Diagnosis and treatment of adolescents with dual diagnosis

Mental health care must be approached with the patient’s age and unique diagnosis in mind. The human brain develops over many years, and during adolescence, a lot of cognitive and physical changes must be considered when providing mental health care services at any level. Dealing with adolescent patients requires a great deal of careful handling, particularly by health care professionals. 

Some adolescents may be diagnosed with a mental health disorder and substance abuse problem at the same time. A dual diagnosis means professionals must consider how one condition influences the other to establish a treatment plan. Handling dual treatments such as substance abuse and mental health disorders will often require specialized care from qualified practitioners. 

A more complex the diagnosis requires greater care

In some cases, an adolescent may be diagnosed with multiple mental health disorders and substance abuse issues. The more complex the problem, the more challenging it is to create an effective treatment plan. Fortunately, mental health professionals and counselors can meet these challenges and help adolescents change their lives for the better and stick to a positive life path. The key is to make sure that professionals take the time to fully grasp the nature of the adolescent’s issues and discover as much as possible about their likes, dislikes, thought processes, and goals. 

Multiple methods of treatment are needed

Mental health professionals must use the tools available for treating multiple conditions. Using several professionals and an extended support network is ideal in many cases. The more supported and accepted an adolescent feels, the more likely their treatment plans will work.


For mental health and substance abuse issues, counseling is an extremely effective approach to learning to cope and overcome issues. Anyone who is suffering from short-term or long-term mental health or addiction issues can benefit from talking to a counselor regularly. Providing a way to talk to a counselor or someone sympathetic and helpful at any time of the day or night is also useful for those who are battling multiple issues. Crisis numbers or emergency numbers at counseling centers where a patient is receiving treatment can save lives and prevent relapses into negative behavior patterns.

Counseling is a way for patients to have an outlet for expressing their thoughts and frustrations. Adolescents who keep their feelings and thoughts to themselves can sometimes negatively express themselves.


For some disorders, a counselor may recommend that a patient see a psychiatrist, mental health nurse, or other professionals for a formal diagnosis that could lead to medications being recommended temporarily or on an ongoing basis depending on the exact diagnosis.

Some mental health and substance abuse disorders may need short-term treatment with medication just to help the patient through the initial period of making changes or going through substance withdrawal.

Inpatient treatment centers

For some adolescents, staying at an inpatient treatment center initially may be the best option to get them on the right path. Being removed from social and family situations that may be contributing to negative behaviors, thought patterns and substance use can sometimes break the cycle and allow the adolescent to focus on healing their mind and body.

Unfortunately, the demand is high for this type of treatment, so it can be challenging to find the right place for some patients. Mental health counselors can help patients find resources and support for accessing in-patient treatment. Providing support and treatment while waiting for availability at an in-patient facility may be a good compromise.

Outpatient clinics

Mental health centers that specialize in outpatient treatment are more plentiful than in-patient offerings. For most patients, outpatient therapy and services are the best option because it allows them to continue with their daily lives. This means they can continue going to school, attending extracurricular activities, and spending time with family.

Outpatient clinics may provide a range of services, or they might specialize in a specific type of problem. Substance abuse clinics may not offer the full range of mental health services that some patients may require, for example, or a practice may limit themselves to patients in specific age groups.

Private psychiatrists

A psychiatrist is a trained medical doctor who specializes in the diagnosis and treatment of mental health issues. These professionals can provide a formal medical diagnosis of suspected mental health issues. Licensed clinical mental health counselors may refer a patient to a psychiatrist after an initial session if they feel they need more than short-term counseling for a mental health condition or episode. Mental health counselors may continue counseling the patient between visits to a psychiatrist.

If medication is needed to treat a mental health disorder or help with substance abuse, a psychiatrist or mental health nurse will typically provide the prescription; mental health counselors cannot prescribe medication.

Physical medical care

Mental illness can be related to physical issues. Untreated addiction or mental illness can lead to short-term or long-term physical problems that must be treated as part of the overall treatment process. Screenings for some diseases may be necessary since drug use can increase risk factors and exposure.

Adolescents may be fearful of medical tests and treatments, so it is important that counselors are reassuring and supportive during this time. Patients should be informed that some measures may be precautionary and are only being done because people care about them and want to ensure they can heal properly.

School counseling and support

School counselors play a significant role in helping adolescents get the help and support they need. School counselors are sometimes the first professionals to have signs of mental health issues or substance abuse brought to their attention. School counselors may talk to a student initially and then involve a parent or caregiver if they feel it is necessary.

A school counselor may involve social services, law enforcement, or other agencies in severe situations, such as domestic violence, abuse, or drug addiction. School counselors may make referrals and help set up appointments for other professionals, such as private mental health counselors, to become involved in a student’s case.

School counselors can genuinely make a difference in the lives of adolescents. An Online School Counseling Master’s degree may be the start of a rewarding career for those who like to help others. St. Bonaventure University’s comprehensive Master of Science in Education in School Counseling degree program can help students realize this career goal. The MSED program at St. Bonaventure teaches group counseling, communication skills, multicultural counseling, play therapy, and other topics. 

Mental illness and substance abuse in adolescents are often related

Approximately 50% of adolescents who have mental illness also develop a substance abuse problem at one time or another. There are also instances where substance abuse itself leads to mental illness. The two disorders combined can be a tough cycle to break.

Substance abuse has many root causes. A family history of substance abuse makes it far more likely that an adolescent will develop a problem at some point in their life. Using substances to cope with stress or mental illness is very common. 

Adolescents do not necessarily know why they are experiencing certain feelings. Without support or opening up to someone about the challenges they are facing, they sometimes turn to substances to help them cope. Peer pressure and the group of friends an adolescent is a part of or desires to be a part of also play a vital role. Mental illness can affect judgment and make a younger person want to do whatever it takes to feel like they are part of a group or ensure that they get the emotional response they desire from a particular person.

Substance abuse withdrawal may be one of the first steps in recovery

Dealing with complex mental health issues while withdrawing from substances can be very challenging. Substance abuse is typically addressed first so the adolescent can get in a good frame of mind to work through their other issues. Brain chemistry and physical health can play a major role in the outcome of any mental health counseling sessions. Offering support and getting adolescents the attention they need while stopping substances is important. For example, a young person needs to be provided with healthy activities to participate in, including socialization, while withdrawing. This can mean finding an entirely different group of people to spend time with if the patient’s primary group includes people who use substances, even if their use is only occasional.

Treatment needs to be of an appropriate length

Adolescents facing a dual diagnosis need long-term treatment and support. After an initial diagnosis, there may be a lot of appointments with specialists and counselors to attend. This may seem like a lot for a patient and their family, but it is necessary to get on the right path. Stopping counseling, medications, or other recommended treatments and activities too soon can increase the chances of relapses into negative behavior patterns and substance use.

When larger issues are under control, adolescents may need to attend regular counseling sessions in person or via telehealth. These sessions offer the adolescent and their family the support they need to stick to making healthy decisions. 

Everyone is different, and that means that some adolescents with similar issues may require more or less treatments or more of one treatment than another. For example, one patient may need more counseling time and fewer medical interventions.

Families need to be supported

The family support network of an adolescent also needs access to helpful resources. It can be very challenging to support a young person who is battling mental illness and addiction, and adolescents may lash out at family members when dealing with complex emotions and problems. 

The people who make up these support systems need to learn methods for keeping their emotions in check and being supportive without giving into the pressures that a young person may place on them to allow certain behaviors. For example, a young person may be very upset if a caregiver prohibits them from socializing with their regular group of friends or attending certain social events.

Problem-solving techniques

Adolescents who are suffering from mental health and substance abuse issues often need help finding effective methods to deal with problems presented to them. This is sometimes referred to as individual cognitive problem-solving. It entails giving adolescents exercises that enable them to learn how to stop and carefully consider decisions before making them and coming up with strategies to direct behavior in a positive direction. 

Ideally, when an adolescent is feeling the urge to relapse, they will learn to stop and think. Redirection strategies that involve doing something they enjoy, like taking a bike ride, can help redirect negative thoughts and urges.

Dual-diagnosed adolescents are more likely to experience homelessness

Mental illness can manifest in many ways, and untreated mental illness can lead to substance abuse. Mental illness can also lead to adolescents running away or feeling unwelcome in their homes. Homelessness and running away can lead to further tragedy and mental health decline. 

Adolescents are particularly vulnerable to human traffickers and have an increased risk of becoming addicted to substances when homeless. A young person who has experienced any of these circumstances may have more trauma and emotional issues to deal with.

In cases where a young person does not have a stable home, a counselor may need to involve agencies that can help them with housing, food, and other necessities. This may involve a permanent or temporary foster family or other living situation that is conducive to getting them the help and support they need.

More counselors are needed

Unfortunately, there is a major shortage of mental health providers in the United States. In addition, many people face other challenges when it comes to accessing mental health care services.

Thanks to the expansion of healthcare coverage, more people have the means to cover the costs of the care they need if they can find a suitable counselor or provider.

Meeting the future mental health care needs of adolescents means training more counselors. Counseling is a rewarding career that helps the world become a better place for everyone. Better mental health means stronger communities and families.

Telehealth appointments and virtual counseling sessions improve access

Telehealth services make it easier for patients to obtain counseling when they need it the most. During COVID-19, many people used video conferencing and online chats to conduct various medical appointments. Virtual mental health counseling can be highly beneficial to patients and increase the likelihood of success in combating their unique challenges.

Virtual visits are helpful for times when a session is needed but a patient may not be able to make an in-person visit. Being able to talk to someone who is trained to help means that patients can get the support they need at their most vulnerable. moments. Reaching out and getting help is preferable to waiting and increasing the risk or resorting to unhealthy choices.

Help is available

Adolescents with a dual diagnosis face specific challenges when it comes to treatment. Collaboration with a team of experts and a great support network is a good start, but therapy must continue for a sufficient time. In some cases, an adolescent may always need some level of mental health care and support to lead a happy and productive life.

Licensed school counselors play a pivotal role in the lives of many adolescents experiencing mental health and substance abuse issues. By reaching out to students and providing support when they are referred to them, school counselors can help students make better life choices and help their families support them through their challenges.

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