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Co-Occurring Disorders in Teens: Bipolar Disorder - The Great Imitator

Angry outbursts, erratic sleep patterns, sudden mood swings, and changes in personality. If you’re a parent of a teenager, these behaviors can be the status quo—actually, we often take these behaviors for granted. When teens are in trouble, when they are struggling to cope with issues that are too difficult for them to handle, drinking or getting high makes these behaviors worse often to the point of frightening us.

Symptoms of drug abuse often mimic other behaviors and make it hard to figure out exactly what’s going on in kids who are getting high. We know that kids (and adults) get high to help manage the difficult emotions associated with life’s challenges. And we know that adolescence presents them (and us!) with unique challenges.

Your parental instinct that something is wrong is often correct, but understanding the difference in the root causes of their erratic behavior will help you decide what course to take with your child.

What are Co-Occurring Disorders?

Image previewPlease note: This is the first in a series of blog posts that will address the relationship between addiction and associated mental health problems. I'm starting with a general overview here and will add posts that will be more specific, focusing more on specific mental health issues as they relate to children and the family.

Comments, suggestions, and questions are always welcome and will help me develop and tailor the blog to your interests/needs.

Addiction doesn't happen in a vacuum.

Sometimes we take for granted what our brains are for. We are not robots--our brain controls everything that we do, from monitoring breathing and heart rate to deciding whether to eat a cheesesteak with or without fried onions or reaching for a salad instead.

We know that drug, alcohol, and other addictions are complex problems that involve the interaction among many variables:

  • Biological, such as heredity or genetic makeup
  • Environmental, such as family, school pressures.
  • Social, or interactions and relationships with others
  • Emotional, or feelings such as anxiety, depression, anger.

It's the emotional variables that underly and contribute to the symptoms we most often associate with co-occurring disorders and compromise our mental health. I've previously written here before about the interaction between addiction and mental health, but what I want to focus on now is what happens when an addicted person's emotional issues become prominent and seem to take on a life of their own.

'Co-occurring disorder' is a fancy term for mental health problems that occur alongside the addiction, when a person's ability to manage their emotional world becomes a problem in itself. The main types of co-occurring disorders are:

The first of the two listed above sometimes start prior to the addiction, when the person turns to drugs (marijuana, cocaine, opiates, etc.), alcohol, or other compulsive behaviors (overeating, gambling, shopping, video gaming, etc.) to help manage their difficult emotions better. Choosing drugs, alcohol or compulsive behaviors helps to escape the painful and/or scary feelings by numbing, avoiding, or disconnecting from feelings altogether. Our emotions are often warning signs that something is wrong. Just like ignoring warning light on your car's dashboard can become a serious mechanical problem, not paying attention to our emotions can lead to coping-with-life problems.

ADHD, on the other hand is related to addiction and emotional well-being in a different way than the emotions described so far. ADHD is a neurobiological, or brain-based disorder, that contributes to increased impulsivity in behavior and emotional expression. Impulsivity often contributes to low frustration tolerance and anger management problems.

Sometimes, when a person becomes sober and lets go of their longstanding coping mechanisms, anxiety, depression, and ADHD problems become revealed and will need specific attention in addition to traditional addiction counseling and relapse prevention approaches.

It's estimated that 60% of people with a drug and alcohol problem also have a co-occurring mental illness. Symptoms of addiction--mood and personality changes, sleep and appetite disturbance, irritability and impatience--often mimic co-occurring disorders. Symptoms of depression are often expressed differently in children and adolescents, so that can complicate things even more.

Research suggests that the best treatment approach is one where both addiction and mental health issues are addressed at the same time. Finding a therapist skilled in treating both addictions and mental illness is crucial if there is any uncertainty of mental health problems.

Don't be afraid to ask a potential therapist if she/he has experience with co-occurring disorders, if you're at all unsure about your child or family member's situation. It will greatly increase the likelihood of getting the comprehensive treatment that's needed.

Is My Teenager Getting High?

by Barry Lessin

November 14th, 2010

The thought of your teenager getting high is likely to make you very uncomfortable.

“My kid?”

When you say those two words to yourself, you don't want to believe that your child could be involved in using drugs or alcohol, but you also don't want to ignore the possible early warning signs. So what do you do? We are often so worried that we become immobilized and lose sight of one of the basics of human communication:

WE ASK THEM….

If you think your child is drinking or using drugs, the most important thing to do is to come right out and ask. Research suggests that when we talk openly about drugs and drinking, children are more likely to have better self-control and develop more negative perceptions about these risky behaviors. The work you put into opening up lines of communication now can make all the difference in the future.

Some tips for how to ask:

1. Begin by preparing:

  • Role-playing with your husband or partner to anticipate possible responses
  • Get as much information about your child from other people (teachers, friend’s parents, etc).
  • Get into their world first, try to understand where she’s coming from.

2. Use a tone of concern, not interrogation. You’re not trying to “catch” her lying or pressure her to share information she’s doesn’t want to. You want to be having a regular conversation with you expressing genuine interest.

3. Find an opportunity when your child is available, during their down time. It’s never a good idea to talk while they’re in the middle of/on their way to an activity.

4. Ask questions about the general availability of drugs and alcohol in the community or if they know anybody getting high. Ask them about their friends’ behavior and express interest in their opinion about their friends’ risky behavior.

Remember that we were teenagers once. Reflecting on our own experience as teens can help us understand better what works when talking to our kids about these difficult issues.

Realize that determining whether your child has a drug and alcohol abuse problem is a process that will have ups and downs over time. Asking is the first step in this process.

Learning as much as you can about this process will increase your success in early identification of a problem. You’re already on that path by being here. Good luck….

In coming blog entries, I’ll share with you some ideas about taking the next steps in the process.

In the meantime you can learn more about these steps yourself by checking out TIME TO TALK.

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