12 Minutes

Edited & medically reviewed by THE BALANCE Team
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A dual diagnosis occurs when an individual, whether a child, adolescent or adult, is diagnosed with both a mental health problem and substance use or alcohol disorder (SUD/AUD) at the same time. Co-existing conditions are what mental health experts refer to when someone has a dual diagnosis. In teenagers, mental health illnesses that frequently co-exist with substance abuse disorders and alcohol include:

  • Depression 
  • Disorders of Anxiety
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder 
  • Disordered behavior
  • Oppositional defiant disorder (ODD)
  • Anorexia nervosa and Bulimia Nervosa

Estimates suggest that 60-70% of teenagers with a co-existing mental health illness also have substance use and alcohol disorder. For a variety of reasons, co-existing illnesses pose a difficulty for both the teenagers who have them and the mental health experts who treat them.

Executive Dual Diagnosis Treatment for Teens

To begin with, it might be difficult to identify the symptoms of alcohol/substance use problems from those of mental health issues, and vice versa. Second, people with co-existing illnesses frequently begin to self-medicate with drugs and/or alcohol in order to relieve the effects of their mental health illness: this is known as self-medication. Finally, drinking and using drugs can increase the symptoms of a mental health condition, which can lead to further drinking and using drugs, which can intensify the symptoms of the mental health disorder even more.

Mutually Reinforcing Cycles. This creates a difficult-to-break cycle of symptom/self-medication/symptom/self-medication – and the whole scenario is troublesome because diagnosing co-existing disorders is worsened by the fact that the signs of a co-existing disorder can often disguise the symptoms of a mental health disorder, and conversely. That may appear to be the same thing as what we mentioned earlier, but it isn’t. The symptoms of substance or alcohol use disorders and mental health illnesses are not only comparable, as we mentioned before, but each can also make the other unnoticeable, causing professionals to overlook one while focusing on the other.

This situation raises an important question for doctors and patients with co-occurring disorders: which emerged first, the mental health disorder or the substance/alcohol use disorder?

That inquiry does not always have a clear answer. What is apparent is that a teenager with a co-existing SUD/AUD and mental health condition can beat both disorders with the right therapy and diagnosis.

In a bit, we’ll talk about treatment.  The National Institutes of Health has just released the most recent information on co-existing SUD/AUD and mental health issues (NIH).

For individuals aged 13 to 16, the 2019 National Survey on Drug Use and Health (2019 NSDUH) provides extensive information on the prevalence of co-existing substance and/or alcohol use disorder. Per the year 2019, the following are the prevalence figures for teenagers:

Major Depressive Episode (MDE) and Substance Use Disorder (SUD)

  • SUD or MDE affected 17.9 percent of teenagers.  That’s more than 4500,000 teenagers.
  • MDE was found in 13.8 percent of adolescents who did not have SUD.  That’s 3400,000 teenagers.
  • SUD was present in 2.7 percent of the population, but not MDE.  That’s 682,000 teenagers.
  • SUD and MDE affected 1.7 percent of adolescents. That’s a total of 397,000 teenagers.

Let’s look at the number of teenagers who underwent treatment.

SUD and MDE Treatment:

  • 66.3 percent of adolescents with SUD and MDE received treatment for one but not the other. That is a little over 250,000 teenagers.
  • SUD treatment was received by 2.4 percent of the population. This equates to around 9,500 adolescents.
  • 63.6 percent received MDE treatment but not SUD treatment. This equates to around 248,000 adolescents.
  • Treatment for both SUD and MDE was given to 1.3 percent of the population. That’s a little more than 5,000 teenagers.
  • 33.7 percent of people with SUD or MDE did not obtain therapy. That’s around 134,000 teenagers.

These figures help to put the phenomena of co-occurring in context. Reading figures like “1.7 percent of teenagers had SUD and MDE” might be misleading, as it may cause some parents to believe that the problem isn’t common. We’d want to counteract that notion with one essential fact and a few additional numbers.

The noteworthy statistic is that over half a million teenagers had co-existing MDE and SUD in 2019. (397,000). That’s a lot of teens who need help with not one, but two problems that can have a detrimental influence on their social, emotional, and physical well-being.

The frequency of youth with a major depressive disorder who use drugs is a set of numbers we need to address. When we look at the prevalence data in this way, we get the following:

  • 31.9 percent of teenagers with MDE admitted to using illegal drugs.
  • Adolescents who did not have MDE reported using illicit drugs at a rate of 4%.
  • Marijuana use was reported by 25.1 percent of teenagers with MDE.
  • 1% of teenagers without MDE admitted to using marijuana.
  • Binge drinking was reported by 8.9 percent of teenagers with MDE.
  • Binge drinking was reported by 2percent of teenagers who did not have MDE.
  • Opioid use was reported by 4.6 percent of adolescents with MDE.
  • Opioid use was reported by 8 percent of teenagers who did not have MDE.

These figures clearly reveal that teenagers with MDE use illegal drugs opiates and marijuana at a rate that is more than twice as high as adolescents without MDE. Furthermore, statistics reveal that adolescents with MDE binge drink more than twice as often as teenagers without MDE, ingesting more than 5-6 alcoholic drinks in one sitting.

While not all of these teenagers will acquire AUD or SUD in conjunction with MDE, they are at a higher risk. These figures also reveal a treatment gap: around two-thirds of the over 400,000 teenagers identified with co-occurring SUD and MDE did not obtain treatment for both illnesses. This means that in 2019, over 250,000 adolescents in the United States did not receive the therapy they required to manage their co-existing diseases.

In spite of this, it is critical for families of teens with co-existing mental health and substance/alcohol use disorders to recognize that therapy is effective. However, data suggests that both the substance/alcohol use disease and the mental health illness must be managed.

When one illness is treated without another, both disorders have a worse prognosis, but when a person with a dual diagnosis gets professional assistance and care for both diseases, both abnormalities have a better outcome.

If you feel your teenager has a mental health problem as well as an addiction issue, you should have them reviewed by a psychiatrist, psychologist, or other mental health specialists – preferably one who deals exclusively in or has medical experience in addiction and mental illnesses in adolescents. You should schedule a proper evaluation, also known as a biopsychosocial assessment, which will provide a mental health expert with a complete perspective of all the elements that may be influencing your teenager’s difficulties.

You will almost certainly receive a therapy recommendation after your child has undergone a thorough evaluation. Outpatient therapy either once or twice a week may be enough in some cases. However, if your kid has a dual illness, outpatient therapy may not provide the kind of care needed to help them heal and go ahead.

A more intense form of treatment may be recommended by the evaluating professional for your child. Treatments that are more intensive may include:

  • Intensive Outpatient Programs (IOPs) 
  • Programs for Partial Hospitalization (PHP)
  • Residential Treatment Facilities (RTF)
  • Hospitalization

These levels of care are described as follows:

Programs of Intensive Outpatient Care (IOP). This is a definite upgrade from weekly therapy or alcohol and drug counseling. The duration and frequency of treatment are determined by the program. Teenagers in an intense outpatient program often attend treatment three times a week for three hours per session. The benefits being the patients can live at home with their parents, and continue attending school.

Programs of Partial Hospitalization (PHP). This is a level up from intensive outpatient treatment. As is the case with IOP treatment, the duration and frequency of treatment are determined by the particular program. Teenagers receive treatment every day, often for four hours, and go to school on a part-time basis. They either live in the house or in a sober living center if extra support is required.

Residential Treatment Centers (RTC). Residential alcohol therapy, often known as inpatient alcohol treatment, involves your daughter or son living in a non-hospital treatment center 24 hours a day. Based on your child’s therapy requirements and progress, this intense standard of care may last between 1 and 4 months. Along with undergoing full-time alcohol therapy, one of the primary benefits of residential alcohol rehabilitation is living in an alcohol- and drug-free atmosphere. This allows your child to concentrate on healing rather than on the desire to consume alcohol.

Teens who obtain a dual diagnosis for co-existing disorders may benefit from IOP, PHP, and RTC treatments.

Hospitalization in a Psychiatric Facility. Hospitalization may be essential if your kid poses a serious threat to themselves or people (e.g., psychotic or suicidal) or requires 24-hour medical supervision because of too much alcohol consumption. Medical supervision may be required in conjunction with excessive binge drinking, a harmful trend among teenagers and young adults. Quitting alcohol abruptly (cold turkey) can result in hazardous and perhaps fatal symptoms of withdrawal, which is why medical observation may be essential.

Except for psychiatric hospitalization, which has as its major purpose urgent safety and psychological stability, these levels of care often entail some combination of various therapeutic approaches:

  • Individual counseling and treatment
  • Counseling and group treatment
  • Psychotherapy and therapy for families
  • Fitness and meditation are both experiential activities.
  • Support from the community (Alcoholics Anonymous or SMART Recovery)
  • The specific treatment regimen will vary depending on the treatment center and the level of care required for your kid.
  • Providing Support and Encouragement for Your Child

If your teen is diagnosed with two disorders and requires intense therapy, the most critical thing you can do is to provide sincere and constant support and encouragement. The journey to rehabilitation can be challenging and may cause pressure in your relationship with your adolescent. The following are some things you can do to assist your teen and reduce the difficulties associated with recovery:

  • Maintain open avenues of communication
  • Become knowledgeable about their specific diagnoses.
  • Discover the difference between a mental health issue and a substance use disorder.
  • Participate actively in their treatment and rehabilitation
  • Make yourself available and eager to truly listen.
  • Continue to show up — and remain real, empathetic, and loving – and they will ultimately open up.
  • Create a recovery-friendly environment in your house. If you store drugs or alcohol in your home, try eliminating them entirely.
  • If your adolescent has an alcohol abuse use problem, think about the effect that family, relatives, and friends’ alcohol usage may have on your adolescent.
  • Be an inspirational figure for your adolescent by practicing what you teach.
  • Be understanding and supportive if your teen relapses. Avoid being judgmental, mocking, or aggressive.
  • Recognize that managing a co-existing disorder can be extremely tough. If your teen struggles, this does not indicate that there is something profoundly wrong with them. This indicates that individuals are struggling to overcome not one, but two persistent, recurring medical illnesses.
  • Be willing to confront personal concerns that may cause friction or tension in your connection with your teen or have a negative effect on your family’s overall dynamic.

Love and compassion are the bedrock of helping your child during treatment. Sympathy and understanding come next, accompanied by honest, truthful, and direct interaction. If your adolescent gets a dual diagnosis, this implies they require your assistance. They require your leadership, wisdom, and assistance. But most importantly, they require your love and affection: they require assurance that you are on their side and will accompany them through the ups and downs of the recovery road. A youngster who understands their family is on their team and has their support is more likely to achieve a full recovery than one who has that basic degree of familial support.

You must also look after yourself during the therapy and recovery process. The road will be difficult. That is a near-certainty. Of course, your primary goal should be to assist your child, but in order to do so effectively, you must ensure that you are emotionally, psychologically, and physically capable of providing that support. As a result, do not forget to take care of yourself along the route. You will be more approachable and helpful if you maintain a healthy emotional state during your teen’s treatment.

Self-care will benefit you, and when you take better care of yourself, you also set an example for your teen regarding appropriate self-care. And as all parents are aware, teenagers are more likely to follow your actions than your words.

Several steps can be taken to model healthy self-care for your teen while he or she is in treatment:

  • Assemble a support network by attending a local or online support network, consulting a counselor, and reaching out to friends and family. You are not alone in this.
  • Assure that you have three nutritious meals each day and obtain adequate sleep and rest.
  • Utilize healthy stress management techniques such as meditation, yoga, and exercising.
  • Make more time for yourself to unwind, rejuvenate, and rebalance your life.

Rehabilitation rarely happens in a simpler straight line. There will be triumphs and failures. There will be difficult days and fantastic days – but never lose hope. Adolescents do recover from substance misuse issues. Additionally, they develop skills for managing the effects of co-existing mental health issues.

Your family can restore itself with your care, trust, and devotion. Your teen can manage to live free of drugs and alcohol and unencumbered by a mental health issue.

All of this is confirmed by scientific proof: your adolescent can recover as well!

The primary obstacle that the majority of teenagers experience when they have a co-existing addiction and mental health issue is receiving an accurate diagnosis. Diagnosing addiction and co-existing mental health issues accurately often takes time. This is why:

  • When a patient has Substance use disorder (SUD) or Alcohol Use Disorder (AUD), it may take time for the signs of the mental health issue to manifest.
  • When signs of the teen’s mental health issue manifest, doctors, the patient, and family members must adjust the treatment regimen.
  • Professionals in a treatment center – or provider of treatment – must have the expertise, competence, and ability to treat both diseases concurrently.

Parents of teenagers who have been diagnosed with a dual illness must realize that treatment is effective. The evidence indicates that the most successful treatment for dual diagnosis disorders is an integrated care approach that targets the patient as a whole, rather than symptomatic relief of one or the other disorder individually.

Parents and family are critical in assisting a child with co-existing disorders in their treatment efforts. You can have a significant role in the management of your teen’s mental health by knowing the clinical symptoms of the mental health and addiction disorders, recognizing that there is a problem, encouraging them to seek help, supporting them with their therapy, and helping them in maintaining their positive improvements. Positive family involvement has been proven in studies to increase therapeutic efficacy.

You can help a child with co-existing disorders in a variety of ways, including:

  • Taking part in family learning to understand the symptoms of mental health conditions, signs of substance abuse, treatment choices, prescriptions, and red flags and reasons for relapse.
  • Personal or family counseling to resolve any issues, enhance family interactions, learn how to react to your child appropriately, and find solutions to problems.
  • Monitoring your child’s medicine includes making sure prescriptions are filled and used properly, keeping track of any adverse effects and symptom reduction, and talking about how the drug is working.
  • Healthy participation and framework, such as returning to school, job, voluntary work, interests, hobbies, and other events, can help your kids regulate their mental health, remain sober, and give a regular foundation.
  • Attending a family support organization can help you learn from other parents in similar circumstances, learn about new services, and feel comforted by others in your neighborhood.
  • Recognize the indications of relapse so that you can get immediate treatment and get your kid back on the road to recovery.

You and other relatives can assist your kid get the support they need, encourage them throughout treatment and rehabilitation, and inspire them to believe that change can happen and that they can live a happy life.


The Balance RehabClinic is a leading provider of luxury addiction and mental health treatment for affluent individuals and their families, offering a blend of innovative science and holistic methods with unparalleled individualised care.


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