Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Substance Use Disorders in Adolescents
Since the early 1990s there has been a“sharp resurgence” in the misuse of
alcohol and other drugs by adolescents (Johnston et al., 1996). A recent review,
focusing particularly on substance abuse and dependence, synthesizes research
findings of the past decade (Weinberg et al., 1998). The authors review
epidemiology, course, etiology, treatment, and prevention and discuss
comorbidity with other mental disorders in adolescents. All of these issues are
important to public health, but none is more relevant to this report than the
co-occurrence of alcohol and other substance use disorders with other mental
disorders in adolescents.
According to the National Comorbidity Study, 41 to 65 percent of individuals
with a lifetime substance abuse disorder also have a lifetime history of at
least one mental disorder, and about 51 percent of those with one or more
lifetime mental disorders also have a lifetime history of at least one substance
use disorder (Kessler et al., 1996). The rates are highest in the 15- to
24-year-old age group (Kessler et al., 1994). The cross-sectional data on
association do not permit any conclusion about causality or clinical prediction
(Kessler et al., 1996), but an appealing theory suggests that a subgroup of the
population abuses drugs in an effort to self-medicate for the co-occurring
mental disorder. Little is actually known about the role of mental disorders in
increasing the risk of children and adolescents for misuse of alcohol and other
drugs. Stress appears to play a role in both the process of addiction and the
development of many of the comorbid conditions.
The review by Weinberg and colleagues (1998) provides more detail on
epidemiology and assessment of alcohol and other drug use in adolescents and
describes several effective treatment approaches for these problems. A
meta-analysis and literature review (Stanton & Shadish, 1997) concluded that
family-oriented therapies were superior to other treatment approaches and
enhanced the effectiveness of other treatments. Multisystemic family therapy,
discussed elsewhere in this chapter, is effective in reducing alcohol and other
substance use and other severe behavioral problems among adolescents (Pickrel &
Henggeler, 1996).
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