Co-Occurring Issues in Youth
By: Alainna Hanson
Presentation Series by: Alicia Hengel, MA, LPCC, LPC

What Are Co-Occurring Issues?

Substance use and mental health conditions among youth are tightly connected.

Mental health disorder- diagnosable mental, behavioral, or emotional disorder that interferes with how a child functions. Ex: depression, anxiety, ADHD, eating disorders
Substance use disorder- recurring use of drugs/alcohol that prevents user to meet daily responsibilities. 

Drug use typically starts in adolescents, the same time the first signs of mental illness appear. The combination of both is called co-occurring. These disorders happen to people of all walks of life which is why it is important to understand the cause, how to spot them, and how to prevent/treat them properly. 


There are many reasons why adolescents use substances. Some just want to experiment, while others use it as a way to connect socially and lower their social anxiety. No matter the reason they started using drugs, teens end up self medicating their anxieties, stresses, and insecurities with substances. This self medicating reinforces their behavior because it seems to work and provides a quick fix to their problems. There are different risk factors that can increase the likelihood of co-occurring issues, such as early exposure to stress and trauma. Adverse childhood experiences can have negative lasting effects on health and well being. 

Adverse childhood experiences-
Abuse (emotional, physical, sexual)

Neglect (emotional, physical)
Household challenges: domestic violence, substance use, mental illness, divorce, incarcerated parent.

“Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.”Dr. Robert Block, former President of the American Academy of Pediatrics

Another risk factor is genetics. Up to 60% of an individual’s vulnerability to substance abuse is due to genetics. Genes can act indirectly by altering how individuals respond to stress and increase the likelihood of risk taking and novelty seeking behaviors. Mental illness can contribute to substance use because they often try to self medicate. Substance use can contribute to mental health disorders by causing more anxiety, depression, and other physical and psychological effects. A common link for substance use disorders in untreated ADHD. ADHD stimulant medication present challenges for treating children due to the addictive potential of these drugs. Over 60% of adolescents with substance use disorders also meet the criteria for mental health disorders. 


Developing co-occurring issues in youth, increases the later risk for continual development of addiction and mental health conditions as an adult. The brain during adolescence is still under construction and continues to develop through the formative years. Things like executive functions, decision making, and impulse control are the last to mature. This means an adolescent with co-occurring issues may engage in risky behaviors including sexual, violent, and other threatening situations. Teens that frequently use marijuana increase their risk of psychosis in adulthood. 

Psychosis- thought and emotions are so impaired that contact is lost with external reality

Warning Signs & Behaviors

There are different things parents can watch out for from their child. They may notice an impaired functioning in different areas such as home, school, social life, or work or any sudden changes in behavior. A child may become very isolated and demanding more privacy by always having their door locked. Teens may partake in more risk taking behaviors. Their sleep patterns and level of energy may change– either sleeping all day and being lethargic or staying up all night and having an abundance of energy. Teens with these disorders often have sudden mood shifts and become easily agitated. A more obvious sign is paraphernalia or missing prescriptions or alcohol. 

How to Help

It is important to keep lines of communication with your child open and be attuned to their behavior so you can spot these signs early. If a child does show signs of mental health or substance use disorder it is important to listen and try to understand the child’s point of view. Consider the child’s motivation and their barriers to treatment. Early intervention and treatment is key, so it is important to know resources and treatment options in your community ahead of time. Try to implement protective factors so your child has someone who gives support within the family, at home, at school, and within the community. A child with these challenges will need continued support from ages 18-25 to help navigate the stressful life changes in a healthy manner. A family member’s role is to provide emotional support and encourage participation. The family member should also participate in treatment (as appropriate) by gaining education, engaging in family psychotherapy, attending support groups. And assisting in medication management. It is important to continue to promote healthy supports to help with coping mechanisms for the child. These supports can be different hobbies, interests, groups. If a family is able to create and promote an environment of structure and sobriety for an adolescent it will make it easier for them to stay on a good path and lead a healthy life.

La Crosse police: (608)785-5962
Winona police: (507)457-6302

Being a teen is a difficult time filled with stress and pressure. Adolescents do not always know how to handle this new life change and often have to experiment with different lifestyles. By adults and teens being aware of the causes of co-occurring disorders, they can better prevent and intervene if necessary in order for teens to pave the way at a healthy life.