Mixing Mental Health and Substance Use

Alcohol use or smoking tobacco or marijuana high among mentally ill young people

February 13, 2013 / Author:  / Reviewed by: Robert Carlson, M.D

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(dailyRx News) If you're treating a teen for mental health, it's important to understand the big picture. The big picture includes how much they drink, smoke or use marijuana.

Being sure that a doctor or mental health professional knows a patient uses one of those substance can help them offer more effective treatment.

The knowledge of a person's substance use can also help a clinician select appropriate medications, if necessary.

A recent study measured how often youth with mental health issues used alcohol, nicotine or marijuana.

The researchers found that smoking rates were high and that individuals were more likely to use any of the substances as they got older. At least one in ten mentally ill youth used at least one of the three substances.

"Tell your doctor if you smoke or drink."

The study, led by Daniel F. Hermens, PhD, of the Brain and Mind Research Institute at the University of Sydney in Australia, looked at how often teens with mental health conditions were drinking or smoking tobacco or marijuana.

The study included data collected from 2,122 Australian youth, aged 12 to 30, based on both questionnaires given to the participants and on clinical assessments from their mental healthcare providers.

The participants were asked about their frequency of using alcohol, nicotine and marijuana products. Within the larger group, 522 of the participants provided more detailed information about their alcohol use.

All the participants in the study were being assessed and/or treated for one or more mental health conditions. These conditions included depression, bipolar disorder, anxiety disorders, psychosis (schizophrenia), substance use, personality disorders, eating disorder, autism spectrum disorders and behavioral or developmental disorders, such as attention deficit hyperactivity disorder (ADHD) and impulse disorders.

After gathering data on alcohol, nicotine and marijuana use, the researchers then divided the responses into three categories based on age groups: ages 12 to 17, ages 18 to 19 and ages 20 to 30.

They found that those who used any of these three substances tended to start using them at about 15 years of age, regardless of which substance it was or how old they were at the time of the study.

Almost half (45 percent) of those aged 20 to 30 used alcohol on a weekly basis. Meanwhile, 12 percent of the participants aged 12 to 17 reported alcohol use. Among the 18- and 19-year-olds, 39 percent reported weekly alcohol use.

The rates of daily smoking were relatively high across all three age groups as well. A total of 41 percent of the older youth reported smoking daily.

Nearly a quarter (23 percent) of the youngest group smoked daily, and over a third (36 percent) of the 18- and 19-year-olds smoked daily.

Finally, 18 percent of the older youth, 14 percent of the 18- and 19-year-olds and 7 percent of the youngest group reported smoking marijuana at least once a week.

In general, those who smoked either nicotine products or marijuana or who drank tended to be older and male. They also tended to be more likely to have schizophrenia or bipolar disorder than to have the other mental health disorders included.

Overall, 5.4 percent of all the female respondents and 7.9 percent of all the male respondents used all three substances at least once a week.

The study's information was limited because the researchers did not ask how much the participants smoked cigarettes or smoked marijuana.

The results are also based on the participants' own reports, so there may be inaccuracies if the participants were being untruthful or if they under- or overestimated their use.

Still, the finding that at least one in 10 mentally ill youth are using any of these substances points to the need to reduce these behaviors at the same time as mental health treatment occurs.

"Reductions in the use of these substances need to be prioritized within services provided to these at-risk young people," the authors wrote. "Traditionally, mental health services have been separate to interventions that target substance use; however, there are growing suggestions that complex young people (with comorbid mental health and substance-use problems) would be most receptive to integrated approaches."

The study was published February 4 in BMJ Open. The research was funded by the Australian government, the National Health and Medical Research Council (of Australia), the New South Wales Ministry of Health and the Centres of Clinical Research.

Three of the study authors have financial ties (honoraria, advisory board experience or past research funding) to medical or pharmaceutical companies that include Janssen-Cilag, Servier, Eli-Lilly, Pfizer, Wyeth and AstraZeneca.

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Review Date: 
February 11, 2013
Last Updated:
February 11, 2013