Teens with mental health and addiction problems get dual diagnosis

By: Joseph Lombardo
   It is not unusual for adolescents to be experimental, but for some, this kind of behavior is more dangerous than for others. For some, it means a one-way ticket into a lifetime of addiction.
   Adolescents who are predisposed toward psychotic behavior may exacerbate the situation when they give in to the lure of drugs. What adolescents do not know is that as they continue to introduce certain drugs into their systems, their bodies become addicted.
   In many cases, these students will be able to go to school, play sports and hold a part-time job, but their performance in all areas may eventually begin to slip. As the addiction takes hold, they will go from taking a drug to feel good to having to take a drug in order to feel well.
   In the majority of cases, home life is a major factor; abuse and emotional abandonment are rampant. Often in an attempt to self-medicate, these adolescents become easy prey for today’s lively drug scene.
   Drugs are seductive and readily available, with schools and teen parties serving as trading grounds. The underage club scene is a booming business.


‘One of the most important things to remember is that both psychiatric conditions and addiction problems are treatable.’

Joseph Lombardo


Mental health professional, Princeton House

The Medical Center at Princeton


   Word spreads through school that a rave, or all-night party, is scheduled for the weekend at a certain location, sometimes a club, sometimes a warehouse, sometimes at a private residence.
   Because no alcohol is served, parents are willing to drop off their kids for a night of socializing and dancing. It is in this setting that predators reign and drugs such as the in creasingly popular Ecstasy are made available.
   According to USA Today, of about 23.6 million teens in the U.S., about 11.3 million have tried an illegal drug at least once, and 9.2 admit it has been within the past year. In 1995, 5 percent of teens surveyed said they had tried Ecstasy, an amphetamine-based drug that has psychedelic properties. The figure doubled to 10 percent in the year 2000.
   A stimulant that first surfaced in the 1920s, Ecstasy creates a feeling of euphoria and is often referred to as the "love drug." Anxious teens lose their inhibitions and give in to the touchy-feely nature of the drug.
   Because many teens view Ecstasy as a low-risk drug, they are willing to try it. What these teens do not realize is that what Ecstasy is cut with could raise the body temperature to sometimes fatal degrees. One adolescent who died after swallowing an Ecstasy pill cooked his liver when his body temperature rose to 112 degrees. Four hours after he was dead, his temperature remained high at 104 degrees.
   After just one or two times, adolescents may suffer a psychological addiction to drugs that surfaces prior to their physical addiction. For example, those teens who get turned on to heroin may try snorting it on a Saturday night. Within a few weeks, it becomes a Friday and Saturday night routine. As their urge to use it increases, they must add a mid-week fix to make it to the weekend. Now they are hooked.
   Adolescents who suffer from mental health ailments in conjunction with a substance addiction are considered dual diagnosis (DD) patients. Fortunately for these adolescents, the development of a dual diagnosis program over the last quarter century means that they can get help for both problems at the same time.
   These youngsters are referred to a program such as the one offered at Princeton House from a variety of sources, including general practitioners, family members, school guidance teams, private psychiatrists and therapists. Getting substances out of the picture is imperative to the patients’ success.
   Once adolescents enter a DD program, a treatment plan is developed. What problems are you facing? What are the concerns of your family, school and other interested agencies? What direction do we want to go in? Posing these questions and exploring the answers is an integral part of the program and this is why each day’s session begins with a goal group meeting.
   After that, the adolescents receive two hours of active education. This setting is more active than a typical classroom and averages about 12 students at any given time. The teachers who work with the children pass on the information with a lot of necessary intervention by the psych-techs whose primary objective is to help the clients remain in control.
   When focusing on the functional impairments of the individual, mental health professionals recognize that a pharmacological approach can have a tremendous impact on patients’ health. While there is no one drug that works all the time or in all cases, there are multiple drug classes including mood stabilizers, antidepressants and beta blockers that have the potential to lessen the severity of disabling symptoms. These medications work best in conjunction with therapy, a strong support network, and some distance from the most severe stressors.
   Because there is often an immediate risk of danger, the sooner the process gets underway, the better off the patient and family will be. Those facilitating the DD programs at Princeton House hope to lessen the length and severity of current episodes while creating a learning experience for both patients and their support networks. All work is geared toward maintaining and improving function.
   After the adolescents leave the program, efficacy calls are made to see how they are doing. While some return, many gain the ability to carry on and be successful. For patients enrolled in Princeton House’s partial programs, their average length of stay is between one to three weeks for six hours a day.
   Professionals strive to make a difference from the moment the clock starts ticking. Treatment and discharge planning routinely begins during the first contact with the patient. All patients are assessed by the program psychiatrist prior to beginning the program or on the first day of treatment.
   One of the most important things to remember is that both psychiatric conditions and addiction problems are treatable. Many parents and educators wonder which problem came first for these adolescents, but it really doesn’t matter. What does matter is that patients stay in the here and now, make therapeutic connections with their treatment team, get through the day, and develop a plan for recovery.
   Joseph Lombardo is a mental health professional on staff at Princeton House, a unit of The Medical Center at Princeton. Health Matters appears Fridays in the Lifestyle section of The Packet and is contributed by The Medical Center at Princeton.