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Comorbidity in young people: perspectives and challenges

Published online by Cambridge University Press:  24 June 2014

I. B. Crome
I. B. Crome*
Affiliation:
Keele University Medical School, Stoke on Trent, UK
*
*Ilana B. Crome, Academic Psychiatry Unit, Keele University Medical School (Harplands Campus), Academic Suite, Harplands Hospital, Hilton Road, Harpfields, Stoke on Trent , ST4 6TH, UK. Tel: +44 (0)1782 441658; Fax: +44 (0)1782 441650; E-mail: [email protected]
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Abstract

Trends in prevalence in substance misuse in young people in the UK are described: increased use over the last decade, the tendency to polydrug use, the narrowing of the gender gap. The complex issues relating to the description, definition and classification, and diagnosis of psychiatric comorbidity and substance misuse are outlined. The fact that there is no uniformly accepted definition of what constitutes ‘dual diagnosis’ or ‘psychiatric comorbidity’ in young people is highlighted: this variability impacts upon clinical assessment and study design. Despite these considerable drawbacks, a degree of consistency is beginning to emerge in the co-occurrence of some conditions, e.g. disruptive and suicidal behaviours. It is recognized that psychological distress and substance misuse are also associated with multiple social and physical complications. The rapid advances in treatment options are presented. At present the ‘best practice’ is implementation of what works for adults with addiction and young people with psychiatric disorder. This includes psychosocial interventions such as motivational enhancement techniques and cognitive behavioural treatment, as well as appropriate safe (usually), short-term use of a range of pharmacological agents. Very few comprehensive designated adolescent addiction services exist, while child and adolescent mental health services are under serious pressure. Thus the need for a longitudinal and multidisciplinary approach, with appropriate assessment instruments in young people, is required to further explore diagnostic classification which will classify the degrees and patterns of relationships between disorders. In this way it may be possible to build up a picture of the nature and extent of numerous complex, and sometimes overlapping, problems and needs in children and adolescents in a variety of settings: primary and secondary care, the criminal justice system and educational establishments. This might strengthen the development of innovative treatment services where novel interventions are tested as a priority.

Keywords

psychiatric disorderssubstance misuseyoung people
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 1 , February 2004 , pp. 47 - 53
Copyright
Copyright © 2004 Blackwell Munksgaard

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References

Crome, IB. Substance misuse and psychiatric comorbidity: towards improved service provision. Drugs: Education, Prevention Policy 1999;6: 151–174. Google Scholar
World Health Organisation. International Classification of Mental and Behavioural Disorders. Geneva: World Health Organisation, 1992. Google ScholarPubMed
Hibell, B, Andersson, B, Ahlstrom, B, Balakireva, O, Bjarnason, T, Kokkevi, A, Morgan, M, eds. The ESPAD (European School Project on Alcohol and Other Drugs). Stockholm: Swedish Council for Information on Alcohol and Other Drugs, 1999. Google Scholar
Kandel, D B, Johnson, J G, Bird, H R, Canino, G, Goodman, Sh, Lahey, B B, Regier, D A, Schwab-Stone, M. Psychiatric disorders associated with substance use among children and adolescents: findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. J Abnorm Child Psychol 1997;25: 121–132.CrossRefGoogle ScholarPubMed
Kandel, D, Johnson, J, Bird, H, Weissman, M, Goodman, S, Lahey, B, Regier, D, Schwab-Stone, M. Psychiatric comorbidity among adolescents with substance use disorders: findings from the MECA study. J Am Acad Child Adolesc Psychiatry 1999;38: 693–699.CrossRefGoogle ScholarPubMed
Stowell, R J, Estroff, T. Psychiatric disorders in substance abusing adolescent in-patients: a pilot study. J Am Acad Child Adolesc Psychiatry 1992;31: 1036–1040.CrossRefGoogle Scholar
Costello, E J, Erkanli, A, Federman, E, Angold, A. Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Psychol 1999;28: 298–311.CrossRefGoogle ScholarPubMed
Kumpulainen, K. Psychiatric symptoms and deviance in early adolescence predict heavy alcohol use 3 years later. Addiction 2000;95: 1847–1857.CrossRefGoogle ScholarPubMed
Marmorstein, N, Iacono, W. An investigation of female adolescent twins with both major depression and conduct disorder. J Am Acad Child Adolesc Psychiatry 2001;40: 299–306.CrossRefGoogle ScholarPubMed
Brown, SA, Lewinsohn, PM, Seeley, JR, Wagner, EF. Cigarette smoking, major depression and other psychiatric disorders among adolescents. J Am Acad Child Adolesc Psychiatry 1996;35: 1602–1610.CrossRefGoogle ScholarPubMed
Brown, SA, Gleghorn, A, Schuckit, MA, Myers, MG, Mott, MA. Conduct disorder among adolescent alcohol and drug abusers. J Stud Alcohol 1996;57: 314–324.CrossRefGoogle ScholarPubMed
Lewinsohn, P, Rohde, P, Brown, R. Level of current and past adolescent cigarette smoking as predictors of future substance use disorders in young adulthood. Addiction 1999;94: 913–921.CrossRefGoogle ScholarPubMed
Beiderman, J, Mick, E, Faraone, S, Burback, M. Patterns of remission and symptoms decline in conduct disorder: a four year prospective study of an ADHD sample. J Am Acad Child Adolesc Psychiatry 2001;40: 299–306.Google Scholar
Suzuki, K, Takeda, A, Matsushita, S. Co-prevalence of bulimia and alcohol abuse and smoking among Japanese male and female high school students. Addiction 1995; 90: 971–975.CrossRefGoogle Scholar
Lipschitz, DS, Grilo, CM, Fehon, D, McGlashan, TM, Southwick, SM. Gender differences in the associations between post-traumatic stress symptom and problematic substance use in psychiatric in-patient adolescents. J Nerv Ment Dis 2000;188: 349–356.CrossRefGoogle Scholar
Renaud, J, Brent, DA, Birmaher, B, Chiappetta, L, Bridge, J. Suicide in adolescents with disruptive disorders. J Am Acad Child Adolesc Psychiatry 1999;38: 846–851.CrossRefGoogle ScholarPubMed
Kjelsberg, E, Winther, M, Dahl, AA. Overdose deaths in young substance abusers: accidents or hidden suicides? Acta Psychiatr Scand 1995;91: 236–242.CrossRefGoogle ScholarPubMed
Kjelsberg, E, Sandvik, L, Dahl, AA. A long-term follow- up study of adolescent psychiatric in-patients. Part 1. Predictors of early death. Acta Psychiatr Scand 1999;99: 231–236.CrossRefGoogle ScholarPubMed
Fombonne, E. Suicidal behaviours in vulnerable adolescents. Br J Psychiatry 1998;173: 1540159. CrossRefGoogle ScholarPubMed
Appleby, L, Cooper, J, Amos, T, Faragher, B. Psychological autopsy study of suicides by people aged under 35. Br J Psychiatry 1999;175: 168–174.CrossRefGoogle ScholarPubMed
Hawton, K, Arensman, E, Townsend, E, Bremner, S, Feldman, E, Goldney, R, Gunnell, D, Hazell, P, Von eeringen , K, House, A, Owen, D, Sakinofsky, I, Traskman- Bendz, L. Deliberate self-harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ 1998;317: 441–447.CrossRefGoogle ScholarPubMed
Crowley, T, Mikulich, S, Ehlers, K, Whitmore, E, Macdonald, M. Validity of structured clinical evaluations in adolescents with conduct and substance problems. J Am Acad Child Adolesc Psychiatry 2001;41: 265–273. CrossRefGoogle Scholar
Fergusson, DM, Lynskey, MT, Horwood, LJ. Conduct problems and attention deficit disorder in middle childhood and cannabis use by age 15. Aust N Z J Psychiatry 1993;27: 673–682.CrossRefGoogle ScholarPubMed
Fergusson, DM, Lynskey, MT, Horwood, LJ. Alcohol misuse and juvenile offending in adolescence. Addiction 1996;91: 483–494.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ. Early onset use and psychosocial adjustment in young adults. Addiction 1997;92: 279–296.CrossRefGoogle ScholarPubMed
Lynskey, MT, Fergusson, DM. Childhood conduct problems, attention deficit behaviors and adolescent alcohol, tobacco and illicit drug use. J Abnorm Child Psychol 1995;23: 281–302.CrossRefGoogle ScholarPubMed
Brook, J, Richter, L, Rubenstone, E. Consequences of adolescent drug use on psychiatric disorders in early adulthood. Ann Med 2000;32: 401–407.CrossRefGoogle ScholarPubMed
Rowe, J, Sullivan, P, Mulder, R, Joyce, P. The effect of a history of conduct disorder in adult major depression. J Affect Disord 1996;37: 51–63.CrossRefGoogle ScholarPubMed
Mueser, KT, Rosenberg, S, Drake, R, Miles, K, Wolford, G, Vidaver, R, Carrieri, K. Conduct disorder, antisocial personality disorder and substance use disorder in schizophrenia and major affective disorders. J Stud Alcohol 1999;60: 278–284.CrossRefGoogle ScholarPubMed
Crome, I B, Christian, J, Green, C. Tip of the national iceberg? Profile of adolescent patients prescribed methadone in an innovative community drug service. Drugs: Education, Prevention Policy 1998;5: 195–197. Google Scholar
Crome, I B, Christian, J, Green, C. The development of a unique designated community service for adolescents: Policy, prevention and education implications. Drugs: Education, Prevention Policy 2000;7: 87–108. Google Scholar
Zeitlin, H. Psychiatric comorbidity with substance misuse in children and teenagers. Drug Alcohol Depend 1999;55: 225–234.CrossRefGoogle ScholarPubMed
Gossop, M, Marsden, J, Stewart, D, Rolfe, A. Reductions in acquisitive crime and drug use after treatment of addiction problems: 1-year follow up outcomes. Drug Alcohol Depend 2000;58: 165–172.CrossRefGoogle ScholarPubMed
Catalano, RF, Hawkins, JD, Wells, EA, Miller, J, Brewer, D. Evaluation of the effectiveness of adolescent drug abuse treatment, assessment of risks for relapse and promising approaches for relapse prevention. Int J Addict 199091;25: 1085–1140.CrossRefGoogle ScholarPubMed
Williams, R, Chang, S, Adolescent research group. A comprehensive and comparative review of adolescent substance abuse treatment outcome. Clin Psychol Sci Prac Summary 2000;7: 138–166. CrossRefGoogle Scholar
Project Match Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH post treatment drinking outcomes. J Stud Alcohol 1997;58: 7–29.CrossRefGoogle Scholar
Fonagy, P, Target, M. The efficacy of psychoanalysis for children with disruptive behaviours. J Am Acad Child Adolesc Psychiatry 1994;33: 45–55.CrossRefGoogle Scholar
Target, M, Fonagy, P. The psychological treatment of child and adolescent psychiatric disorders. In: Roth, A, Fonagy, P, eds. What Works for Whom? a Critical Review of Psychotherapy Research. New York: Guilford, 1996: 263–320. Google Scholar
Kaminer, Y, Blitz, C, Burleson, J, Kadden, R, Rounsaville, B. Measuring treatment process in cognitive behavioural and interactional group therapies for adolescent substance abusers. J Nerv Ment Dis 1998;186: 407–413.CrossRefGoogle Scholar
Kaminer, Y, Burleson, JA. Psychotherapies for adolescent substance abusers: 15 month follow-up of a pilot study. Am J Addict 1999;8: 114–119.Google ScholarPubMed
Winters, K, Latimer, W, Stinchfield, R. The DSM-IV criteria for adolescent alcohol and cannabis use disorder. J Stud Alcohol 1999;60: 337–344.CrossRefGoogle Scholar
Kaplan, CA, McArdle, P. Ethical and legal principles. In: Crome, IB, Gilvarry, E, McArdle, P, Ghodse, A-H, eds. Young People and Substance Misuse. London: Gaskell, 2004: 184–198. Google Scholar
Health Advisory Service. Children and Young People's Substance Misuse Services: an NHS Health Advisory Thematic Review. London: HMSO, 1996. Google Scholar
Health Advisory Service. Review 2001: the Substance of Young Needs. London: HMSO, 2001. Google Scholar
Wagner, E, Brown, S, Monti, P, Myers, M, Waldron, H. Innovations in adolescent substance abuse intervention. Alcohol Clin Exp Res 1999;23: 236–249.CrossRefGoogle ScholarPubMed
Crome, I B. Treatment interventions – looking towards the millenium. Drug Alcohol Depend 1999;55: 247–263.CrossRefGoogle Scholar