by Claudia S. Mesa, M.A., & Dawn M. Pflugradt, PsyD, LP, LCSW

Adolescence is a unique developmental period characterized by significant maturation of all bodily systems. As such, clinicians and researchers have been interested in understanding the impact that substances have on the developing individual. Alcohol and marijuana use during adolescence is widespread, and polysubstance use is growing. Although the average age of initial substance use in North America has been increasing, over half of the individuals who have used substances initially did so prior to age 20 (2).  

Since adolescence is a crucial period for development and substance use is common during this time, it is perhaps unsurprising that research demonstrates a higher impact of substance use on the mental health of young men. However, it does not suffice to discuss the potential risks of substance use without also addressing the circumstances in which the use of substances is initiated. Adolescents with mental health concerns are more likely to use substances to cope with emotional distress. However, substance use can also exacerbate existing mental health conditions or even trigger the onset of new mental health disorders (2). This relationship creates a vicious cycle in which substance use and mental health problems reinforce each other, creating a downward spiral in the overall well-being of a young individual.

Substance use is an especially common clinical concern among justice-involved youths, with estimates of substance abuse disorders being between 20% and 79% in that population (5). There is also a strong connection between adolescent substance use problems and criminal behavior and ongoing aggression in adulthood (4).

Incarceration further complicates this dynamic, exposing young individuals to an environment characterized by stress, trauma, and in most cases, limited access to mental health services. Consequently, incarcerated juveniles may be more likely to use substances as a coping mechanism or in an attempt to self-medicate, directly exacerbating their existing mental health symptoms (2). Diagnoses such as anxiety, depression, posttraumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD) are prevalent among justice-involved youths and can contribute to increased vulnerability, impaired decision-making abilities, and difficulties with emotion regulation, all of which exacerbate substance usage (4).

Most notably, a high proportion of justice-involved youths also come from disenfranchised, culturally diverse backgrounds. The intersectionality of culture, ethnicity, and socioeconomic factors can significantly influence the manifestation of substance use and mental health issues (3). These factors are further complicated by experiences of discrimination, acculturation stress, intergenerational trauma, and limited access to culturally appropriate resources (3). For instance, individuals from marginalized communities may be more vulnerable to substance use due to systemic inequalities, poverty, or exposure to community violence. Additionally, cultural beliefs about mental health, such as the perception of mental illness as a sign of weakness or spiritual affliction, can impede help-seeking behaviors and contribute to the underdiagnosis or misdiagnosis of mental health disorders (3).

Although some may view experimental substance use during adolescence as unproblematic, research shows this outlook minimizes the potential long-term risks and impacts. When adolescent substance use is left unaddressed, youths are more likely to become involved in crime, which contributes to the revolving door of the legal system. Individuals with an earlier onset of substance use are also more likely to continue use into adulthood and are more susceptible to experiencing significant mental health concerns.

For example, one recent study published in 2023 in The American Journal of Psychiatry looked at the connection between substance use and mental health disorders. Specifically, the study focused on the relationship between substance-induced psychosis and the onset of schizophrenia spectrum disorder or bipolar disorder (1). The researchers followed patients with a diagnosis of substance-induced psychosis (14.2% with alcohol-induced psychosis, 17.6% with cannabis-induced psychosis, 22.2% with amphetamine-induced psychosis, and 38.8% with psychosis induced by multiple substances) for multiple years.

Ultimately, the study discovered that 27.6% of patients with substance-induced psychoses developed schizophrenia within six years. Men had a higher risk of developing schizophrenia than women. The risk of developing schizophrenia was highest for the youngest patients, as 32.7% were aged 18 to 25 years. Cannabis-induced psychosis had the highest transition rates to schizophrenia, while alcohol-induced psychosis had the lowest. Of the patients diagnosed with schizophrenia, 56.4% received the diagnosis within one year of experiencing substance-induced psychosis (1). Thus, the study concluded that substance-induced psychosis, particularly when caused by cannabis use, significantly increases the risk of schizophrenia, especially for younger men.

What Can Professionals Do?

1. Take substance use and abuse seriously in all youths.
2. Fully assess and examine substance use and mental health disorders in youths through a multicultural lens. This is essential for understanding the unique challenges faced by diverse populations. Adopting a multicultural perspective allows service providers to address the complexities of these co-occurring conditions while considering the individuals specific cultural contexts and experiences.
3. Use comprehensive and integrated approaches to provide adequate mental health support and substance abuse treatment within the juvenile justice system.
4. Promote prevention efforts that target risk factors both within institutions as well as in the community.
5. Implement programs such as LifeSkills Training or Positive Family Support, in which prevention is prioritized through educating youths and their adult caregivers regarding positive and appropriate mental health development.
6. Recognize the interconnectedness of mental health and substance abuse issues and how its manifestation impacts individuals.
7. Provide individualized interventions to address specific needs (2,3,4).

By implementing culturally relevant evidence-based assessment and interventions that target substance use and mental health issues, we can provide justice-involved and other at-risk youths with the necessary support to overcome challenges and improve their odds of becoming successful, productive adults.

Authors

Claudia S. Mesa, is a doctoral candidate from Spalding University in the process of completing her PsyD in clinical psychology with a forensic emphasis. She received her Bachelor’s degree in psychology with a minor in criminal justice from Florida International University in Miami, Florida. Ms. Mesa has conducted research in the area of justice-involved Hispanic populations and is pursuing further training in forensic assessment and evaluation.

Dawn M. Pflugradt, is a licensed psychologist specializing in forensic and clinical psychology. She has advanced degrees in psychology, social work and bioethics. She works as a risk assessment specialist for a Midwestern Department of Community Corrections and maintains a private psychology practice. Dr. Pflugradt is also a professor at the Wisconsin School of Professional Psychology. Further, she serves on the scientific advisory board for the International Association for the Treatment of Sexual Offenders (IATSO) and is a SAARNA certified STATIC-99R and STABLE-2007 trainer. In addition to her years of clinical experience, Dr. Pflugradt has published books, articles, and book chapters in the areas of pediatrics and criminology.

Sources

1. Rognli, E. B., Heiberg, I. H., Jacobsen, B. K., Høye, A., & Bramness, J. G. (2023). Transition from substance-induced psychosis to schizophrenia spectrum disorder or bipolar disorder. The American Journal of Psychiatry, 180(6), 437–444. https://doi.org/10.1176/appi.ajp.22010076
2. Halladay, J., Woock, R., El-Khechen, H., Munn, C., MacKillop, J., Amlung, M., Ogrodnik, M., Favotto, L., Aryal, K., Noori, A., Kiflen, M., & Georgiades, K. (2020). Patterns of substance use among adolescents: A systematic review. Drug and Alcohol Dependence, 216, 108222. https://doi.org/10.1016/j.drugalcdep.2020.108222
3. Unger, J. B., Ritt-Olson, A., Teran, L., Huang, T., Hoffman, B. R., & Palmer, P. (2002). Cultural values and substance use in a multiethnic sample of California adolescents. Addiction Research & Theory, 10(3), 257–279. doi:10.1080/16066350211869
4. Underwood, L., & Washington, A. (2016). Mental illness and juvenile offenders. International Journal of Environmental Research and Public Health, 13(2), 228. doi:10.3390/ijerph13020228 
5. Pyle, N., Flower, A., Fall, A. M., & Williams, J. (2016). Individual-level risk factors of incarcerated youth. Remedial and Special Education, 37(3), 172–186. https://doi.org/10.1177/0741932515593383