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Abstract
Adolescent use and abuse of substances can have serious health consequences, as well as increasing the risks of poorer scholastic attainment, increased delinquency and later psychiatric problems.
The association between drug abuse and psychiatric cormorbidity, often described as dual diagnosis & has become an increasing source of clinical concern.
Since psychiatric disorders beginning in childhood may continue into adult life then there is an opportunity to intervene to prevent or reduce conditions complicated by substance misuse, if services are accessible.
Experimentation with substances during adolescence is not uncommon. However, studies have shown that children who experiment with substances at a young age are more likely to use other drugs later in life. Some adolescents’ exposure may be limited to experimentation, but others will develop a dependency, even moving on to more dangerous drugs, and causing significant harm to themselves and possibly others and often develop psychological or social problems. Studies of males entering the juvenile justice system confirm the link between substance use and crime, even more is the fact that they also have a diagnosable mental health disorder. Not all complications are acute, and many may manifest themselves some years in the future.
Children and adolescents, misusing drugs and alcohol, are at significant risk of comorbidity. There is a significant association between attention - deficit disorder and conduct disorder, major depression and substance misuse. Treatment of comorbid conditions is complex. Also services for children and adolescents, either with substance misuse alone or comorbidity with psychiatric disorder, are scarce and urgently need to be developed.
There are very few programs specifically designed to treat co-occurring disorders, and those that do exist are relatively new. Consequently, most methods have not been objectively evaluated with children and adolescents for effectiveness. The studies failed to demonstrate the superiority of any one treatment approach over another, and instead have shown only that some treatment is better than no treatment. However, researchers have identified certain treatment characteristics that are associated with more successful outcomes in dually-diagnosed children and adolescents. They include:
• Treatment of sufficient duration, intensiveness, and comprehensiveness to address the chronic nature of the disorders
• The presence of after-care or follow-up treatment
• Sensitivity to cultural, racial, and socioeconomic factors
• Family involvement
• Collaboration among service providers and agencies
• Promotion of prosocial activities and drug-free lifestyle
• Involvement in self-help groups such as Alcoholics Anonymous and Narcotics Anonymous
Preliminary studies also support the use of integrated mental health and substance abuse treatment programs. Under the integrated treatment approach, both the mental health and the substance abuse treatments are provided simultaneously within the same treatment plan, rather than being conducted in a consecutive or parallel manner. SAMHSA is informing health professionals to expect patients to present with simultaneous substance abuse and mental health disorders . SAMHSA’s Treatment Improvement Protocol (TIP) 42: Substance Abuse Treatment for Persons with Co-occurring Disorder recommends the coordination of substance abuse and mental health interventions. Although requiring additional study, optimal treatment involves an integration of treatment modalities rather than merely concurrent or consecutive treatment with specific modalities for either substance abuse disorder or psychiatric disorders.
Research has found that the integrated approach offers several advantages. Participants are more likely to maintain a connection with the program, which has been found to result in decreases in rehospitalization, increased sobriety, and decreased psychiatric symptoms. In addition, participants demonstrate modest improvements in the areas of immediate and extended social relationships, self-reported satisfaction with family relationships, and psychiatric symptoms.
It is also important to note that different approaches to integrated treatment have been found to result in similar rates of improvement. If supported, this finding could have important policy implications, because the choice of approach could then be based on the ease of implementation and the cost of the intervention method.
The research supporting integrated treatment programs can only be generalized, however, due to the existence of certain limitations. Most of the studies used small sample sizes, lacked an experimental design, and failed to employ standardized instruments to assess diagnosis of substance abuse. Furthermore, most incorporated relatively brief follow-up periods (typically 18 months or less). This short-term design may downplay the effectiveness of the approach, as research shows that the benefits of this form of treatment become more visible as time progresses.