Co-occurring Disorders

The term co-occurring disorder means an individual has at least one mental health challenge and at least one substance-related issue. Research shows that about 80% of teens and young adults with a substance use disorder also have a diagnosable mental health challenge. In my experience, the most common are trauma, depression, anxiety, and ADHD.

WHY DO THEY USE?
There isn’t one easy answer to this question. However, teens and young adults with co-occurring disorders often use substances — at least in part — in an attempt to manage difficult feelings or distressing symptoms.

Traditional drug counselors can be hesitant to acknowledge this, but substance use does indeed provide relief from those feelings and symptoms — maybe not forever and definitely not in an effective manner, but for a little while everything feels better. If we want to create real change, it seems to me we must non-judgmentally acknowledge this as true — and then help them find their own reasons to consider sobriety anyway.

INSECURE ATTACHMENTS
Sometimes teens and young adults with co-occurring disorders also exhibit insecure attachments, which we can define as disorders of mood, behavior, and social interactions that result from a failure to form healthy attachments to a primary caregiver in early childhood.

Insecure attachments are common in adopted youth, as well as children who grew up in homes impacted by parental substance use, mental health issues, or violence. Bowlby (1969) described attachment as a “lasting connectedness between human beings.” He stated that the earliest bonds formed by children with primary caregivers have significant, lifelong impacts.

If a child’s primary caregiver is dependably present and appropriately nurturing, that child will have a secure base from which to explore the world. If a child’s primary caregiver is not dependable, this normal attachment process will be disrupted. As a result, the child is unlikely to develop a secure base and may experience lifelong challenges related to relationships, self-esteem, and personality development.

When considering the connections between substance-related problems and insecure attachment among teens and young adults, there are three especially relevant ideas:

Learn By Seeing. Teens and young adults with substance-related problems typically report using in an effort to manage uncomfortable feelings. These individuals may have been without healthy attachments during early childhood, so lacked opportunities to observe caregivers engage in effective emotion regulation. When we don’t learn emotion regulation by observing it in the adults around us, we’ll look for other ways to manage feelings.

Drugs As A Secure Base. Connectedness is a normal human desire, hard-wired into us at birth in order to help assure survival. If denied a secure base, we will seek one. For some teens and young adults, this secure base comes in the form of substances. As a former client stated, “I’ll never leave weed because it’s never failed me. I smoke. I get high. No surprises.”

Filling the Void. If we don’t connect to other people in emotionally satisfying ways, we’ll find something else to fill that void. Often teens and young adults try filling this void with alcohol and drugs — as well as risky sexual activity, self-harm, video-games, and other problematic behaviors.

BEYOND THE STUCKNESS
If someone doesn’t get effective help for their mental health challenges,  trauma, or insecure attachments, then lasting change is unlikely — not necessarily because they’re an addict or unwilling to change, but because they don’t know what else to do. In other words, they’re stuck.

It seems to me the goal of drug treatment should be to help teens and young adults get unstuck, not force them into sobriety, fulfill external mandates, or behave better. We can hope these things happen — I certainly do — but lasting change only occurs when teens and young adults move beyond the stuckness.