A Better Way to Treat Youths With Co-Occurring Disorders

More than 50 percent of teenagers in the U.S. affected by substance use disorder also have symptoms of at least one other serious mental health issue. Doctors use the term dual diagnosis to identify both adolescents and adults in this situation. In a study review published in December 2014 in the journal Substance Abuse, researchers from four U.S. institutions gauged the usefulness of a new, combined approach—called the Adolescent Community Reinforcement Approach—in treating simultaneous substance and mental illness problems in teens.
dual diagnosis in teenagers

Dual Diagnosis in Teenagers

Dual diagnosis is applicable whenever a person diagnosed with any form of substance use disorder (e.g., opioid use disorder or stimulant use disorder) also has a form of mental illness not directly related to dysfunctional substance intake. The presence of these overlapping issues is important because, generally speaking, a mentally ill person dealing with additional, serious drug or alcohol problems has a substantially smaller chance of recovering his or her health and well-being than a person with mental illness who doesn’t have additional substance problems. Underlying reasons for this fact include the tendency toward lack of treatment compliance in people affected by substance abuse/addiction and the potential for ongoing substance use to interfere with the most effective treatments for people dealing with depression and other forms of serious mental illness.

Just like their adult counterparts, teenagers with dual diagnosis commonly encounter difficulties that include a reduced likelihood of finding appropriate treatment for their condition, a reduced likelihood of staying actively enrolled in a suitable treatment program, an increased chance of falling back into a pattern of uncontrolled substance intake and a reduced chance of returning to mental wellness in the aftermath of treatment.

Dual Diagnosis Treatment

Some programs for people affected by dual diagnosis start by addressing issues related to substance abuse/addiction, then transition into the treatment of the specific forms of mental illness present in any given individual. However, other programs deal with substance-related issues and additional mental illness-related issues simultaneously. Forms of non-medication-based treatment used for teenagers with dual diagnosis include a behavior-changing form of psychotherapy called cognitive behavioral therapy, a family dynamic-oriented form of counseling called brief strategic family therapy and a social interaction-oriented form of counseling called multisystemic therapy. Medication-based options are essentially the same as the options used to treat separately identified cases of alcohol-, nicotine/tobacco- and opioid-related substance problems. However, researchers, doctors and public health officials know relatively little about how medication-based treatments affect the overall outcomes for people affected by substance problems and separately diagnosable mental health concerns.

A New Treatment Approach

The Community Reinforcement Approach (also known as CRA) combines aspects of cognitive behavioral therapy with aspects of family therapy. Both of these non-medication-based treatment techniques have demonstrated benefits for addressing issues of substance abuse/addiction, as well as for addressing issues of separately defined mental illness. In the study review published in Substance Abuse, researchers from the National Institute on Drug Abuse, Chestnut Health Systems, the University of New Mexico and Johns Hopkins University examined the results of a several previous studies that explored the usefulness of a specially modified form of CRA—known as the Adolescent Community Reinforcement Approach or A-CRA—as a treatment for teenagers affected by dual diagnosis. This modified form of the approach incorporates family counseling into the treatment process whenever possible; however, it also gives therapists the flexibility to adapt treatment when parental cooperation is difficult or impossible to achieve.

Specific teen-oriented adaptations found in A-CRA include encouragement of involvement in health-supporting leisure activities, improvement of program participants’ problem-solving skills, measurements of program participants’ general happiness levels, improvement of anger management skills, improvement of program participants’ relationships with their parents and improved monitoring of adherence to any medication routines that support overall treatment. After completing their review, the researchers concluded that these adaptations make the Community Reinforcement Approach suitable for teenagers affected by dual diagnosis. In line with this conclusion, they recommend that dual diagnosis programs for teenagers begin incorporating elements of the Adolescent Community Reinforcement Approach.

The study review’s authors note that their recommendation is tentative and based on the proven effectiveness of cognitive behavioral therapy and family therapy as treatments for substance-related problems and separately diagnosable mental health problems. They point toward a need for additional research to further clarify the potential benefits of A-CRA for specific combinations of substance and mental health issues.

Posted on March 8th, 2016

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