The Forest for the Trees: Beginning to Clarify the Complexities of Co-Occurring Disorders in Adolescent Drug Users

Background and Purpose: Evidence within the growing body of literature concerning co-occurring issues of substance abuse and mental health disorders has established strong correlations between the two, especially within the adolescent population.  However, there is little discussion of the variety and types of drugs that are used by this population.  Because different drugs’ physical and psychological withdrawal affects impact patients’ abilities in treatment, drug types used have important implications on services and methods of delivery offered to treatment-seeking adolescents as well as aftercare recommendations for this population.

Methods: This study examined adolescent responses to the 2012 National Study on Drug Use and Health (NSDUH) to provide further confirmation of the relationship between mental health and substance abuse disorders as well as to investigate relationships between mental health disorders and specific types of drugs abused.  The hypothesis guiding the study was: Adolescents who have been diagnosed with anxiety disorder or major depressive disorder (MDE) within the past year will be more likely to have used or abused alcohol and other types of drugs within the past year. A secondary data analysis was conducted on 2012 NSDUH responses provided by adolescents between the ages of 12 and 17 (n = 17399) regarding whether they had been diagnosed with anxiety disorder or major depressive episode by a medical professional in the past year, if any.  A factor analysis examined 111 different drug categories explored by the NSDUH survey.  Five categories of interest encompassing the commonly-encountered drugs in substance abuse treatment facilities and agencies (alcohol and marijuana; stimulants; hallucinogens; prescription medications; and heroin, cocaine, and crack) were identified.  Separate logistic regression analyses were then conducted using anxiety diagnoses and major depressive episode diagnoses as independent variables predicting the likelihood that respondents had also used drugs in those 5 identified categories while controlling for the effects of age, gender, and race. 

Findings: Past year anxiety and major depressive disorder diagnoses were found to be statistically significant predictors of past year use of all substance groups identified through the factor analysis.  Odds ratios ranged between 1.609 times through 3.503 times more likely for persons diagnosed with anxiety in the past year to have used 1 of the 5 substance groups as compared to persons who were not diagnosed with anxiety.  Odds ratios ranged between 2.228 times through 2.831 times more likely for persons diagnosed with major depressive disorder in the past year to have used 1 of the 5 substance groups. 

Conclusions and Implications: Overall, findings show that anxiety and major depressive disorder diagnoses significantly increase the likelihood of adolescents having used alcohol or other drugs.  When considering treatment interventions, practitioners must begin to understand the range of substances used having an impact on the method and types of interventions employed in treatment settings rather than treating substance abuse as one generic condition.  Further, this study shows the importance of understanding the prevalence of the co-occurring nature of substance abuse and mental health disorders when considering the treatment interventions used within this population.