More than half of the people who seek help for an addiction also have a mental illness. These concurrent disorders present some of the most complicated and difficult-to-treat cases for our healthcare system. The links between mental health and substance use are complex, and causality can vary or be unclear. For example, a young person might use alcohol to cope with anxiety; on the other hand, the use of alcohol and drugs may promote or worsen the presence of psychological symptoms. Regardless of the direction, one way to approach the problem is to try to understand the common factors that can underlie both.
Research suggests there are many developmental pathways through which substance-use disorders and mental illnesses arise, but let’s look at one example: a child who tends to be socially withdrawn, displays emotions such as anxiety and depression, and is fearful of new experiences. Children with these characteristics seem to be at a greater risk of developing concurrent disorders. One study has shown that children with this temperament at age three were more likely later in life to attempt suicide, meet the criteria for depression, and experience alcohol-related problems. Another study of those showing these behaviours in early childhood revealed heightened activity in brain areas sensitive to reward during adolescence, which was later tied to higher levels of substance use in young adulthood.
At first blush, the developmental path to concurrent disorders might seem unavoidable, but with increasing knowledge of risk factors comes the capacity to address the issue from a preventive approach. Often overlooked, children who are socially withdrawn and anxious can be seen as less problematic by parents and teachers than their peers with overt behavioural problems. Because of such tendencies, the essential first step towards intervention is to inform parents, childcare professionals and teachers about how to detect concerning behaviours in children.
While drug-based education aimed at preventing or delaying substance use is often implemented in schools, earlier interventions that enhance social skills are lacking. Emerging evidence suggests that such interventions can be effective in addressing problems that can lead to concurrent disorders later in life. Interventions to enhance parenting skills can be beneficial in reducing behavioural and substance use problems. School-based programs where teachers are trained to implement curricula aimed at improving cognitive, emotional and social competencies in young students are showing promising results, but need to be further examined to ensure their effectiveness. Each child is unique and the best intervention strategy will be one tailored to meet his or her specific needs.
To improve policies, programs and practices in addiction prevention, detection and treatment, the Canadian Centre on Substance Abuse (CCSA) has partnered with organizations such as the Mental Health Commission of Canada, the Canadian Executive Council on Addictions, and the Ontario Centre of Excellence for Child and Youth Mental Health to provide evidence-based information through a number of CCSA publications:
- Childhood and Adolescent Pathways to Substance Use Disorders outlines personality and environmental factors that increase or decrease the risk of developing a substance use disorder (see also Concurrent Disorders).
- Collaboration for Addiction and Mental Health Care: Best Advice offers principles and examples from practice to enhance much-needed collaboration between mental health and addictions services.
- Systems Approach Workbook contains a module on Integrating Substance Use and Mental Health Systems that includes practical tips.
Concurrent disorders are both preventable and treatable, with earlier detection and intervention producing better long-term results. More information is available at www.ccsa.ca.
Author: Opal McInnis, M.Sc., Research and Policy Analyst, Canadian Centre on Substance Abuse; PhD Candidate, Department of Neuroscience, Carleton University.
**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC