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Co-occurring Substance Abuse and Mental Health Disorders

Blamed and Ashamed!

There are individuals who have no mental health problem and who become involved with the use of alcohol and drugs because they want to change the way they feel. These single-disorder individuals start out feeling o.k., but want to feel even better. Then substance abuse and addiction can make them feel much worse.

But for depressed or anxious, shy, fearful, or hyperactive children and adolescents, the motivation for drug use is very different. They are trying to just feel normal.

Mental health symptoms can be temporarily relieved by medicating with alcohol, marijuana, or cocaine. However, as drug effects wear off, the post-intoxication rebound tends to worsen the original bad feelings, causing a double motivation to use more and more drugs and alcohol.

The Continuum of Abuse

The earlier alcohol and other drug abuse starts, the shorter and faster the road to abuse and dependence:
  • Experimentation: Almost all drug abuse begins this way. Young people are curious, feel invulnerable, and just want to see what its like.
  • Recreational alcohol and other drug abuse: If experimentation progresses, the young person will be using, with friends, once or twice a week...or every day.
  • Habitual use: With continued recreational use, vulnerable individuals, especially those with a mental health problem, increase the amount and frequency of use.
  • Drug abuse: When alcohol and other drug abuse becomes so frequent and important that it interferes with school, family life, and personal development, the person has reached this level.
  • Drug dependence: If the situation grows even more serious, the individuals body craves the drug, and avoidance of the pain of withdrawal becomes an additional motivator for drug use. Now the central focus of the persons life is the acquisition and use of drugs.

Many people who are familiar with the concept of the continuum of abuse do not know that the length of time it takes to go from one stage to the next varies with the age of first use.

  • Someone who begins experimenting in their twenties may not become dependent until their fifties, if ever.
  • Someone who begins recreational use at 16 may become dependent by 20.
  • A child, beginning to use drugs at 10 or 11, may become dependent within just two years.

This information has been substantiated in study after study, looking at a wide variety of drugs, from nicotine and alcohol to cocaine. That is why, from a public health and family perspective, we should do everything we can to delay childrens first use of any intoxicating substance, including tobacco.

Do mental health and substance abuse problems in childhood and adolescence affect the maturation of the individual?

We often see that the early development of anxiety, depression, thinking problems, behavior problems, when compounded by early use of drugs and alcohol, interfere with the development of a mature, stable, functional personality and sense of self. I have identified several common personality immaturities that may result from childhood and adolescent mental health/alcohol and other drug abuse problems. Each is normal in a young child:

  • Low frustration tolerance: Trouble working hard, and sticking to it, when gratification is not immediate.
  • Lying to avoid punishment.
  • Hostile dependency: A dependent person, unable to do things on their own, may have trouble developing a confident, independent self. Continued dependency may be expressed as hostility toward the very people whose help they need, such as parents. Hostile dependency, although often directed against others, may really be directed against the self. In extreme cases it can lead to a suicide attempt.
  • Limit testing: All children test limits; that is a normal part of childhood. It is a troublesome form of immaturity when it persists into later adolescence and adulthood.
  • Alexithymia. Children and older people with this condition are unable to verbalize their feelings effectively. As a consequence, they may act out their feelings, just as young children do. Rather than verbalizing anger, they may strike out physically. Rather than talking about their fears, they may avoid, run away, and hide. Instead of talking about feelings of hopelessness and depression, they may act out by attempting suicide. People with alexithymia cant soothe themselves or ask for help. Learning to talk about feelings is a key step in recovery.
  • Present tense only: Very young children only live in the present. They do not have a sense of future, cannot anticipate consequences of their own behavior, and have not become able to learn from past experiences. Adolescents who have no clear sense of past and future can repeat the same mistake over and over again.
  • Rejection sensitivity: Young children, and many people with co-occurring disorders are so eager to please, have friends, and be accepted, that they may agree to do things that they dont really want to do. They may seek approval by trying too hard to please. If their efforts fail, they may feel terribly rejected, withdraw, and not try again. They can be very thin-skinned.
  • Dualistic: Young children, when they first learn the difference between right and wrong, put every action into one or the other category: Something is either Right or Wrong. As a consequence, moderation is a problem. A slip—having a glass of wine at a birthday party—may be so wrong that they might as well go ahead and get drunk. Dualism can turn a slip into a relapse. Dualistic judgment toward a counselor or a parent can cause condemnation; that person is now useless and hopeless.

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