It’s not uncommon for teens with disorders such as depression, anxiety, or bipolar disorder to turn to substances to feel better. For instance, if a teen is experiencing symptoms of depression with low energy, inability to concentrate, feeling the need to isolate, and generally feeling down, they may rely upon alcohol or drugs to help themselves feel better. Some teens might feel pressure from their parents to do well in school, for instance, but the lack of concentration and low energy may get in the way of succeeding academically, and as a result, they may drink or use drugs to try to overcome their symptoms.

Dual Diagnosis in Teens

As a teen continues to rely upon substances, they may develop an addiction. Having both a mental illness as well as an addiction is known as a dual diagnosis. This is also sometimes referred to as co-occurring disorders. Approximately, 60-75% of teens who abuse drugs or alcohol have a mental illness. What’s important for caregivers and parents to know is that mental illness can worsen an addiction as well as the other way around.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), those with an alcohol use disorder are up to three times more likely to suffer from an anxiety disorder, and nearly four times more likely to suffer an experience of major depression.

Common Teen Disorders and Addictions

According to, there are certain types of psychological illnesses that a teen tends to have with a particular addiction. Below is a summary of those pairings:

Alcohol and Depression

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), depression is a common mental illness that is found among alcoholics. In fact, the incidences of first time drug use in teens is higher among those who have experienced a major depressive episode than those who have not. Furthermore, according to, Eighth-grade female teens who reported drinking heavily are three types more likely to attempt suicide than eighth-grade teens who do not drink. Along these lines, intoxication with alcohol is often associated with suicide attempts using more dangerous methods and those who succeed in committing suicide frequently have positive blood alcohol levels.

Marijuana and Schizophrenia

The characteristic symptom of schizophrenia is psychosis, a severe experience of losing contact with reality and experiencing either hallucinations or delusions. Psychosis is a symptom of the mind that, if an individual is prone to, will typically show up in the late teen years. As mentioned above, taking drugs or drinking can be a way for a teen to self-medicate and reduce the effects of their symptoms. The National Alliance on Mental Illness (NAMI) reports that 47% of those with schizophrenia also have an addiction to alcohol or drugs. This is about four times greater than the general public.

Marijuana, as well as nicotine, are common addictions for teens facing symptoms of schizophrenia.

Opioids and PTSD

Post Traumatic Stress Disorder or PTSD commonly develops after a teen has experienced a trauma, such as a car accident, natural disaster, war, assault, or another type of life-threatening experience. The combination of an opiate addiction and PTSD is particularly true if a teen was wounded and requires medication to treat severe pain. Prescription painkillers are an opiate, the same type of drug as heroin. Common forms of opioids, in the form of painkillers, include the following:

  • oxycodone
  • hydrocodone
  • diphenoxylate
  • morphine
  • codeine
  • methadone

Opioids can have a calming effect and create feelings of ease and pleasure. They are highly addictive, especially if a teen is not only facing physical pain but also the psychological symptoms of PTSD.

Heroin and Depression

Another common addiction that tends to be found among teens with depression is heroin. Heroin is also an opioid, like prescription pain pills, and can produce an easy-going pleasurable effect. In essence, it can help a depressed teen feel good again. Heroin can be injected or inhaled by snorting or sniffing or smoking it. Unfortunately, surveys of teens indicate that they don’t believe short-term use of the drug is dangerous. Mental, emotional, psychological and even physical abilities can become severely impaired with continued use of heroin.

Which Comes First – Addiction or Mental Illness?

Although the mental illness might be the cause for the use of drugs and a developing addiction, it’s often difficult to determine which came first:  the substance use or the mental illness. However, both can contribute to the other:

Symptoms of mental illness can lead to drug use and eventually addiction. As mentioned above, when a teen is struggling with symptoms of mental illness, they may turn to substances to help themselves function and feel better.

Drug use can bring about symptoms of mental illness. With continued drug use, a teen might begin to feel more and more anxious or depressed. It’s not uncommon for a mental illness to develop as a result of an addiction.

No matter which came first, research indicates that the best form of treatment for a co-occurring mental illness and addiction is to treat both disorders at the same time. In fact, when they are treated concurrently, there is a significant decrease in suicide attempts and other severe mental health concerns.

Treatment for Dual Diagnosis in Teens

One of the reasons why it’s important for parents and caregivers to know about dual diagnoses or co-occurring disorders is because it may help them understand why their teen is using alcohol or drugs. Simply telling a teen to stop drinking or using substances isn’t going to work nor will any parental demands, confrontation, or punishment. If a teen has a mental illness, then their attempt to quit using substances are going to become a complicated and difficult challenge. As mentioned earlier, it’s essential that both the addiction and the mental illness be treated simultaneously.

Furthermore, having both an addiction as well as mental illness can complicate mental health treatment. For this reason, treatment must thoroughly address the addiction, the mental illness, as well as any underlying issues that might also be contributing to substance use. For instance, if a teen began drinking because they have been witnessing domestic violence between their parents, and then subsequently developed an anxiety disorder, treatment should be as holistic as possible. This would include treating the alcoholism and the anxiety disorder, as well as addressing violence in the family.

It is common for teens with dual diagnoses to receive treatment that does not address all of the contributing factors. In turn, this usually leads to teen chronic relapse because the primary cause for the addiction was not addressed. Ideally, teen mental health treatment for dual diagnosis should include:

  • Alcohol or Drug Detox
  • Addiction Treatment
  • Drug Counseling
  • Psychotherapy
  • Psycho-education
  • Psychiatric Medication, if necessary for the mental illness
  • Medical Attention, if required
  • Family Therapy
  • Teen Support Group
  • Well Being Modalities like Meditation or Yoga

If a teen is receiving services from different mental health providers (individual therapist, psychiatrist, family counselor, etc.), there should be communication between these professionals so that a teen’s mental health is more fully supported.

If you are a concerned caregiver or parent, and you suspect that your teen is struggling with co-occurring disorders, it’s important to seek help from a mental health professional. Calling a therapist, psychologist, or psychiatrist today can facilitate getting the appropriate treatment for your teen.