blog.bonus.ly/hubfs/peer-relationships.jpg.

If you think that you are experiencing comorbidity, seek help and encourage others to do so as well. Even with the lack of a clear consensus on what “works best” to treat comorbidity in teens, as previously mentioned, there are still viable options for therapy that acknowledge both/all of your disorders rather than focusing on treating each individually, without consideration of their effects on each other. 

There are many ways to find therapy options that work for you:

  1. Talk to your primary care physician and request a referral to a counselor or therapist and also do some research into your state’s (if you’re in the U.S.) laws on minor consent for treatment and parental notification if you need (here is an example of a chart of Health Care services available for minors without parental consent provided by WA state).
  2. Search for a therapist online at sources like Psychology Today.
  3. Some crisis lines can help if you need some additional assistance finding therapy services, etc. Some teen-specific lines exist, such as Teen Link!

How will you help?

In the comments below, please consider and share:

  1. How might greater awareness about comorbidity benefit teens in your community?
  2. What might you start to do to increase awareness around comorbidity in teens in your community?
  3. Do you know of any other ways in which teen comorbidity can be tangibly approached for the general public or specifically in your community?

Works Consulted and Cited

Feel free to check out some of my Works Cited and Consulted if you are interested in learning more about comorbidity in teens!

Works Cited for presentation on Teen Comorbidity, GOA, 2020 (Katie Wang)

Share this project
COMMENTS: 10
  1. April 23, 2020 by Emma McDermott

    Hi Katie! I really enjoyed reading through your project. It was a very informative piece on a topic that in general does not have a lot of information! Your work was very organized, and I loved the inclusion of quotes throughout. It broke up the text and made reading more manageable. You also really catered to the needs of your audience by including lots of resources and links! I think a greater awareness of comorbidity would be really beneficial at my school because a lot of students experience both anxiety and depression, and knowing that others experience the same feelings would open up a conversation and help them feel less alone. I definitely think that you could share this project with people at your school to start spreading awareness too!

    • April 25, 2020 by Katie

      Thank you so much for your kind words Emma! I’m glad to hear that you think my project could be a suitable medium for awareness-spreading/educating students.

  2. April 23, 2020 by Helena

    hi katie this is really really great work! You explain very eloquently the mental illnesses you are focused on and really show how “comorbidity” , a term I had never heard before but now love, intersects with addiction. This was really thought provoking and made me think deeply about my own experiences and observations in the world around me.

    How might greater awareness about comorbidity benefit teens in your community?
    i think when you understand how mental illnesses interact with one another inside of a person you will better be able to empathize and understand them. This will make you more able to help them. i always feel like anxiety and depression are doing a little dance in my body and i think you explained really well what this is like for a lot of people.

    What might you start to do to increase awareness around comorbidity in teens in your community?
    i would def start out by looking at highschool health curriculums so that teens and learn about mental health in order to assess their own. sometimes you don’t know you need help till you learn how to identify mental illness within yourself.

    Do you know of any other ways in which teen comorbidity can be tangibly approached for the general public or specifically in your community?

    I think communities should find a way to share personal stories so that people can build empathy and understanding.

    • April 25, 2020 by Katie

      Hi Helena! Thank you so much for sharing your thoughts and also how they relate to your own experiences. I definitely agree that learning more about mental illness in general would help with building empathy in peers. I also think that finding a way to share personal stories through communities would be fantastic (maybe like some sort of curated anonymous high school blog about mental health experiences?).

  3. April 24, 2020 by Elise

    Katie!!!! Thank you for getting this conversation started and making it really easy to comprehend what comorbidity is and what the scope of the issue is to someone who was previously uneducated about it! At our school, we learned about substance usage and mental health separately, but I can’t recall learning about the intersectionality between them. Nice work!

    • April 25, 2020 by Katie

      Elise, thanks so much for stopping by my page! I’m glad that my explanation was understandable for you. I think that the division between substance use and mental health education is a very common thing in health curriculums and it’s vital that their intersection is addressed!

  4. April 25, 2020 by Jadyn

    Hi Katie!
    I really loved your project! You made it easier to understand a more complex subject and I think that considering there is not much information on it I think you did a fantastic job! I also really loved that you gave us questions to think about and answer at the end, it helps the audience sit back and digest what they just learned. I think that one way that it can be approached in a school setting is maybe to talk about it in health class or at an assembly for mental health. I think that by doing this it is a great way to share about comorbidity to a larger audience and especially in a health class you are letting students open up and share their thoughts on this topic and how they feel.

    • April 26, 2020 by Katie

      Hi Jadyn–Thanks for checking out my project! I’m glad that you were able to learn a little about comorbidity. I really love your idea of including comorbidity in health classes or mental health assemblies. I think one of the big problems with its coverage is that it’s excluded from these types of things, despite other forms of mental health being covered.

  5. April 26, 2020 by Charlotte

    Hi Katie! I think your presentation was incredible. Comorbidity is honestly never spoken about to the level that it should be, considered it effects more individuals than what we are aware of on a day-to-day basis. Also, it is a really complex topic that can be challenging to understand and explain, but I think you did a great job of it. I really loved how you added ways to watch out for peers, in addition to resources that are accessible to most teenagers. With any mental health challenge, stigmas come along with it, so I think addressing comorbidity to relieve some of those stigmas and provide awareness is a really important step for teenagers to overcome these issues. Again, great job on the presentation!

    • April 27, 2020 by Katie

      Thanks for stopping by and for your kind words Charlotte! Stigma definitely comes with most mental health, so I agree that comorbidity is no different in the respect that greater awareness about it is super necessary, especially in teenagers! I hope that my project was helpful for you and provided some information that you can possibly share with your classmates in the future as well. 🙂

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