Detecting Co-existing Psychiatric and Substance Use Disorders in Young People

Introduction
In September 2004, a local social service agency initiated construction of a short-term inpatient unit for youths under the age of 18 who are a danger to themselves or to others. The significance of this program is that it eliminates children spending unnecessary time in the adult county ward as well as reduces transfers to hospitals in the Sacramento or San Francisco Bay area. This in turn encourages the development of effective treatment plans that the young people and their guardians can follow after discharge.

Many of the youths who will be utilizing the children’s impatient area have a documented mental health disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000). Abrantes, Brown, and Tomlinson’s (2003) study concluded that a co-occurring Axis I diagnosis with a substance use disorder exists at high rates in adults, and that youth may have a similar prevalence. Multiple other studies have shown that at least 33% of adolescents hospitalized due to psychiatric reasons are abusing or dependent upon alcohol or drugs (Abrantes, Brown, & Tomlinson, 2003). Without intervention, the substance use only intensifies the mental illness. Ultimately, these individuals are confronted with devastating consequences and are at higher risk for future homelessness, incarceration, HIV, and suicide (Pepper, 2000).

Statement of Need
During my senior internship at this local social service agency, I noticed staff routinely assessed for mental illness in the youth served. On the other hand, they did not have a standardized approach to evaluate the psychological, social, and physiological signs and symptoms of substance use during initial screening. This was concerning since research has determined that 83% or more of the time, the mental health disorder will develop first with the median onset around age 11. The median age of onset for the substance abuse disorder is between 17 and 21 (Pepper, 2000). It appeared that this agency was missing an ideal opportunity to identify youths at risk to assist in the prevention of the negative outcomes often associated with co-existing disorders.

Through multiple interviews with administrators, staff, and clients, there was mutual agreement that a standardized screening approach should be enacted to increase detection of co-existing disorders in youth. Therefore, a crisis oriented assessment tool for alcohol and drug use was immediately assigned to a staff member for development. Although, through further investigation, it appeared that knowledge of dual diagnosis in children was limited amongst the crisis counselors. It was concluded that by increasing the staffs’ understanding of issues concerning co-existing disorders, a higher number of youth would be detected and referrals for specialized treatment would be more likely.

Description of the Intervention
To increase awareness surrounding the co-morbidity of mental health disorders and substance use disorders in young people, I therefore conducted a one hour training for clinical and non-clinical staff members. It occurred on Tuesday, March 29, 2005, at 4:00 p.m., during a scheduled employee meeting. Information based on interviews from experts in the field and current data found in scholarly journals was presented. Specific topics included: substances youths with a specific mental health diagnosis are most likely to abuse, risk and protective factors associated with co-morbidity, interviewing techniques for the detection of substance use, and the current guidelines for treatment. In addition, a resource list for services for youth with substance use or dual diagnosis issues was made available.

Evaluation of the Intervention
Overall, the staff training appeared successful. I was able to provide the most current information on co-existing mental health and substance use disorders in young people to the agency’s supervisor and approximately 15 crisis counselors. The members appeared interested and remained interactive throughout the entire presentation. Afterwards, multiple members remarked that the demonstration was “exceptional” and they were thankful since the data that I provided would guide them in their future practice. My intern supervisor stated, “It was perfect, you couldn’t have changed a thing.”

Even though, the true significance of the training cannot be known. Since my internship is coming to an end, I did not incorporate a method, such as a single case design, to accurately evaluate the intervention. Nevertheless, instinctively I do feel that awareness of the staff was raised and when the new alcohol and drug screening form is enacted, the information that was provided will aid in the future detection of youth with issues in mental health and substance use disorders.

Reflections on the Project
This project tended to be challenging due to the narrow availability of information on co-existing disorders in young people. Adult co-morbidity is scarcely understood and knowledge regarding youths is even more limited. I often found myself frustrated as I spent endless hours searching for significant data. This project definitely increased my ability to become resourceful.

Therefore, what facts I was able to uncover and share with my colleagues gave me great satisfaction and I wished I had planned to present to additional agencies. I felt that I was providing a vital service to our community since the crisis counselors at this local social service agency would have more knowledge to help detect youth with dual diagnosis along with the newly developed alcohol and drug screening form. Ideally, I felt this would decrease the destructive consequences often associated dual diagnosis as youth gained treatment for their disorders.

Although, as I created a resource list, I was disappointed to discover that there is a lack of funding and resources available for young people with substance use disorders in the county. Since Medi-Cal does not pay for these types of services, agencies cannot realistically support these types of treatments. Unfortunately, at this time, youths must grow into adulthood with extreme illness before interventions are available. Therefore, this project has encouraged me to begin advocating for strategies that integrate care for both mental health and substance use disorders for youth. If treatment was available, young people with co-existing disorders may have the opportunity for developing a healthy and fulfilling life.

References
Abrantes, A. M., Brown, S. A., & Tomlinson, K. L. (2003). Psychiatric comorbidity among inpatient substance abusing adolescents. Journal of Child & Adolescent Substance Abuse, 13(2), 83-101.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders fourth edition text revision (4th ed.). Washington, DC: Author.
Pepper, B. (2000.). Blamed and ashamed: The treatment experiences of youth with co-occurring substance abuse and mental health disorders and their families. Retrieved February 24, 2005, from http://www.mentalhealth.org/publications/allpubs/KEN02-0129/pepper.asp