Co-Occurring Psychiatric Disorders

Psychiatric disorders commonly co-occur with substance use disorders in young people. This is not surprising since psychiatric disorders in childhood, such as Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder/Conduct Disorder, and Depression are associated with an increased risk for developing a substance use disorder.

One study found 83% of young people with opioid use disorder had a co-occurring psychiatric disorder that was equivalent to the prevalence of co-occurring psychiatric disorders in young people with an alcohol or cannabis use disorder. Opioid use is associated with psychiatric symptoms including depression, thoughts of suicide, and suicide attempts. Furthermore, there has been increasing concern that many drug overdose deaths may have been suicides. Anxiety is another symptom and disorder that has specifically linked to opioid use/disorders in young people seeking substance use disorder treatment. 

Assessment for Co-Occurring Psychiatric Disorders

Given the high prevalence of Co-Occurring psychiatric disorders in young people with opioid use disorders it is important that providers screen and monitor for psychiatric symptoms/disorders, and assess safety including risk for suicide. Factors to consider when assessing for a co-occurring psychiatric disorder include the relationship between substance use and psychiatric symptoms, whether or not the psychiatric symptoms/disorder preceded the onset of substance use, and the presence or absence of a family history of psychiatric illness. Generally, individuals with a co-occurring psychiatric disorder will have experienced psychiatric symptoms in the absence of substance use, the psychiatric disorder preceded the onset of substance use, and/or they have a family history of psychiatric illness. 

Appropriate Management of Psychiatric Disorders

Integrated treatment, including therapy and/or medication for both co-occurring disorders is important. Medication and/or therapy for the co-occurring psychiatric disorder in the absence of substance use disorder treatment will not likely be adequate to stabilize either disorder. When medications are prescribed for a co-occurring psychiatric disorder, providers need to consider risk associated with continued substance use (continued use of opioids, alcohol, and/or benzodiazepines) while the young person is taking the medication. Furthermore, while prescription medications with a risk for misuse (e.g. prescription stimulants) are not contraindicated within the context of a substance use disorder, patients should be closely monitored for any signs of symptoms of medication misuse or diversion.