MCOSA, MPN, MISD, MCTFT, and CADCA
sponsored
Exploring the Link: Drugs and Mental Health
December 13, 2013
How does Mental Health and Substance Abuse co-exist?
 They are intertwined, known as co-occurring disorders, are the rule not the exceptions.
 Dr. Knight indicated that in a treatment program when both disorders are treated simultaneously,
the outcomes are very good.
 Ms. Morehouse provides prevention services in secondary schools (middle and high schools),
and they find that most of the students that use substances do not have mental health issues.
They do see some students medicating for mental health issues, and some students who have
mental health issues end up selling or trading their psychotropic drugs for street drugs.
Sometimes students who have mental health issues drink or use drugs to fit in.
Behavioral health is a word used differently by different people. There is a lot of controversy about the
words, depending on who you talk to. Some people think it is a broader meaning such as behavioral,
mental health, and substance abuse problems; some may use it as term to describe a disorder (such as
autism). The term is not well understood, and that’s part of the controversy behind it.








At SAMSHA, behavioral health means both substance abuse and mental health problems. It also
means the prevention of disorders and behavioral health problems, as well as treatment and
recovery. States are now using this term to describe agencies that have both substance abuse
and treatment programs.
Behavioral health in the medical community, many children they see also have medical
disorders and may have behavioral problems including substance abuse. The children also have
special issues in treatment, because they may be fatalistic about their use. They look at each
individual as having multiple axis of diagnosis.
In the Affordable Care Act the term is being used as “mental health and substance use disorder
services, including behavioral health treatment”.
Behavioral health includes prevention in SAMSHA’s criteria.
In the medical community, the word “addiction” is a term favored by a group of physicians from
many different specialties. The word “disorders” are used by the DSM-V (the Diagnostic and
Statistical Manual of Mental Health Disorders, published by the American Psychiatric
Association), and it is further broken down to “abuse” or “dependence”.
Pediatricians will probably take a developmental view of this. There are very important factors
that play into a behavior. Behavior is a symptom that people observe that can cause terrible
problems, but it has complicated underpinnings. Part of it lies in our genes, the other part lies in
our environment.
Another term should also be noted. It is “co-morbidity” this refers to a combination of substance
abuse problem, mental health problem and physical health problem.
Ms. Morehouse explained the difference between the terms substance use, abuse, and addiction.
Substance use is (for example) when young people drink alcohol and they are under 21; use an
illicit drug; or an over the counter/prescription drug that wasn’t prescribed for them. Substance
abuse is that substance use has repeatedly interfered with someone’s functioning or the lost
control over their behavior or the amount they consume. Addiction per DSM-V deals with a
number of criteria, ranges from mild, moderate, or severe.
Elements of Recovery (this can also wrap right around to Prevention, because people need all of
this in their life:
Health – Home – Community – Purpose
People can have mental health disorders without having substance use disorders.
Risk factors to Substance Use but Not Mental Disorders
 Availability of alcohol and other drugs
 Parental attitudes favorable towards drugs
 Friends who use drugs
 Low perceived risk of drug use
 Peer approval for drug use
Mental Use Disorders Associated with Substance Abuse:
 Major Depressive Disorders
 Bipolar Disorders
 Anxiety Disorders
 Conduct Disorders
 Attention deficit hyperactivity disorders.
According to Dr. Knight, longitudinal studies by other countries have identified that if you start using
alcohol or marijuana before the age of 14, you are greatly increasing your risk of developing a series of
very bad mental health disorders, addiction rates quadruple, among those who start before age 14.
Additionally their rates of major depression and anxiety disorder are 3-4 times more, and psychotic
thinking is 2 to 6 times greater. The study indicated that the opposite relationship does exist, so looking at
those who develop an anxiety disorder or depression at a younger age, does not predict greater
substance use later on.
How does SAMSHA use data to show links?
They do surveillance to track the use of substances as well as mental health disorders in the country.
About 2/3 of the people who start drinking before age 14, will also take an illicit drug. About 40% of those
who start drinking before age 14 will end up having a problem with alcohol as an adult. Institute of
Medicine (IOM) looked at mental health, emotional and behavioral health disorders, indicated that about
half of the adults with mental health issues start using drugs before the age of 14, and about 3/4 of them
before the age of 24.
Mental Health and Substance Abuse Among Youth:
 NSDUH 2011: 1.5% (367,000) had both substance abuse and major depressive episodes.
 NCSA-A 2011-2003: 40.3% aged 12-17 had either a mood (10%), anxiety (24.9%), behavior
(16.3%), or substance (8.3%) disorder
 Therefore there is much overlap in disorders
Best results for someone is to treat the disorders (mental health and substance use) simultaneously.
-Break“Talk They Hear You” Campaign
 New National Public Service Announcement aimed at empowering parent to talk to their children
– as early as 9 years old – about the dangers of alcohol use. Informed by the General Surgeon’s
call-to-action to prevent underage drinking.
Mental Health issues can start much earlier than 9 years old, for example, ADHD, in which symptoms can
be seen at around age 5 or 6.
Two biggest reasons for kids self medicating are having anxiety disorder and depression.
Which Drugs can lead the way to mental health problems?
 Cocaine and other stimulants have been demonstrated to cause psychiatric problems

Long-term marijuana use has been hypothesized to lead to chronic anxiety (local note: find facts
on cvcoalition.org or mcosa.net under Mobilizing Michigan toolkit)
SAMSHA (www.samhsa.gov) has a toolkit the helps with integrated treatment for mental health and
substance abuse service.
Two messages that have the greatest impact on teenagers about not using substances:
 Science – kids want to know the “facts”. They don’t want you to tell them what not to do.
 True Life Stories – it’s the power of the narrative – put a human face on it to drive the message
home.
What is SBIRT? Screening Brief Intervention Referral to Treatment
SBIRT is a process of assessing or screening and if you find an issue, you do a brief intervention, but if
there is a more difficult issue, the person should be referred to treatment. The process for alcohol abuse
has been shown to be very effective. SBIRT can be done by nurse practitioners or other individuals.
It’s a mandated behavior for pediatricians to screen, however by their own self report, fewer than 50%
screen every adolescent patient that comes in. The concern for pediatricians is time – they usually get 20
minutes for a complete visit, and there are probably 30-40 different behavioral health issues to screen for.
There is an educational website for parents called Teen Safe (www.Teen-Safe.org) , which helps parents
understand the link between mental health and substance use.
SAMSHA has a website about mental health – www.mentalhealth.gov – helps people to recognize the
signs and symptoms of mental health issues.
SAMSHA Key Message:
 Behavioral Health is essential to health
 Prevention works
 Treatment is effective
 People do recover

Content Providers:
Pamela S. Hyde, J.D., Administrator, Substance Abuse and Mental Health Services Administration, United States Department of Health and
Human Services
Pamela Hyde was nominated by President Barack Obama and confirmed by the U.S. Senate in November 2009 as Administrator of the
Substance Abuse and Mental Health Services Administration (SAMHSA), a public health agency within the Department of Health and Human
Services. The agency's mission is to reduce the impact of substance abuse and mental illness on America's communities. Hyde is an attorney
and comes to SAMHSA with more than 35 years experience in management and consulting for public healthcare and
John R. Knight, M.D., Founder and Director, Center for Adolescent Substance Abuse Research, Boston Children's Hospital
Dr. John Knight is an Associate Professor of Pediatrics at Harvard Medical School and a Senior Associate in Medicine and Associate in
Psychiatry at Boston Children's Hospital. He is the founder and director of the Center for Adolescent Substance Abuse Research, the first
center of its kind to be located at a children's hospital in the U.S. He has been a committed pioneer in research on adolescent substance abuse
prevention, screening and early intervention, and treatment in healthcare setting and has published more than 100 original scientific articles,
clinical reviews, and book chapters related to substance abuse and other
Ellen Morehouse, LCSW, CASAC, CPP, Licensed Clinical Social Worker, Credentialed Alcoholism and Substance Abuse Counselor,
Credentialed Prevention Professional, and the Executive Director of Student Assistance Services, a non-profit, corporation in Tarrytown, New
York
Ellen Morehouse is the creator of three national model alcohol and drug abuse prevention and early intervention programs and has served as a
consultant to treatment programs, school districts, parent and professional organizations, community groups, and state agencies in planning
and implementing alcohol and drug abuse prevention, early intervention, and treatment programs. Morehouse has been the recipient of several
grants, has published several articles in professional journals, and is a member of several boards.
This broadcast may be viewed at: http://www.mctft.com; click on
“Broadcasts/Videos”, Click on “Past Broadcasts” then look for the program you
want to view.
Links from Exploring the Link : Drugs & Mental, Health:
Substance Abuse and Mental Health Services Administration (SAMHSA) - http://www.samhsa.gov/
SAMHSA Public Service Announcement Campaign - http://www.samhsa.gov/underagedrinking/
The Health Insurance Marketplace - https://www.healthcare.gov/
The National Survey on Drug Use and Health (NSDUH) - http://www.samhsa.gov/data/NSDUH.aspx
SAMHSA Suicide Prevention - http://www.samhsa.gov/prevention/suicide.aspx
National Conference on Mental Health - http://www.mentalhealth.gov/
Student Assistance Services - http://www.sascorp.org/
Center for Adolescent Substance Abuse Research (CeASAR) - http://www.ceasar.org/
Indian Health Services - http://www.ihs.gov/
Cherokee Nation - http://www.cherokee.org/
Teen Safe - http://www.teen-safe.org/
LOCAL: resources for Mobilizing Michigan www.cvcoalition.org
Resource for SBIRT tools and Mobilizing Michigan www.mcosa.net