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Drugs, alcohol and mental health issues: which came first?

When mental health issues arise among teenagers, parents often wonder: Did alcohol or drugs cause this?
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Dr. David Smith

When mental health issues arise among teenagers, parents often wonder: Did alcohol or drugs cause this? Or did a pre-existing mental health issue cause the substance use?

Substance use and mental health problems often go hand-in-hand. In fact, surveys show that 33 per cent of youth with a diagnosed mental health condition also have a substance use issue. The rates are even higher among those with a diagnosed substance use condition (such as dependence on alcohol or addiction to drugs), with anywhere from 60 to 80 per cent found to have an underlying mental health condition.

Why do the two issues so often occur together? One reason is that the risk factors underlying both the mental health condition and the substance use issue are similar and may include a genetic predisposition, family history or any of a series of common life stressors such as a past experience of loss, trauma, abuse or poor attachment; a difficult or unstable family or living situation; limited supportive adults in their life; chronic stress; learning disabilities or poor school performance issues; poverty and neglect.

Sometimes the substance use itself can actually trigger mental health concerns like depression, paranoia or hallucinations that may clear up once the substance use is stopped.

Another reason is self-medication. Sometimes a teenager begins to use substances because he or she finds it provides temporary relief from uncomfortable symptoms. They may feel using the substance helps relieve anxiety, tension or depression. For a time it reduces psychological or physical suffering or makes them feel better. When self-medication is occurring, there is a greater risk of long-term dependence because the youth truly feels the substance is helping them cope.

Alcohol and marijuana (or cannabis) are the substances most used by B.C. teenagers. We now know that adolescent brains are not completely developed until about age 25. Youth brains appear to be more vulnerable to substance use in ways that adult brains are not. It seems that the younger the start, the higher the risk. Fortunately, results from the 2013 Adolescent Health Survey found that more B.C. students are waiting to try alcohol and/or cannabis until after they are at least 15 years of age or older. But the 2013 survey also found that 75 per cent of 16 to 18 years had tried alcohol and 46 per cent had tried marijuana.

Protective factors against using either drugs or alcohol include good supervision from caring adults, strong connections to school, a positive peer group, involvement in extracurricular activities, and positive self-esteem and attitudes.

If you suspect that drugs or alcohol may be a problem with your child, see your family doctor. The doctor may refer you to the Child and Youth Mental Health Services or to the Provincial Youth Concurrent Disorders Program at BC Children’s Hospital. Other resources include: the BC Alcohol & Drug Information & Referral Service at 1-800-663-1441. For more see:  mindcheck.ca, camh.ca; kelthymentalhealth.ca

And talk to your children from early ages about the importance of avoiding the use of any substances to protect their brain health. Dr. Carol-Ann Saari, medical director of the BC Youth Concurrent Disorder Clinic at BC Children’s Hospital notes: “The longer youth can let their brains develop without exposure to drugs, the healthier their brains will be.”