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Mental health problems are prevalent in adolescents, with drug overdose now one of the leading causes of death in this group. [1] Studies have found that up to 40% of high schoolers have persistent feelings of sadness or hopelessness. [2] Despite this, research has shown there is a significant gap in treatment for depression and substance use in adolescents. [3]
Current landscape of depression and substance use disorder in US adolescents
A nationwide survey was conducted looking at the prevalence of substance use, mental health conditions, and associated treatments in a sample of over 32,000 12-20 year olds. [3] This study found that 13% of the sample met the criteria for substance use disorder (SUD), and this group was more likely to have a concurrent mental health diagnosis. [3] However, only 51% of those with a mental health diagnosis and 10% with SUD had received any treatment for their condition. [3]
This shows a significant treatment gap, with the study estimating this equates to over half a million adolescents with a mental health condition not receiving any treatment in the U.S. [3] Lack of treatment in this group is linked to worse long-term outcomes, highlighting that this treatment gap must be addressed.
Gaps and barriers in treatment for adolescents and young adults
Several barriers to treatment are present in this group, which may explain the treatment gap discovered by this research. Cost and insurance-related issues are significant factors, with higher rates of uninsurance or private insurance compared to public insurance in this age group. [3] This can lead to substantial costs for treatment, with upfront fees for residential treatment averaging at $18,000, which is simply unaffordable for many adolescents.
Even with insurance coverage, administrative issues still provide a treatment barrier, with relatively low clinician reimbursement making accepting insurance less appealing. [3] Additionally, only 20% of pediatricians think treating SUD is their responsibility, but only 26% of addiction treatment facilities accept adolescents, highlighting the challenge for adolescents to get the appropriate treatment. [3]
The overlap of depression, suicidality, and substance use
Substance use is linked to developing several mental health disorders, including depression and anxiety. [4] As the brain is still developing during adolescence, it’s particularly vulnerable to the effects of substances, with early substance use being linked to an increased chance of developing SUD and depression. [4] Research also shows that those with SUD are more likely to experience severe depressive episodes and suicidal ideation. [3]
Evidence-based treatments & intervention strategies
There are many different effective treatments for depression and SUD. They are often used in combination to create a comprehensive individual treatment plan, which can increase the likelihood of long-term recovery. For depression, antidepressant medications can be used, often in combination with behavioral therapies, such as cognitive-behavioral therapy (CBT) or professional counseling. [3] In particular, evidence shows CBT is effective in treating several mental health problems in adolescents, including depression and SUD. [5] Computer-based therapy has also been shown to be effective in this group. [6]
SUD sometimes requires an inpatient detox or treatment at a specialist facility. As SUD is linked to depression and other mental health issues, treatment is often integrated. For example, a treatment plan frequently combines medical detox with behavioral therapies. Strong support networks, regular exercise, a healthy lifestyle, and good sleep all help to complement these treatments and promote long-term recovery.
The role of prevention & early intervention
Prevention and early intervention strategies are crucial for addressing adolescent depression and substance use before they develop into more severe conditions requiring intensive treatment. School-based programs have been a main focus for prevention and intervention, with several established programs based on psychosocial theories relating to substance use. [7] These programs often incorporate education about the risks of early substance use and teach coping skills for managing stress and emotional challenges.
Family-based prevention programs that improve communication and strengthen family bonds can also help to reduce both substance use and depressive symptoms. [7] Additionally, adolescents who are more engaged in their community, such as active involvement in school or church groups, are less likely to engage in substance use. [7] Early intervention approaches can be implemented at schools or community centers, making them cost-effective and accessible.
Practical recommendations for caregivers and providers
Healthcare providers and caregivers play essential roles in identifying and addressing mental health and substance use issues in adolescents. Providers could use validated screening tools to help identify adolescents at risk of substance use or mental health problems, who may not voluntarily disclose their problems. Implementation of routine screening for both depression and substance use could help identify those who might otherwise go unnoticed.
Caregivers should be educated about warning signs for depression and substance use, including mood changes, social withdrawal, and declining academic performance. Creating an environment where adolescents feel safe discussing their struggles without fear is crucial for early identification. Open communication about mental health and substance use, in a non-judgmental way, can encourage adolescents to seek help when needed.
Both providers and caregivers should be aware of available resources in their community, including crisis hotlines, outpatient treatment programs, and support groups specifically designed for adolescents.
Closing the gap for vulnerable youth
The treatment gap for adolescent depression and substance use is concerning and must be addressed. Changes at the individual, community, and policy levels are needed to help close this gap. Healthcare systems should prioritize the development of adolescent-specific treatment programs that address their unique developmental needs, including training more providers in adolescent mental health and substance use treatment.
Policy changes to improve affordability for mental health and substance use treatment for adolescents would be beneficial. Expanding insurance coverage to include evidence-based treatments can reduce financial barriers that prevent many from accessing care. Additionally, increasing funding for school-based mental health programs and community prevention initiatives can help reach adolescents who might not otherwise receive services.
By implementing these changes, we can work toward ensuring that the half a million adolescents currently without treatment receive the care they need to achieve long-term recovery.
