COEXISTING DISORDERS IN AN ADOLESCENT PATIENT WITH A SUBSTANCE USE DISORDER Many adolescents who present for substance use treatment may also have other diagnoses, such as conduct disorder, anxiety disorders, trauma- and stressor-related disorders, bipolar and related disorders, depressive disorders, attention-deficit/ hyperactivity disorder, or oppositional defiant disorder. For example, many substance-using adolescents exhibit symptoms of bipolar and related disorders; substance use may represent these adolescents’ attempt to self-medicate for their symptoms. The high prevalence rates for co-occurring diagnoses in adolescents have led some researchers to note that dually diagnosed adolescents are not a special subpopulation but are instead the norm (Yoshimasu et al., 2016). Thus, an important aspect of working with adolescents relates to the diagnosis of coexisting disorders.
Physical Illnesses Several physical illnesses are public health concerns for both patients and healthcare professionals in SUD treatment programs. These include HIV, AIDS, and viral hepatitis. HIV infection prevention and reduced infection rates are central goals in SUD treatment programs. Research indicates that HIV testing and risk-reduction interventions are linked to cessation or reduction of drug use as well as associated high-risk behaviors, such as unsafe sex (SAMHSA, 2020). HIV/AIDS HIV can be contracted when someone comes into contact with the body fluids of an infected person. Having unprotected sex and sharing needles when participating in injection drug use are examples of methods of HIV transmission. If women are infected and are not treated, they can pass HIV to their infants during pregnancy, delivery, and lactation. Alcohol and drug misuse can exacerbate symptoms of HIV (SAMHSA, 2020). Evidence-Based Practice In 2019 in the U.S., people who injected drugs accounted for 7% (2,508) of the 36,801 new HIV diagnoses. Men who injected drugs accounted for 4% (1,397) of the new HIV diagnoses. Women who injected drugs accounted for 3% (1,111) of the new HIV diagnoses (CDC, 2021c). 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
Hepatitis The three key strains of viral hepatitis infection are hepatitis A, hepatitis B, and hepatitis C. Vaccines are available for hepatitis A and hepatitis B. Currently, there is no vaccine available for hepatitis C. The primary source of hepatitis C infection in the U.S. is injection drug use. Injection drug use is a significant risk factor for contracting and spreading hepatitis C (SAMHSA, 2020). Although most hepatitis C infections occur via exposure to blood from unsafe injection practices and drug use, there are additional major causes, including unsafe healthcare practices, unscreened blood transfusions, and sexual practices that lead to blood exposure (World Health Organization [WHO], 2019 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 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). consistent with a developmental stage or an episode of another disorder. However, it should be 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). 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). 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.
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)
● Borderline personality disorder ● Antisocial personality disorder
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 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.
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Book Code: SWUS1524B
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