Principles of Care for Young Adults With Co-Occurring Psychiatric and Substance Use Disorders

Abstract

Over 50% of young adults (defined as individuals aged 18-25 years) with substance use disorders (SUDs) have at least 1 co-occurring psychiatric disorder, and the presence of cooccurring disorders worsens SUD outcomes. Treatment of both co-occurring psychiatric disorders and SUDs in young adults is imperative for optimal treatment, yet many barriers exist to achieving this goal. We present a series of evidence-informed principles of care for young adults with co-occurring psychiatric disorders derived by a workgroup of experts convened by Boston Medical Center's Grayken Center for Addiction. The 3 principles are as follows:(1) young adults should receive integrated mental health and addiction care across treatment settings; (2) care should be responsive to the needs of young adults exposed to trauma and other adverse childhood experiences; and (3) treatment programs should regularly assess and respond to the evolving mental health needs, motivations, and treatment goals of young adults with co-occurring disorders. Our guidance for each principle is followed by a review of the evidence supporting that principle, as well as practice considerations for implementation. More research among young adults is critical to identify effective treatments and service systems for those with co-occurring disorders.

Pathways to recovery model of youth substance misuse in Assam, India

“…Psychosocial skills education, and early identification and treatment of young people with psychological disorders, could prevent many cases of SUD. 41 Although research indicates that it is possible to recover from SUD unassisted, for example, through 'maturing out', 42 our work demonstrates that a risk for young Assamese people attempting to quit substances alone is entering an extended period of Chaotic Addiction characterized by a cycle of abstinence and relapse. A key aspect of this phase is captured by the slogan 'abstinence is not recovery', in which recovery is considered to be a 'voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship'.…”

“…Psychosocial skills education, and early identification and treatment of young people with psychological disorders, could prevent many cases of SUD. 41 …”

“…However, as Temmingh 40 points out, there is little research on this in LMIC. Psychosocial skills education, and early identification and treatment of young people with psychological disorders, could prevent many cases of SUD 41 …”

Editorial

“…Primary prevention has relevance to a range of populations, including the prevention of mental disorders in younger people (Spencer et al , 2021), prevention of foetal alcohol spectrum disorder in pregnancy (Roozen et al , 2016), prevention of alcohol-related cognitive impairment in older people (Rao et al , 2022) and prevention of intimate partner violence (Karakurt et al , 2019) in people at risk of alcohol use disorder, to name but a few. In the longer term, this has implications at a population level for the prevention of alcohol-related hospital admissions for mental and behavioural disorders and prevention of suicide associated with depression and alcohol use disorders.…”

Coproduction in evaluating a dual diagnosis tool with youth in a residential mental health service

“…Thus, rather than a generic understanding of what might work, it would enhance treatment to explore how interventions work in practice. Most of the literature recommends that integrated dual diagnosis treatment be provided to young people (Spencer et al , 2021). The current study looked at the impacts of a locally developed dual diagnosis resource with young people in a mental health youth residential setting.…”