As people use intoxicating substances on a regular basis, their bodies typically adjust to the substance. This means that they need to take more and more of the substance to get the desired “high.” Using substances via intake methods that deliver more of the substance to the brain Mental Health Disorders Many people who have SUD are also diagnosed with mental health disorders, and people with mental health disorders may also be diagnosed with SUD. Various national population surveys show that approximately 50% of persons with a mental health disorder also have a SUD and vice versa. There are few studies on comorbidity in the youth population. However, available data indicate that over 60% of adolescents in community-based SUD programs also meet the diagnostic criteria for a mental health disorder. Around one in four people with serious mental illness also have SUD (National Institute on Drug Abuse, 2020). Some of the most common mental health disorders that coexist with SUD include the following (National Institute on Drug Abuse, 2020; SAMHSA, 2020). ● Anxiety and mood disorders ● Schizophrenia ● Bipolar disorder ● Major depressive disorder ● Conduct disorders ● Posttraumatic stress disorder (PTSD) ● Attention-deficit/hyperactivity disorder (ADHD) Many youth present with a dual diagnosis of substance use disorder and a personality disorder. An accurate diagnosis of personality disorder can be made for older adolescents if the symptoms are pervasive and persistent, and the behavior is not consistent with a developmental stage or an episode of another disorder. However, it should be Timing of Drug Use During adolescence, the brain continues to develop. In fact, functions such as decision-making and impulse control are among the last to mature. These functions are critical to making mature decisions and are lacking, to some extent, in younger adolescents. Therefore, early drug use is a very strong risk factor for the later development of mental health disorders. Development is also associated with other risk factors such as genetic influence, psychosocial experiences, and/or general environmental factors (National Institute on Drug Abuse, 2020). ● Borderline personality disorder ● Antisocial personality disorder Some research findings show that mental health disorders may precede SUD. Thus, early diagnosis and treatment of mental health disorders may help to decrease comorbidity. Other findings suggest that young adolescents develop internalizing disorders, or disorders that are grounded in distress emotions such as depression and anxiety, before developing SUD (National Institute on Drug Abuse, 2020).
swiftly soon occurs. Injecting is one way to accomplish the desired rapidity of delivery. Individuals who get to this point of substance use without treatment are more likely to share needles and contract hepatitis C (American Addiction Centers, 2019). noted that personality disorder features that are present in adolescents usually do not remain into adulthood. Therefore, to diagnose an adolescent (or anyone younger than age 18) with a personality disorder, the symptoms must have been in existence for at least one year (APA, 2013). This criterion rules out a significant number of young people. There is one important exception to diagnosing adolescents with a personality disorder: Antisocial personality disorder. A diagnosis of antisocial personality disorder cannot be made in adolescents because the definition of this disorder includes the existence of dysfunctional behavior that begins in childhood or early adolescence (must contain some of the criteria for conduct disorder before age 15). All other personality disorders can, theoretically, be diagnosed in adolescents, but personality disorders are seldom diagnosed in young people. Of course, if the adolescent has symptoms that meet the diagnostic criteria for such a disorder, then this diagnosis should be given (APA, 2013). Many mental health providers are reluctant to definitively diagnose an adolescent for fear of labeling a situational reaction or transient developmental issue without long-term evaluation. Healthcare Professional Consideration: During an adolescent’s transition to young adulthood (18–25 years of age), if they have comorbid disorders, they need coordinated support to cope with life’s challenges and achieve maximum states of wellness (National Institute on Drug Abuse, 2020). Research findings indicate that untreated ADHD in youth increases the risk for SUD. Healthcare professionals must identify whether these young people have received effective ADHD treatment and what treatment initiatives have been implemented (National Institute on Drug Abuse, 2020). Treatment of childhood ADHD often includes the administration of stimulant medications such as amphetamine. This is a matter of concern, since prescribed stimulant medications have addictive potential. Research findings are not consistent regarding this treatment. Some studies suggest that AHDH medications do not increase the risk of SUD among children. It is essential that when stimulant medications are prescribed, healthcare professionals teach patients and families about the chronic nature of ADHD and the risk for SUD (National Institute on Drug Abuse, 2020).
CONTINUUM OF CARE
It is important to incorporate a continuum of care for SUD in adolescents if treatment is to be effective. The care continuum begins with prevention and education; involves outreach for adolescents who are more difficult to reach; and occurs across various care settings, including outpatient, inpatient, residential and therapeutic communities, and halfway houses.
Healthcare Professional Consideration: Acute inpatient detoxification is the first step in the treatment and recovery process. Detoxification is not considered to be a treatment itself. Acute inpatient care settings can provide medications that can help to suppress withdrawal symptoms during detoxification. It is important to note that persons who do not receive further treatment after detoxification (e.g., via therapeutic communities or halfway houses) usually resume their substance use (National Institute on Drug Abuse, 2019b).
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Book Code: SWUS1525
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