In Compass Health Center’s adolescent mental health programs, staff frequently hear firsthand about the increasing pressures our youth face daily. Whether it is pressure to measure up academically, comparing themselves to others, trying to fit in, or finding the courage to open up and seek support, these stressors often escalate and lead to increased mental health struggles. That being said, it is not shocking that the research shows a continuing increase in the number of adolescents who report they experience poor mental health. The most recent data sets from the Youth Risk Behavior Survey show that 42% of high school students report experiencing persistent feelings of sadness and hopelessness, and 29% of high school students report experiencing poor mental health (1). Seeing these numbers is eye-opening and can lead adolescents to engage in unhelpful coping strategies, including substance use.  

When asking high school students about substance use in the last 30 days, 18% of them report using e-cigarettes (nicotine), 23% of them report using alcohol, and 16% of them report using marijuana (1).  There is a concerning and distinct correlation between adolescents who experience poor mental health and those who use substances. When these issues overlap, they impact one another in an increasingly reinforcing cycle known as co-occurring disorders.  To combat the ever-increasing concerns and statistics related to co-occurring mental health and substance use in teens, Compass Health Center launched our adolescent Mental Health & Substance Use programs to treat teens and their families experiencing the complexities that come with these co-occurring concerns.

 

What is the relationship between poor mental health and substance use?

 

Some adolescents may find themselves trying a substance at least once during their high school years; however, we often see that those with mental health struggles find themselves more likely to keep using substances once they start (2). Teens in treatment often report using substances to “numb” the emotions that come along with a mental health disorder. They share that getting “high or buzzed” helps to turn off their negative thoughts and allows them to “escape” from feelings of depression or anxiety. This makes sense when taking into consideration that the feeling of a “high or buzz” is because substances stimulate the reward center in the brain, releasing high levels of dopamine, one of our “feel good” neurotransmitters (3). Essentially these adolescents are “self-medicating” or trying to find a way to cope with their emotions in the short term, even though the long-term effects may be counterproductive (2).

Alternatively, we also see patients coming into program who report they didn’t start experiencing mental health struggles until after they started engaging with substances.  This is due to the way continued use can chemically alter dopamine production and absorption in the brain (2). In response to the amount of dopamine that gets released with continued substance use, the brain attempts to “adjust or self-correct,” leading it to produce and absorb less of its own dopamine (3). With this change, patients find that their mood is more dull or flat and they have less motivation to engage in things. Activities such as athletics, the arts, and other social interactions and hobbies that an individual once enjoyed and found rewarding are no longer able to bring them the same enjoyment. Essentially, continued use of a substance can lead someone to develop mental health symptoms such as depression (2). This is when we see an adolescent feeling they need to be under the influence more frequently, with increasing amounts of the substance, to feel any enjoyment (3).

While substance use and mental health struggles do not always necessarily lead from one to the other, it becomes clear that they can contribute to each other in critical ways. Mental health struggles can lead to substance use when adolescents are looking to self-medicate and substance use can lead to mental health struggles by triggering a change in brain function (2). No matter if mental health struggles or substance use came first, we see this population of adolescents continuing to feel that they “need” substances to manage and just feel “okay”. The good news is, that with a break in the cycle, and sustained periods of abstinence, dopamine function within the brain can repair (3) and adolescents can learn the skills they need to cope with mental health in more healthy and prosocial ways.

 
What makes the relationship between mental health and substance use even more complex for teens?

 

When talking about the relationship between mental health and substance use, one must also take into consideration the crucial stage of brain development that an adolescent is going through. The human brain is not fully developed until the age of 25, putting adolescents in a middle range where some parts of the brain are more mature than others (4). During adolescence, parts of the brain that lead to experiencing emotions are much more developed than the part that allows for ability to regulate and make thoughtful decisions about these emotions (4). The slower development of this part of the brain, known as the Prefrontal Cortex, hinders one’s ability to fully understand and weigh the potential consequences of risky decisions. This is why adolescents find themselves with intense emotions and a desire to feel good in the moment coupled with a lack of ability to regulate emotions and fully comprehend and think through risks involved with something like using substances.

 
How does Compass Health Center work towards breaking the cycle?

 

Intervention for an adolescent with co-occurring disorders means figuring out ways to help them take steps towards decreasing use while also providing them with the coping skills needed to manage mental health symptoms, cravings, and urges. At Compass, within our adolescent Mental Health and Substance Use programs, patients engage in individual, group and family therapy as well as meet with a psychiatrist or nurse practitioner who specialize in working with adolescents who struggle with substance use. This work also often involves increasing motivation toward change in the first place for many adolescents which is no small task.  Our goal is to empower an adolescent to understand exactly how substances and their mood affect one another, support them through cravings and the withdrawal process, hold them accountable to their goals, and encourage them to better understand, express, and cope with emotions.

 
What can parents do?

 

Empower: Knowledge and resources are key! In our experience, adolescents appreciate understanding the facts. Help your adolescent understand what exactly is going on with them, and, specifically, how their mental health and substance use are related. When an adolescent understands what is going on with their body and, specifically, their brain, as well as what is within their control to effect change, their motivation to do so increases. Empowering may also mean opening your adolescent up to resources such as a therapist or program depending on the extent of their struggles.

Support: Make sure your adolescent understands that you are in this process with them, not against them. Even if they do not show it, many adolescents feel a significant sense of shame about their use and mental health struggles, often reporting that they feel like a burden. You can help with this by avoiding judgment-based language including labels. Discuss an adolescent’s decisions and behaviors when addressing concerns, not their character. Validate what they are going through; acceptance or understanding do not equal approval.

Hold Them Accountable: Accountability is one of the hardest parts, and something against which your adolescent may push back against. This is often due to them navigating ambivalence, wanting to maintain control in a situation where they feel helpless, or lacking confidence in their ability to make change.  You can help them overcome these barriers by helping them reflect on their unhelpful behaviors, challenging them to try differently, and reminding them of their goals. This is a delicate balance between remaining firm with boundaries and expectations while reminding them you are still there to support them. Reinforcing for them that we believe that they can handle hard things is crucial versus conveying worry that they may not have this ability. 

Encourage Understanding, Expressing and Coping with Emotions: Through all of this, there will be a lot of emotions, both for your adolescent, yourself, and the rest of your family. You can encourage your adolescent to better express and cope with their emotions by modeling this through the way you handle your own emotions. Make time to check-in and ask the hard questions. Much of learning to work through mental health struggles is accepting that while it is challenging to sit with uncomfortable emotions, it is possible and eventually empowering. Your adolescent identifying what helps them cope through these moments will be crucial for their recovery.

Youth MHSU-2

Citations

  1. Centers for Disease Control and Prevention. [2021] Youth Risk Behavior Survey Questionnaire. Retrieved from cdc.gov/yrbs on October 4, 2023.
  2. The National Institute of Mental Health. [March 2023] Substance Use and Co-Occurring Mental Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health on October 7, 2023.
  3. National Institute on Drug Abuse. [July 2020] Drugs, Brains, and Behavior: The Science of Addiction, Drugs and the Brain. Retrieved from https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain on October 4, 2023.
  4. Addiction is Real. [2023] Teenage Brain. Retrieved from https://addictionisreal.org/parent-toolkit/teenage-brain/ on October 17, 2023.
Stephanie Snow
Author