Dual Diagnosis among Adolescent

A Review of the Literature

            Research on child and adolescent mental illness is available; research on child and adolescent drug use is available, but research on dual diagnosis among children and adolescents is limited. However, you would think that this would be a time when we would want to know all of the facts. That way we can intervene in a young ones life and help them, because they are at a crucial stage where learning is important. So, how do children and adolescent with a mental illness and substance use problem impact our educational System? What does the future hold for children and adolescents with a dual diagnosis?

            Children and adolescents with a mental illness and substance abuse problem impact our educational System – through lower grades, lower attendance rates, and a higher probability to drop-out of school. The American Academy of Child Adolescent Psychiatry (2007) published statistics that showed some children 12 and older were using illicit drugs, tobacco, marijuana, and vicodin (p. 2). According to Substance Use and Academic Outcomes, substance use “impairs cognitive development which, in turn, reduces academic achievement and disrupts academic progression” (King, 2006, p. 1) Substance use has an effect on an individual’s cognitive development. The effect can be likened to having a brain problem; “Addicts can articulate very well the consequences of their behavior. But they fail to act accordingly. That’s because of a brain problem… (likened to) damage in the ventromedial area which causes a disconnect between what you know and what you do” (Gladwell, 2005, p. 60).

            Mental illness is thought to be a brain disorder as well; although, not all people are willing to accept a mental health diagnosis due to the stigma that surrounds it. Children that have an ADHD diagnosis have an inability to “control their behavior and/or pay attention;” whereas, children that are depressed have a problem with their “ability to think, feel, and behave in a normal manner” (NIDA, 2007, p. 1); are you seeing similarities? Substance use and mental illness impair a child’s ability; this in turn, can have an effect on their social life, the desire to achieve, and their behaviors displayed. These impairments will have an impact on their ability to learn, and the educational systems ability to help them; without appropriate supports.  

What does the future hold for children and adolescents with a dual diagnosis? The future looks grim; without appropriate supports their worlds will continue to spiral downhill. Their academic outcomes will likely be met with failure and/or extremely challenging. This will cause a lack of desire to try – educationally. Socially and behaviorally the individually will not be “normal,” and thus they will be shunned by the majority of society. Chances are all of this will lead to a high probability of being incarcerated in the future. So, what are appropriate supports?

First, it is important for the interview to include “A consensus approach… combining self-report and interview data, along with collateral reports and longitudinal data accumulated by case managers through repeated contacts over time”(164) the authors go on to explain that we must provide interventions that benefit both types of disorders, “For example: provide training in social skills and effective communication, problem solving, stress management, increasing pleasant activities, vocational rehabilitation, and cognitive-behavioral techniques and coping skills”  (Monti, 2002, p.174-176). Children and adolescents might have a hard time expressing all of their thoughts and ideas, so it might be beneficial if they can write in a journal/diary or have materials that are age appropriate.

There are five general principles that people need when interviewing individuals with a mental illness and substance abuse problem. They are:

(1) it is nonconfrontational; (2) it views motivation for change as a dynamic state rather than a static state; (3) readiness to change can be influenced by major life crisis and by therapeutic interventions; (4) building readiness to change may be a long-term process; and (5) key elements include discrepancies, altering the perceived cost-benefit ratio, and enhancing self-efficacy (White, 1998, p.48).

Thoughts and Feelings

            It is vital that we intervene in a young ones life, because they are at a crucial stage where learning is important. The developmental stages that they are endeavoring to succeed in are being hindered by a mental illness and a substance use problem (dual diagnosis). These issues impact their learning and set them up to fail, because both mental illness and substance abuse have an effect on children and an adolescent’s cognitive ability. It is hard for them to perceive events and information in a way that will bring about success within society, and for them to make judgments that are successful. This is not to say that they are unable to solve problems. There is no doubt in my mind that they can figure out how to manipulate a situation or person; or how to solve a problem and/or get the drugs that they need; or to make decisions that will get them what they want. The problem is that the choices they are making are not helping them to stay in school, get an education, and to learn how to behave socially, so that they can live within society “norms”. It is hard for children (and adults) to know that they are not “normal” and that they do not belong for some reason or another; therefore, it is vital that they learn what is acceptable and techniques that will help them to fit into society.

            Children that have been identified as having a need are entitled to services within the educational system: if the school receives funding from the government. Identified as having a need means that their education is being effected due to a condition that will not likely change within the next few days: substance use and mental diagnosis would fit into this category. The child or adolescent can receive services through an Independent Educational Plan (IEP). However, these are only successful if the parent, school, and community work together for the benefit of the child or adolescent.

I can see how it is easy for an individual to fall through the cracks in our society; hopefully, as more data is compiled we will be better able to serve children and adolescents. The most important thing is to treat not just the child or adolescent, but to include their entire homeostasis (Everything that surrounds the child/adolescent: family, friends, school, environment, etc).

References

Child and Adolescent Mental Illness and Drug Abuse Statistics. (2009, March 18). American Academy of Child & Adolescent Psychiatry. Retrieved from http://www.aacap.org/cs/root/resources_for_families/child_and_adolescent_mental_illness_statistics

Gladwell, M. (2005). Blink. New York, NewYork: Back Bay Books.

King, K., Meehan, B., Trim, R., Chassin, L. (2006). Substance Use and Academic Outcomes: Synthesizing Findings and Future Directions. Addictions, December; 101(12): 1688-1689. doi: 10.1111/j.1360-0443.2006.01695.x.

Monti, P., Kadden, R., Rohsenow, D., Cooney, N., Abrahs, D. (2002). Treating Alcohol Dependance : A Coping Skills Training Guide. (2^nd ed.). New York, New York: The Gilford Press.

White, R., & Wright, D. (1998). Addiction Intervention. Binghamton, New York: Hayworth Press.