Treating teen drug problem alone may not be enough

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Teenagers being treated for alcohol and drug problems may fare better when they also receive therapy for other mental health conditions they may have, according to a new study.

In a study of more than 400 12- to 18-year-olds being treated for substance abuse, researchers found that 55 percent had at least one other psychiatric condition such as depression, anxiety, Eating disorders or some type of behavioral disorder. 

Those who received additional treatment for these co-existing conditions were 57 percent more likely than their untreated peers to be abstinent from drugs and alcohol 6 months after entering their substance abuse program.

The findings are published in the journal Alcoholism: Clinical & Experimental Research.

It seems intuitive that addressing teenagers’ overall mental health would improve their outcomes after substance abuse treatment, said lead study author Stacy Sterling, a researcher with Kaiser Permanente Northern California, the large managed care plan to which study participants belonged.

However, said Sterling, much of the research on the issue has focused on adults. And, she said, the whole notion of integrating substance abuse treatment and other psychiatric services is relatively new.

Also, integrated services are not widely available. The various substance abuse programs nationwide differ greatly in their capacity to screen for and treat other mental health conditions, Sterling said, particularly when clinics are small or based in rural areas.

“I think programs try as hard as they can,” she noted.

Her study looked at teenage patients in four different Kaiser Permanente chemical-dependency treatment programs in Northern California. Overall, 54 percent of patients with a co-existing mental health disorder were referred for a psychiatric evaluation.

Exactly why more of these teenagers did not receive psychiatric treatment is unclear, Sterling and colleague Constance Weisner note in the report. One possibility is that some teenagers and their parents may not want additional treatment while they’re in a substance abuse program.

Another, the researchers write, is that there may be a lack of communication between providers in substance abuse programs and those in psychiatric services.

At two of the sites included in the study, substance abuse and psychiatry services were located in the same building or across the street from each other, while the other two sites had these services in separate locations.

Teenagers at sites where services were in close proximity, the study found, were more likely than those at the other two sites to be off drugs and alcohol 6 months after starting treatment.

This was the case whether patients had psychiatric symptoms or not. The reasons for the greater success at these sites is unclear, according to the researchers, but it may have to do with better communication among providers—even if the actual number of referrals to psychiatric care aren’t higher.

Overall, teenagers in the study had rates of mental health problems many times higher than the norm. More than one-third had depression, while 16 percent and 17 percent, respectively, had an Anxiety disorder or attention deficit-hyperactivity disorder (ADHD). Many had conduct disorder, which is marked by behavioral and emotional problems such as aggressiveness, stealing and serious rule violations.

“The point is that many of these kids have multiple problems,” Sterling said.

This is far from the first study to show as much, she noted. The body of evidence, Sterling said, points to a need to screen kids for substance abuse further “downstream”—such as during routine doctor visits or even in school—before the problem and its associated disorders become severe.

SOURCE: Alcoholism: Clinical & Experimental Research, May 2005.

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