VCU news

By Sathya Achia Abraham

The Virginia Treatment Center for Children at the Virginia Commonwealth University Medical Centerrecently launched the Youth Co-Occurring Disorders Clinic for the assessment and treatment of teens who have a substance abuse and mental health disorder at the same time.

The clinic, which combines research, training and clinical practice, is the only one in Virginia, and one of just three evidence-based clinics in the nation serving youth, aged 12 to 17, with co-occurring disorders.

Teens with mental health problems are at very high risk for substance abuse. About half those teens with mental health problems also have a substance use problem. Conversely, teens with substance abuse problems are at even higher risk for mental health problems:  60 percent of them also have a mental health problem.

Despite how common co-occurring disorders are among youth, there has been very little research in the field. Traditionally, substance abuse and emotional or behavioral problems have been treated separately, but researchers are now learning that it's imperative to have integrative therapies in place to treat both problems.

"Generally speaking, most people are unaware of the significant overlap between substance abuse and mental health problems in our youth population," said Brian L. Meyer, Ph.D., a child psychologist at the VCU Medical Center and executive director of the Virginia Treatment Center for Children. Meyer obtained the grant for the clinic.

"We've got to look at the behavior and problems that have brought the teen to this point. If we can address and successfully treat the teen's depression, we can also successfully treat their drug or alcohol addiction," he said.

According to Meyer, in 40 percent of youth the substance abuse problem starts before the mental health issue. He said that the earlier youngsters start experimenting with drugs and alcohol, the more serious the problem can become. By the time children leave eighth grade, approximately 44 percent have had their first drink of alcohol, while 16 percent have tried marijuana. Meyer added that children can move from gateway drugs, such as tobacco, alcohol or marijuana, into teen years filled with more illicit drugs such as cocaine, speed or crystal meth.

At the VTCC clinic, teens participate in one-hour long therapy sessions once a week for 16 weeks, including four family therapy sessions. Through a combination of cognitive behavioral therapy (CBT), motivational enhancement therapy and skills-based therapy, these teens learn to reduce substance abuse and relapse. This treatment has been found to improve family relationships, school performance, job-seeking skills, communication skills and anger management.

For this population, the key has been allowing the teens to set their own goals, make their own decisions and gain independence.

Child and adolescent psychiatrists and therapists have found that teens don't like to spend time drudging up negative episodes from their past and reopening the misery, hurt and suffering of old wounds. Instead, the treatment team identifies the triggers that lead individuals to use the drugs and learn what their vulnerable moments are to determine how to protect against relapse.

Some potential triggers could be an argument with parents, disappointment with failing a test at school or peer pressure. Teens also learn problem-solving skills and how to cope with cravings.

Their substance use and mental health status are monitored and measured on a regular basis, so that the treatment team can gauge if the intervention is working – which they can distinguish if the teen is improving.

"While there has been a stigma attached to mental illness, it's nothing compared to the stigma of addiction," explained Meyer. "People need to understand that addiction is a disease. It consumes people, and destroys families, relationships, jobs and quality of life in general. Teens with an addiction issue need to be treated while they are still young."

Scientific evidence shows that addiction is linked to a particular area of the brain and that certain neurochemicals are involved. "Addiction is not a matter of will – it's a chemical truly taking control of the body, and when that chemical leaves, an addict must cope with the aftermath," he said.

Once the teen has completed the program, the VTCC will help to find continued treatment and resources in the community to further aide the patient.

Paula Riggs, M.D., a nationally recognized researcher in the field of teenage addiction and mental health and associate professor at the University of Colorado, serves as consultant for the clinic. She played a key role in working with Meyer and other staff to develop the center.

For more information on this program, contact the VTCC at (804) 828-3124.