Supporting the Need for an Integrated System of Care for Youth with Co‐occurring Traumatic Stress and Substance Abuse Problems

Abstract

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.

Clinician Perspectives on Treating Adolescents with Co-occurring Post-Traumatic Stress Disorder, Substance Use, and Other Problems

“…For instance, in a large sample of adolescents seeking treatment for substance use problems (n=4,421), 28% had co-occurring traumatic stress disorders (Turner, Muck, Muck, Stephens, & Sukumar, 2004). Clinical and developmental outcomes are often worse for adolescents with co-occurring PTSD and SUD (PTSD+SUD) than for teens with either disorder in isolation (Kilpatrick et al, 2003; Kingston & Raghavan, 2009; Suarez, Belcher, Briggs, & Titus, 2012). Adolescents with PTSD+SUD often present with complicated clinical profiles that may include symptoms of depression, high-risk sexual behavior, and self-harm behaviors (Danielson, Macdonald, et al, 2010; Esposito-Smythers & Spirito, 2004; Lichtenstein et al, 2010), further underscoring these youths’ complex needs that may require intervention beyond standard care for PTSD or SUD alone.…”

Conceptual foundations of inclusive systems in and around schools for early school leaving prevention: An emotional-relational focus

“…However, this broader environmental model that concerns itself with resilient systems does not include a focus on State systemic supports, such as integrated services (Edwards & Downes, 2013) or developing inclusive systems of care as sought in community psychology (Cook &Kilmer, 2012;Suarez et al, 2012). Ungar's (2012) systemic broadening of Rutter's resilience needs to go further in its systemic concerns to also include a focus on outreach to marginalised families (Downes, 2017), whether as individual or community outreach (Downes, 2014a).…”

“…System fragmentation is a neglected feature in Bronfenbrenner's accounts (Downes, 2014), while the increasing interest in analysing systems of care in community psychology (Cook &Kilmer, 2012;Suarez et al, 2012) reveals a FOR EARLY SCHOOL LEAVING PREVENTION: AN EMOTIONALRELATIONAL FOCUS frequent concern to address issues of inertia and fragmentation. An important aspect of a framework of inclusive systems overcoming fragmentation is that problems that may be treated as largely distinct when viewed from the perspective of individuals may be addressed through common supports when examined with a systemic lens.…”

The importance of identifying, managing, and appropriately treating comorbidity in young people

“…Given the multitude of adverse outcomes and risk factors described, it is not surprising that young people with comorbidity frequently come into contact with a diverse range of service systems, including health, social welfare, educational, and criminal justice systems (Suarez et al, 2012), and present a significant challenge to service providers. What can clinicians do to address comorbidity among young people?…”