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What does research
say about the relationship between Mental Health and Substance Abuse?
Historically, the fields of substance abuse and mental health have had
different theoretical frameworks and would seldom collaborate and coordinate
services with each other. However, in recent years there has been growing
acceptance in both fields of the relationship between substance abuse
and mental health problems for children and adolescents. This relationship
has been confirmed in various research studies. In a review of the literature,
Costello and colleagues (2000) identified several studies reporting the
prevalence of "psychiatric comorbidity with substance use and abuse
in children and adolescents." Included in their review was the study
conducted by Chong, Chen and Chang (1999) that reported that 45-91% of
adolescents with conduct disorder were also abusing substances and/or
were substance dependent. Rhode et al. (1996) reported in their study
that 80% of adolescents with alcohol abuse or dependence had a comorbid
psychiatric disorder.
Age of Onset or Early Intervention
Evidence also seems to suggest that mental health disorders begin at an
earlier age than substance use problems. According to a study by Kessler
(1994) 85% of people with both substance use and mental health problems
developed the mental disorder first. Thus, there is a clear 'window of
opportunity' to provide prevention interventions with children who display
early or warning signs of behavioral and/or emotional problems, making
them more vulnerable to more serious behavioral and emotional problems,
serious substance abuse and co-occurring disorders.
Risk Factors
It is important to note that mental health and substance use problems
are only two negative outcomes caused by the existence of one or more
risk factors. According to Dryfoos (1990) six common characteristics can
predict any one or a combination of several negative outcomes:
- early initiation of inappropriate behaviors
- doing poorly in school or expecting to do poorly
- acting out, truancy, antisocial behaviors and conduct disorders
- low resistance to peer influence and having friends who engage in
inappropriate behaviors
- insufficient bonding to parents or parents who do not provide sufficient
structure or communicate well
- living in poverty or urban high-density community (Dryfoos, 1990).
Common Risk and Protective Factors
According to other researchers, both risk and protective factors existing
in one of six life domains: individual, family, peer, school, community,
and society can lead to substance abuse problems, mental health disorders
or a combination of both (CSAP, 1999; Loeber and Farrington, 1999). These
risk and protective factors are essential to consider in prevention efforts
for substance abuse and mental health disorders comorbidity. In addition
to considering risk and protective factors, research studies also reveal
that prevention programs are more effective when they are "comprehensive,
family-focused, and include appropriate cultural, developmental and gender
perspectives." (SAMHSA, 2003).
References
Center for Substance Abuse Prevention (1999). Here's Proof, Prevention
Works. Understanding Substance Abuse Prevention - Toward the 21st Century.
DHHS Publication No. (SMA) 99-3300. Rockville, MD: US Department of Health
and Human Services, Substance Abuse and Mental Health Services Administration.
Chong, M.-Y., Chan, K.-W., & Chang, A.T.A. (1999). Substance use disorders
among adolescents in Taiwan: Prevalence, sociodemographic correlates and
psychiatric co- morbidity. Psychological Medicine, 29, 1387-1396.
Costello, E.J., Armstrong, T.D., & Erkanli, A. (2000). Report on the
developmental epidemiology of comorbid psychiatric and substance use disorders.
Presented to the National Institute on Drug Abuse. Durham, NC: Duke University
Medical Center.
Dryfoos, J.G. (1990). Adolescents at risk: Prevalence and Prevention.
New York: Oxford University Press.
Kessler, R.C. (1994). The national comorbidity survey of the United States.
International Review of Psychiatry 6: 365-376.
Loeber, R. & Farrington, D.P. (Eds.) (1999). Serious and Violent Juvenile
Offenders: Risk factors and successful interventions. Thousand Oaks,
California: Sage Publications.
Rohde, P., Lewinsohn, P.M., & Seeley, J.R. (1996). Psychiatric comorbidity
with problematic alcohol use in high school students. Journal of the
American Academy of Child and Adolescent Psychiatry, 35, 101-109.
U.S. Department of Health and Human Services, Substance Abuse and Mental
Health Services Administration. (2002). Report to Congress on the Prevention
and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders.
Rockville, MD: HHS Substance Abuse and Mental Health Services Administration.
For more information see:
FAQ: I often hear people talk about youth with co-occurring substance
abuse and mental health disorders. Where can I find information about
this issue, its prevention, and its treatment? http://www.captus.samhsa.gov/northeast/resources/faq/faq83.cfm
Please contact CSAP's Northeast CAPT at captonline@edc.org
for more information.
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