…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
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”).
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!
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:
- Learn what you can about comorbidity (this WordPress or this page from the National Institute on Drug Abuse may be a good starting point)
- 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)
- 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.
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:
- 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).
- Search for a therapist online at sources like Psychology Today.
- 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:
- How might greater awareness about comorbidity benefit teens in your community?
- What might you start to do to increase awareness around comorbidity in teens in your community?
- 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!