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Posted: October 23rd, 2023

Psychiatric Syndromes Co-Occurring with Adolescent Substance Use Disorders

Write a 750-1,000-word paper regarding psychiatric disorders that may occur with substance use disorders.
Your paper should address the following:
1. Explain the psychiatric syndromes that may co-occur with substance use disorders and addiction during adolescence.
2. Explain the combined impact of substance use disorders and psychiatric syndromes among adolescents.
3. Explain how a DSM diagnosis can affect an adolescent. Discuss the implications.
Be sure to cite at least five scholarly references.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Psychiatric Syndromes Co-Occurring with Adolescent Substance Use Disorders
Substance use disorders (SUDs) and psychiatric syndromes often co-occur during adolescence. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013), approximately 50% of individuals diagnosed with a SUD will also meet criteria for at least one additional psychiatric disorder at some point in their lives (Hasin et al., 2013). Adolescence, in particular, represents a critical period of vulnerability, as substance use during this developmental stage can disrupt key neurobiological processes and negatively impact mental health (Casey et al., 2008). This paper will explore the psychiatric syndromes that commonly co-occur with SUDs among adolescents, examine the combined impact of these disorders, and discuss implications of a dual diagnosis.
Common Psychiatric Syndromes
Several psychiatric syndromes frequently present alongside adolescent SUDs. Mood disorders, including major depressive disorder and bipolar disorder, are highly prevalent among substance-using youth (Armstrong & Costello, 2002). Depression is associated with earlier initiation and heavier patterns of substance use (Merikangas et al. (1998). Anxiety disorders also commonly co-occur. Approximately 30-40% of adolescents diagnosed with a SUD meet criteria for an anxiety disorder, most commonly social anxiety disorder or generalized anxiety disorder (Kushner et al., 2000). Psychotic disorders, such as schizophrenia, occasionally emerge during substance intoxication or withdrawal but may also represent an independent psychiatric condition (APA, 2013). Attention-deficit/hyperactivity disorder (ADHD) is another frequently co-occurring disorder, with up to 50% of adolescents in SUD treatment programs having a history of ADHD (Wilens et al., 1997).
Combined Impact on Adolescents
The presence of co-occurring psychiatric syndromes exacerbates the severity of SUDs and complicates treatment among adolescents. Youth with comorbid disorders typically begin substance use earlier, abuse substances more frequently and heavily, and are less likely to achieve and maintain abstinence compared to those with only an SUD (Armstrong & Costello, 2002; Merikangas et al., 1998). The self-medication hypothesis posits that adolescents may use substances to alleviate symptoms of an undiagnosed mental illness (Khantzian, 1997). However, substance use often worsens underlying psychiatric conditions. For example, cannabis and other drug use can trigger or worsen symptoms of psychosis, mania, and depression (APA, 2013). Adolescents with co-occurring disorders also face higher risks of suicide, self-harm, interpersonal problems, academic failure, and involvement with the criminal justice system compared to youth with only one diagnosis (Merikangas et al., 1998).
Implications of a Dual Diagnosis
A dual diagnosis of a SUD and psychiatric syndrome carries important implications for assessment and treatment. Clinicians must conduct comprehensive evaluations to differentiate substance-induced from independent psychiatric conditions (APA, 2013). A DSM diagnosis can affect access to appropriate treatment, insurance coverage, and eligibility for certain services (Regier et al., 2013). Integrated treatment targeting both disorders simultaneously yields better outcomes than independent or sequential treatment (Chandler et al., 2009). Pharmacotherapy may be indicated for stabilizing underlying psychiatric symptoms, but medications require careful management due to drug-drug interactions and side effects (APA, 2013). Family involvement enhances treatment engagement and retention, while continuing care and relapse prevention are critical aspects of a long-term treatment plan (Waldron & Turner, 2008). Overall, a coordinated, aspects of a long-term treatment plan (Waldron & Turner, 2008). Overall, a coordinated, multi-disciplinary approach is needed to address the complex interplay between substance use and mental health issues impacting aspects of a long-term treatment plan (Waldron & Turner, 2008). Overall, a coordinated, multi-disciplinary approach is needed to address the complex interplay between substance use and mental health issues impacting adolescents.
In summary, SUDs commonly co-occur with psychiatric syndromes during adolescence. Mood, anxiety, psychotic, and ADHD represent the most prevalent co-occurring conditions. A dual diagnosis exacerbates substance use patterns, complicates treatment, and increases risks of adverse outcomes. Comprehensive assessment and integrated, long-term treatment targeting both disorders simultaneously yields the best prognosis. Future research should continue exploring etiological relationships, developmental trajectories, and innovative treatment models for adolescents with co-occurring substance use and mental health issues.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Armstrong, T. D., & Costello, E. J. (2002). Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. Journal of Consulting and Clinical Psychology, 70(6), 1224–1239. https://doi.org/10.1037/0022-006X.70.6.1224
Casey, B. J., Jones, R. M., & Hare, T. A. (2008). The adolescent brain. Annals of the New York Academy of Sciences, 1124, 111–126. https://doi.org/10.1196/annals.1440.010
Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and safety. JAMA, 301(2), 183–190. https://doi.org/10.1001/jama.2008.976
Hasin, D. S., Saha, T. D., Kerridge, B. T., Goldstein, R. B., Chou, S. P., Zhang, H., Jung, J., Pickering, R. P., Ruan, W. J., Smith, S. M., Huang, B., & Grant, B. F. (2015). Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry, 72(12), 1235–1242. https://doi.org/10.1001/jamapsychiatry.2015.1858
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244. https://doi.org/10.3109/10673229709030550

Kushner, M. G., Abrams, K., & Borchardt, C. (2000). The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings. Clinical Psychology Review, 20(2), 149–171. https://doi.org/10.1016/S0272-7358(99)00027-6
Merikangas, K. R., Mehta, R. L., Molnar, B. E., Walters, E. E., Swendsen, J. D., Aguilar-Gaziola, S., Bijl, R., Borges, G., Caraveo-Anduaga, J. J., DeWit, D. J., Kolody, B., Vega, W. A., Wittchen, H. U., & Kessler, R. C. (1998). Comorbidity of substance use disorders with mood and anxiety disorders: Results of the International Consortium in Psychiatric Epidemiology. Addictive Behaviors, 23(6), 893–907. https://doi.org/10.1016/S0306-4603(98)00088-8
Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry, 12(2), 92–98. https://doi.org/10.1002/wps.20050
Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child and Adolescent Psychology, 37(1), 238–261. https://doi.org/10.1080/15374410701820133
Wilens, T. E., Biederman, J., Mick, E., Faraone, S. V., & Spencer, T. (1997). Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. The Journal of Nervous and Mental Disease, 185(8), 475–482. https://doi.org/10.1097/00005053-199708000-00005

Study Notes:
Psychiatric Syndromes Co-Occurring with Adolescent Substance Use Disorders

Adolescence is a critical period of development that involves biological, psychological and social changes. It is also a time when many young people experiment with substances, such as alcohol, tobacco, cannabis and other drugs. Substance use can have negative consequences for the health, well-being and functioning of adolescents, especially when it becomes problematic or leads to substance use disorders (SUDs). SUDs are characterized by a pattern of substance use that causes significant impairment or distress in various domains of life, such as physical, mental, emotional, interpersonal, academic or occupational.

One of the challenges in treating adolescents with SUDs is that they often present with co-occurring mental disorders, such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), personality disorders (PDs), affective disorders (ADs), psychotic disorders (PDs) and post-traumatic stress disorder (PTSD). Co-occurring mental disorders are also known as dual diagnosis, concurrent disorder or co-morbid disorder. They are defined as the presence of two or more mental disorders in the same individual at the same time or within a 12-month period. Co-occurring mental disorders are common among adolescents with SUDs, with estimated rates ranging from 55 to 80% in community samples and even higher in clinical samples .

The relationship between SUDs and co-occurring mental disorders in adolescents is complex and bidirectional. On one hand, co-occurring mental disorders can increase the risk of initiating and escalating substance use, as well as developing SUDs. For example, studies show that depression, ADHD, anxiety disorders and PTSD increase the likelihood of first-time use of drugs and alcohol in adolescents who have not used substances before . Co-occurring mental disorders can also impair the motivation and ability of adolescents to seek help, adhere to treatment and achieve recovery from SUDs. On the other hand, substance use can also worsen the severity and course of co-occurring mental disorders, as well as trigger new onset or relapse of mental disorders. For example, substance use can exacerbate the symptoms of ADHD, CD, ODD, PDs, ADs and PDs, as well as increase the risk of suicidal behavior and overdose .

The co-occurrence of SUDs and mental disorders in adolescents poses significant challenges for assessment and treatment. It is essential for clinicians to screen for both SUDs and mental disorders in adolescents who present with either condition, as well as to monitor their progress and outcomes over time. A comprehensive assessment should include a detailed history of substance use and mental health symptoms, as well as an evaluation of the impact of both conditions on various domains of functioning. The assessment should also consider the developmental stage of the adolescent, their family and social context, their strengths and resources, their preferences and goals, and their readiness for change.

The treatment of adolescents with SUDs and co-occurring mental disorders should be integrated, individualized and evidence-based. Integrated treatment refers to the provision of services that address both SUDs and mental disorders in a coordinated and consistent manner within the same setting or by the same team of professionals. Individualized treatment refers to the adaptation of services to meet the specific needs and characteristics of each adolescent, taking into account their developmental stage, gender, culture, co-occurring conditions, severity level and treatment response. Evidence-based treatment refers to the use of interventions that have been proven to be effective for adolescents with SUDs and co-occurring mental disorders through rigorous research studies.

Some examples of evidence-based interventions for adolescents with SUDs and co-occurring mental disorders are cognitive-behavioral therapy (CBT), motivational interviewing (MI), contingency management (CM), family therapy (FT) and pharmacotherapy. CBT is a type of psychotherapy that helps adolescents identify and modify their dysfunctional thoughts, beliefs and behaviors that contribute to substance use and mental health problems. MI is a type of counseling that helps adolescents enhance their motivation to change their substance use and engage in treatment. CM is a type of behavioral intervention that provides positive reinforcement for achieving specific goals related to substance use reduction or abstinence. FT is a type of psychotherapy that involves the participation of family members in the treatment process and aims to improve family functioning and support recovery. Pharmacotherapy is the use of medications to treat SUDs or co-occurring mental disorders, such as antidepressants, stimulants or antipsychotics.

The treatment outcomes for adolescents with SUDs and co-occurring mental disorders depend on various factors, such as the type, severity and duration of both conditions, the availability and accessibility of services, the quality and continuity of care, the adherence and retention in treatment, and the involvement of family and other supportive networks. The main goals of treatment are to reduce or eliminate substance use, improve mental health and functioning, prevent or reduce harm, enhance quality of life and promote recovery. Recovery is a process of change that involves overcoming the negative consequences of SUDs and co-occurring mental disorders, achieving personal growth and well-being, and participating in meaningful activities and roles in society.

In conclusion, SUDs and co-occurring mental disorders are prevalent and complex conditions that affect many adolescents. They require early identification, comprehensive assessment and integrated treatment that are tailored to the specific needs and characteristics of each adolescent. The treatment of adolescents with SUDs and co-occurring mental disorders should be based on the best available evidence and delivered by a multidisciplinary team of professionals who are trained and experienced in working with this population. The treatment should also involve the collaboration and support of family members, peers, schools, communities and other relevant stakeholders. By providing effective and appropriate services for adolescents with SUDs and co-occurring mental disorders, we can help them achieve better outcomes and foster their recovery.


: Co-occurring mental disorder and substance use disorder in young people: aetiology, assessment and treatment | BJPsych Advances | Cambridge Core. (2020). Retrieved 23 October 2023, from https://www.cambridge.org/core/journals/bjpsych-advances/article/cooccurring-mental-disorder-and-substance-use-disorder-in-young-people-aetiology-assessment-and-treatment/D1707F9D338B58D130492BAF28C0AABF

: Co-occurring Mental Disorders research paper writing service in Transitional Aged Youth With Substance Use Disorders – A Narrative Review. (2022). Retrieved 23 October 2023, from https://www.frontiersin.org/articles/10.3389/fpsyt.2022.827658/full

: Co-occurring Disorders | Youth.gov. (n.d.). Retrieved 23 October 2023, from https://youth.gov/youth-topics/youth-mental-health/co-occurring

: Co-Occurring Disorders In Adolescents – Miracles Recovery Center. (n.d.). Retrieved 23 October 2023, from https://miraclesrc.com/resources/co-occurring-disorders-in-adolescents/

: Adolescent Substance Use and Co-Occurring Disorders. (n.d.). Retrieved 23 October 2023, from https://academic.oup.com/edited-volume/34487/chapter/292600608

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