Concurrent Disorders

What is it?

Concurrent disorders are mental health challenges and substance use disorders that happen at the same time. Depression and alcohol dependence is one example of a concurrent disorder.

What is substance use?

Substance use refers to the use of alcohol or drugs, including substances like nicotine, caffeine, prescription drugs, and illegal drugs. Substances make us see, think, feel and behave differently than we usually do.

Some youth may start to use substances to help them cope with stress, anxiety or depression. There may be conflict at home, school or among their peers. They may be questioning their sexuality and gender. Some children and youth may naturally be more likely to take risks than others or may hold some beliefs that influence their behaviour. For example, they may begin using substances such as vaping nicotine because they think it will lower their appetite or help them will fit in with peers.

How substance use can become a problem

Some people can use substances without it being a problem. However, it is recommended not to use any substances while the brain is still growing. Substance use in a growing brain can interfere with learning, memory, and increase your risk of developing a substance use disorder as an adult.

These are the stages of substance use:

It is normal for youth to experiment, but substance use can become a problem if it starts to interfere with daily life and mental health. It’s important to recognize the different stages of substance use and pay attention to your child’s mental health.

These are the stages of substance use:

spectrum

Problematic substance use means alcohol or other drug use is linked to problems such as:

Health problems like diabetes or mental health concerns, such as psychosis

Problems with friends, family or people at school

Risky behaviour:

Taking a lot of substances all at once

Mixing substances (poly drug use), like drinking alcohol and taking sleeping pills at the same time

Using substances while riding an electric scooter or cycling

Using substances and going to work or school

What is a mental health challenge?

A mental health challenge is a condition that affects the way you think, feel and behave. There are many kinds of mental health challenges, for example:

Attention-deficit/hyperactivity disorder (ADHD)

Anxiety disorders

Depression

Trauma and PTSD

How are substance use problems and mental illnesses connected?

There are four general ways that mental health challenges and substance use problems go together:

A mental health challenge comes first. Example: A young person is experiencing a mental health challenge and uses substances like alcohol or other drugs to help them deal with troubling symptoms.

Substance use comes first. Example: A young person uses cannabis and it triggers symptoms of a mental health disorder like psychosis.

A mental health challenge and a substance use disorder are triggered by the same event. For example, someone is in a very serious car accident and uses opioids to cope with nightmares and flashbacks.

The problems start separately. Example: A young person was diagnosed with separation anxiety in elementary school. There is a family history of anxiety disorders. In high school, they go to a party and are introduced to alcohol. They start drinking daily at school and this leads to an alcohol use disorder.

Substance use and mental health challenges are also connected when they're being treated:

Some substances stop medications from working properly, so symptoms of a mental health challenge become worse.

Some mental health challenges such as psychosis might make it harder to go through some substance use treatments.

Some mental health challenges can get worse if someone stops or cuts back their substance use without proper help.

Some people don't take their medication when they're using a substance, and this makes symptoms of a mental health challenge worse.

When one problem gets worse it can make the other problem worse. For example, drinking alcohol can make symptoms of depression worse.

When a mental health challenge is treated, the substance use may decrease.

For these and other reasons, it's important to take care of both concerns at the same time.

How do I know?

It can be hard to tell the difference between a mental health challenge and a substance use disorder. Many of the symptoms look the same.

When intoxicated and feeling the effects of alcohol or other drugs, it may look the same as many mental health challenges. Mental health challenges can also look similar to withdrawal from alcohol or other drugs.

Substances can hide symptoms of a mental health challenge. For example, stimulants like cocaine may calm young people living with ADHD.

Some substances can make mental health challenges worse. For example, anxiety and benzodiazepines. These medications can reduce anxiety in the short term and then the withdrawal makes anxiety much worse. It may not be possible for a health professional to make a diagnosis until signs and symptoms of intoxication and withdrawal are gone. It is also recommended to ask about mental health symptoms before substance use started and when there have been times of abstinence. It may also be helpful to know how the youth is doing at school or in their peer environment.

A child or youth may hide their substance use for many reasons. They also might not want you or other adults to know what they're using. It's also important to remember that having mental health challenges and using a substance doesn't necessarily mean that a child or youth has a concurrent disorder. If you're concerned, it's best to talk to a doctor or a mental health professional.

What can be done?

A child or youth who may have a concurrent disorder needs to see a doctor for an assessment. The doctor can refer them for special treatment and support services. The goal of treatment should be decided together with the child or youth. It may not be realistic to stop all substance use, but it's possible to lessen the harms linked to it. A child or youth is more likely to follow a treatment plan when it makes sense to them. When the young person works through both problems together, it's easier to make positive changes and lower the risk of relapses.

In general, there are two basic groups of formal treatment: talk therapy and medication. The exact treatment a child or youth receives will depend on many different things:

What mental health challenge and substance use challenge they're living with

How severe each challenge is

How the mental health and substance use challenges interact with each other

Other life challenges they are experiencing

What services are available in their community

Therapies

Here are some of the therapies used to treat concurrent disorders:

Motivational interviewing helps children and youth to make positive changes. Sometimes youth may not want to make a change to their mental health or substance use. This counselling style helps to see the negative impacts both mental health challenges and substance use have on their life.
Cognitive behaviour therapy or CBT teaches how thoughts, feelings and behaviours are related. It also teaches skills like problem-solving and recognizing triggers.
Dialectical behaviour therapy or DBT helps with behaviour problems. It teaches how to manage feelings, cope with distress and improve relationships.
Multisystemic therapy focuses on factors like family, friends, school and the community. It looks at the concerns around you that may lead to problem behaviours.
Family therapy improves relationships by helping family members learn more about the child or youth's problems. It helps them work together, communicate and provide support.
Peer support provides many benefits, including a sense of belonging, and practical coping skills. It helps reduce stigma, offers a supportive environment for sharing experiences, and can increase empowerment and self-esteem by connecting individuals with others who have faced similar challenges. Peer support can inspire hope to both parents and child that concurrent disorders are treatable. Family members may also find family peer support groups helpful.

Medications

There are many effective medications for substance use disorders and mental health challenges. These medications can help reduce symptoms to allow the child or youth to be able to do things they need and want to do. They can improve both their functioning and quality of life.

Medications for substance use disorders include opiate agonist therapy that help reduce cravings and make using a substance less enjoyable. There are also medications that reduce or prevent withdrawal symptoms.

Well-being and healthy living

Support from family, friends, schools and the workplace is important. Having safe housing and all your basic needs met is key. It often helps a child or youth with a concurrent disorder to get involved in community activities like volunteer work, sports and other interests. This may lead to an increase in self-esteem and a sense of belonging. Having one positive adult role model can be protective. In fact, not having these supports may be a risk factor for concurrent disorders.

Withdrawal management

The goal of withdrawal management is to provide support in a safe way to help the young person stop using substances. It is recommended that young people access health care for medical supervision for withdrawal from alcohol, benzodiazepines and opioids. There are strategies including medication to help make withdrawal from substances safe and more comfortable.

Relapse

A youth’s symptoms or substance use problems may come back, even if they're in treatment. This is a normal part of recovery. If there is a relapse, it's a good idea to talk about it and learn from it. Relapses can help a youth understand what their triggers are and what can be done differently to manage situations in a safe way. It's important to remember that a relapse doesn't mean the youth should stop or change treatment without talking to the doctor or mental health professional.

Family members can help by learning about the challenges that their child or youth is living with. They can learn what might increase the risk of relapse and watch for warning signs so they can get help early. Some youth write an action plan that lists their warning signs and what other people can do to help.

Recovery

It's important to think about what will happen when treatment is finished. Treatment can include bed-based treatment, day programs or outpatient services. They can include self-help groups such a SMART Recovery, AA and NA. Family members may engage in family support groups, self-help groups such as SMART Recovery Family and Friends, Al-anon and Nar-anon groups. These can be accessed in person or online.

We know that treatment plans work best when done together with the treatment team and the youth. It’s important to include the youth if possible.

Some factors to consider are:

Safe housing
Programs to help find a job, go to school, or learn other skills
Life changes will continue after formal treatment ends
Support group meetings or doctor's appointments that you and your child can access

Some people define recovery as not using any substances and not experiencing any mental health challenges. But most people experience recovery in less black-and-white terms. It is a process or journey that moves in all directions - steps forward and steps backwards - and is different for everyone. A child or youth will need hope and encouragement to overcome challenges, take control of their life, and achieve their goals. The best outcomes are when both mental health challenges and substance use concerns are treated together.

Tips for caregivers

It is very challenging to care for a young person living with a concurrent disorder. At times, you may feel overwhelmed and helpless. A self-care plan can help you through a difficult time. It could include strategies to help you relax, do things that you enjoy and reconnect with family and friends. It may also help to talk to a mental health professional or a family peer support worker at the Kelty Centre. If you take steps to lower your own stress and model healthy ways to cope, it may help both you and your child or youth.

Where to from here?

Talk to your family doctor, who can complete an assessment for your child and youth. Your doctor can also refer them for specialized treatment and support services. 
Most communities in BC have local Child and Youth Mental Health teams. There are local community youth substance use services throughout BC too. Foundry has numerous hubs in the province and can offer online support to communities who do not have one.

Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.

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