Facts on Co-Occurring Mental Illness and Substance
Abuse Disorders in Children and Adolescents
(Updated August 8, 2004)
Providing effective and culturally competent services for youth with
co-occurring mental illness and substance abuse disorders is essential. Since
childhood is a critical time for the development of life skills, the failure
to treat
co-occurring disorders early has devastating long-term social consequences
and contributes to high health care costs.
Prevalence
-
Youth with behavioral disorders (i.e., conduct disorder, attention deficit
disorder) are more likely to develop substance abuse disorders than youth
with anxiety or depressive disorders, who are still two to four times more
likely than their peers without mental disorders to develop substance abuse
disorders.[3]
Unmet Needs and
Consequences
-
Social costs. Untreated youth with co-occurring disorders have
high rates of suicide, medical problems, homelessness, unemployment, incarceration,
truancy, difficulty concentrating in school or focusing attention on tasks
at home, at part-time work or during extracurricular activities, and poor
peer and parental relations.[5]
Effective Services
-
Integrated services. Research shows that integrated mental health
and addiction treatment programs that are specifically designed for people
with co-occurring disorders are most effective. For youth, services should
be comprehensive and integrate legal, health, recreational and educational
services. A team of family physicians, school psychologists and child
welfare workers trained to assess and treat children with co-occurring
disorders are integral to recovery. Unlike treatment for adults, services
for youth with co-occurring disorders must be designed to suit the needs
of the child’s developmental stage. [7]
Barriers to Meeting
Needs
-
Fragmented delivery system. The health care system is fragmented,
with different delivery systems and separate funding and administration
for public mental health and substance abuse services. The lack of coordination
between education, juvenile justice and child welfare systems further complicates
the process of securing services for children with co-occurring disorders.[8]
-
Gaps in public and private insurance coverage. Health plans continue
to limit coverage for mental health and substance abuse treatment, ensuring
that many American children will not have access to medically necessary,
essential health services.[9]
-
Punishment instead of treatment. Youth with co-occurring disorders
often are incarcerated, rather than treated. Two-thirds of the one million
youth in formal contact with the justice system (i.e., charges and/or court
appearance) have one or more alcohol, drug, and mental disorders.[10] Youth with serious
mental illnesses make up approximately a quarter of the population in the
juvenile justice system, and their numbers are increasing.[11]
Recommendations
Policymakers can promote integrated treatment by:
Notes
[1] U.S. Department of Health and Human Services. (2002,
November). Report to Congress on the Prevention and Treatment of Co-Occurring
Substance Abuse Disorders and Mental Disorders. U.S. Department of Health
and Human Services, Substance Abuse and Mental Health Services Administration. 5
[2] U.S.
Department of Health and Human Services. (2000, May) Draft 3: Prevention
of Co-Morbidity in Children and Adolescents: The Nexus of Mental Health and
Substance Abuse. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration.3
[3] U.S.
Department of Health and Human Services. (2002, November). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration. 6
[4] King,
R.D., Gaines, L.S., Lambert, E.W., Summerfelt, W.T. & Bickman, L. (2000).
The co-occurrence of psychiatric and substance abuse diagnoses in adolescents
in different service systems: Frequency, recognition, cost, and outcomes. The
Journal of Behavioral Health Services & Research, 27, 428.
[5] The
President’s New Freedom Commission on Mental Health. (2003). Achieving
the Promise: Transforming Mental Health Care in American. Final Report.
(DHHS Publication No. SMA 03-3832). Washington, DC: U.S. Government Printing
Office. 59; U.S. Department of Health and Human Services. (1999,
April). The relationship between mental health and substance abuse among
adolescents. Department of Health and Human Services, Substance Abuse and
Mental Health Services Administration. 1
[6] The
average cost of treating youth with co-occurring disorders is $29, 057 while
the average cost of treating youth for either a mental illness or substance
abuse disorder is $13, 067. King, R.D., Gaines, L.S., Lambert, E.W., Summerfelt,
W.T. & Bickman, L. (2000). The co-occurrence of psychiatric and substance
abuse diagnoses in adolescents in different service systems: Frequency, recognition,
cost, and outcomes. The Journal of Behavioral Health Services & Research,
27, 417.
[7] U.S.
Department of Health and Human Services. (2002, November). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration. 79
[8] U.S.
Department of Health and Human Services. (2002, November). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration. 78
[9] U.S.
Department of Health and Human Services. (2002, November). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration. 79
[10] U.S.
Department of Health and Human Services. (2002, November). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration. 91
[11] U.S.
Department of Health and Human Services. (2002, November). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration. 91
[12] U.S.
Department of Health and Human Services. (2002, November). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders. U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration. 78
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