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When Should a Parent Consider Adolescent Dual Diagnosis Treatment Centers?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Treatment for Teens With a Substance Use and Mental Health Disorder

When a parent finds out their teen has a substance use disorder (SUD) or an alcohol use disorder (AUD), the first thing they want to do is to help their child heal. In most cases, they seek evidence-based treatment for addiction. They ask friends, search online, and take the advice of their teen’s therapist or counselor and find the most reputable adolescent treatment center they can. They want the highest quality professional support possible to help their child break free from the negative cycles of alcohol and/or substance abuse.

It’s well-documented that long-term addiction takes a serious toll on an individual. Chronic exposure to alcohol and drugs leads to physical, emotional, and psychological problems. It has a negative impact on school, family, peer relationships, and participation in extracurricular activities. Untreated alcohol and substance abuse in high school correlates with lower college attendance, higher dropout rates, and increased likelihood of adult unemployment.

Untreated mental health disorders create similar problems. The symptoms of disorders like depression, anxiety, or bipolar disorder can prevent a teenager from participating in the typical daily activities of teenage life. Symptoms – whether mild, moderate, or severe – can impair relationships with family and friends, degrade academic engagement and achievement, and disrupt participation in extracurricular activities, hobbies, and passions.

That’s why a parent who finds out their teen has a mental health disorder will respond in a way that’s roughly equivalent to a parent who finds out their teen has an addiction problem. They want to heal their child, which means they seek out the best evidence-based treatment they can find.

But what happens what a teen is diagnosed with an alcohol/substance use disorder and a mental health disorder at the same time?

It creates a unique set of treatment challenges – but parents and teens can meet and overcome these challenges.

Dual Diagnosis Treatment for Teens with Co-Occurring Disorders

When a person has a substance use disorder and a mental illness at the same time, clinicians use one of two terms interchangeably: dual diagnosis or co-occurring disorders. It’s often difficult to determine which develops first – the mental health disorder or the alcohol/substance use disorder – but when they do happen simultaneously, it’s clear that addiction and mental illness can create a negative feedback loop that exaggerates the negative symptoms and effects of both the addiction and the mental illness.

Co-occurring disorders present unique challenges for people in treatment for AUD/SUD and for the counselors and therapists who treat them for three primary reasons:

  1. The symptoms of addiction disorders are often difficult to distinguish from the symptoms of mental health disorders.
  2. Substance misuse often begins as a coping mechanism. Teens may use alcohol or drugs to soothe the painful emotions associated with the symptoms of a mental health disorder. Most people are familiar with this phenomenon, which is known as self-medication.
  3. Over time, the self-medication approach creates more problems than it solves. It often makes the symptoms of mental health disorders worse, which in turn can lead to increased self-medication, which further exacerbates the mental health symptoms. That’s what most people would call a vicious cycle – and it’s something no parent wants their teen to experience.

That’s why co-occurrence makes accurate diagnosis difficult, but also makes it essential for growth, healing, and recovery. An underlying mental health disorder can undermine progress made in treatment for problem alcohol and drug use, and vice-versa: an underlying alcohol or substance use disorder can undermine progress made in treatment for a mental health disorder.

At this point, we can address the question posed in the title of this article:

When Should a Parent Consider Adolescent Dual Diagnosis Treatment Centers?

The answer:

A parent should consider an adolescent dual diagnosis treatment center as soon as their teen receives a diagnosis for co-occurring addiction and mental health disorders.

An accurate diagnosis is the most important component in this equation. Without an accurate diagnosis, a teen and their family can spend months or years taking one step forward and two steps back, because of the situation we describe above: the symptoms of co-occurring addiction and mental health disorders simultaneously mask and exacerbate one another.

That’s why parents of teens diagnosed with co-occurring addiction and mental health disorders should seek an integrated treatment and an adolescent mental health facility with a clinical staff experienced in diagnosing and treating co-occurring addiction and mental health disorders.

We’ll discuss and describe integrated treatment at the end of this article. Next, we’ll review what types of mental health disorders commonly co-occur with addiction, offer a list of signs and symptoms that parents who think their teen may have both an addiction and a mental health disorder should watch for, and share the prevalence statistics on co-occurring addiction and mental health disorders among adolescents.

Which Mental Health Disorders Co-Occur With Addiction?

The mental health disorders that co-occur with substance misuse most often are depression and anxiety. However, addiction is also found in people diagnosed with:

Parents of teens with a mental illness and a substance use disorder should understand that stress, isolation, and boredom can exacerbate both mental health disorders and substance use disorders. Teens with major depressive disorder and/or anxiety have an elevated risk of addiction or substance abuse, and vice versa. Teens with addiction or substance abuse issues are at elevated risk of developing a mental health disorder such as depression or anxiety.

Signs and symptoms of escalating co-occurring substance abuse and mental illness may include:

  • Withdrawing from family and friends
  • Moodiness
  • Irritability
  • Engaging in risky behavior
  • Suicidal Ideation
  • Non-suicidal self-injury
  • Insomnia
  • Drastic weight loss or gain
  • Extreme changes in personality
  • Paranoia
  • Decrease or increase in appetite
  • Fear and anxiety

Here’s a quick reality check. For parents with teens who lived an altered lifestyle for most of the past eighteen months, there may be a perfect storm of circumstances brewing. Online school, disruption of routine, lack of social contact, and the absence of typical stress-relief outlets such as sports, socializing, and extracurricular activities create exactly the kind of stress and isolation that can cause a teen with depression to turn to alcohol or drugs. Or cause a teen with an alcohol or drug problem to develop an anxiety disorder or depressive disorder. That’s why parents of teens with one or the other should watch their teens closely, ensure they arrange a comprehensive evaluation with a qualified mental health professional, and begin treatment as soon as possible if their teen receives a dual diagnosis.

Now let’s get to those prevalence statistics.

Addiction and Depression in Teens: Facts and Statistics

The 2018 National Survey on Drug Use and Health (NSDUH) shows the following data on depression and addiction among adolescents:

  • 3.1 million adolescents age 12-17 were diagnosed with major depressive disorder (MDE)
  • 918,000 adolescents age 12-17 were diagnosed with substance use disorder (SUD)
  • 358,000 adolescents age 12-17 were diagnosed with both MDE and SUD

In addition, the NSDUH reports that in 2018:

  • 32.7% of adolescents who used illicit drugs in the past year also had MDE
    • 0% of adolescents who used illicit drugs in the past year did not have MDE
  • 25.2% of adolescents who used marijuana in the past year also had MDE
    • 5% of adolescents who used marijuana in the past year did not have MDE

When we look at this data, it shows us something troubling. More than twice as many adolescents with MDE used illicit drugs or marijuana than adolescents who did not have MDE. And when we think of this data in terms of stress, anxiety, and isolation millions of teens have experienced over the past year, we realize the following:

  • Almost 4,000,000 in the U.S. with MDE are at increased risk of developing addiction
  • Over 900,000,000 teens in the U.S. with SUD are at increased risk of developing a mental illness
  • The 318,000 teens in the U.S. with MDE and SUD are at increased risk of both disorder escalating

Parents who think their teen is at-risk should understand something important: evidence shows that dual diagnosis treatment works.

Studies published by the Substance Abuse and Health Services Administration (SAMSHA) show that an integrated, dual diagnosis treatment model is effective in helping people with co-occurring addiction and mental illness recover from both.

Integrated Treatment for Substance Abuse and Addiction

The most important part of an integrated treatment for co-occurring disorders is the diagnosis. As we mentioned above, the symptoms of addiction can mask the symptoms of a mental illness, and the symptoms of a mental illness can mask the symptoms of addiction.

When clinicians at a high-quality treatment center identify co-occurring disorders and arrive at a dual diagnosis, they create an individualized treatment plan. Individual plans give a teenager the greatest chance of long-term recovery. Since each teen is different, each plan is different. Treatment plans at integrated treatment centers are adaptable and change as the teen in treatment makes progress. The contents of the plan will change as the teen learns how to manage their disorders.

Approaches and techniques that worked at the beginning of treatment might not be as effective later. Approaches and techniques that didn’t work at the beginning of treatment might resonate and become helpful as time passes.

With some variation for the teen in treatment and the treatment center location and available resources, integrated treatment plans for addiction and substance abuse often include:

The Benefits of Integrated Treatment

Recovering from and managing the ongoing symptoms of one serious mental health issue takes time, energy, and commitment. Recovering and managing the ongoing symptoms of two separate issues requires an added skill: patience. It may take days or weeks for an underlying disorder to appear when a teenager enters treatment.

That works both ways.

A teen who enters treatment for addiction may discover – after some time passes – they have PTSD from childhood trauma. Or that they began using drugs to deal with the symptoms of anxiety or depression.

This complicates treatment in the short run, but over time, leads to a greater chance of treatment success. When the second disorder is treated, it decreases the chance it will interfere with progress for the initial addiction disorder.

Likewise, a teen who enters treatment for a mental health disorder such as depression or anxiety may not reveal their drug or alcohol use to their parents before they enter treatment.  They may not reveal their drug or alcohol use to their therapists at the beginning of treatment, either.

Again, this may make treatment more complex at the outset, but this knowledge is power. Awareness of a co-occurring addiction disorder – and treatment of that disorder – decreases the chance it will interfere with the progress made with the initial mental health disorder.

The Path to Sustained Recovery

When a teen receives an accurate diagnosis and initiates integrated treatment in a high-quality adolescent behavioral health program, they can learn to manage both disorders and regain control over their lives. Their families benefit, too. Rather than spinning their wheels wondering why addiction treatment or mental health treatment were unsuccessful in the past, separately, they can move forward with confidence in the understanding that what their teen needs is treatment for both, rather than one or the other.

This is the first step toward restoring balance and harmony to the family and the first step on the recovery journey for the teen in treatment. The recovery path for a teen with co-occurring disorders is often an ongoing, lifelong process. The sooner a teen starts that process, the sooner they develop the skills necessary to move past the mutually reinforcing cycles of addiction and mental illness. When they do that, they can begin to build a life they define and live for themselves – and get back to the business of being a teenager.

Finding Help: Resources

Parents seeking treatment for their teen can navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting right now.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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