The Role of Internalizing Mental Health Problems in Substance Use Trajectories for Minority Adolescents

Research on adolescence and substance use point to a link between internalizing problems and substance use. The current longitudinal study investigates how internalizing problems and substance use change over time among minority adolescents and the role of internalizing problems in predicting trajectories of substance use among African American and Latinx adolescents, with attention to variation by gender, ethnicity, and generation status. This study follows a large sample of minority immigrant adolescents over three waves of data collection (10th, 11th, and 12th grades). Individual growth curve modeling showed that substance use increased over time while internalizing problems decreased overtime. Results showed that changes in internalizing problems over time significantly predicted changes in substance use over time. Ethnicity moderated this relation; specifically, greater internalizing problems predicted greater substance use for Latinx, but not African Americans. No significant interactions were found among gender or generation status in predicting substance use at intercept. Implications for future research are discussed.

     

Clinical Problems in Community Mental Health Care for Patients with Severe Borderline Personality Disorder

The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedure to identify and prioritize the problems. A total of 36 problems reflecting five categories was found: patient-related, professional-related, interaction-related, social system-related, and mental health care-related. Problems with attachment and dependency and social issues were important patient problems while a lack of skills was an important professional problem. Support from the patient’s social system and the mental health system were identified as limited, which resulted in both the patient and the professional feeling isolated. Patient, professional, and organisational characteristics of community care differ substantially from those of specialized care. The field is thus in need of a more tailored approach that takes these differences into account.     

Unmet Need For Community-Based Mental Health and Substance Use Treatment Among Rural Adolescents

This research assessed the extent of unmet service need for rural youth with mental health (MH) and/or substance use (SU) problems. All adolescents (12–18 years old) living in a three-county region of Iowa and discharged from outpatient MH or SU treatment were included (n=177). Chart review was used to retrospectively assess service utilization and clinical characteristics at time of admission and discharge. Two-thirds (64%) of adolescents with co-occurring disorders did not receive treatment consistent with widely supported guidelines recommending that individuals with co-occurring disorders receive treatment for both their MH and SU problems. Higher severity of depression, more supports, prior MH service utilization and lower prevalence of prior abuse predicted the receipt of dual services. Finally, adolescents with co-occurring problems who received only MH treatment showed improvement on MH needs at discharge but no improvement on SU needs. Similarly, adolescents with co-occurring problems who received only SU treatment showed improvement on SU needs but not on MH needs. There is considerable unmet treatment need among rural adolescents with co-occurring disorders. Efforts to improve care must focus on adolescent, familial, program, funding and policy factors that act as barriers to unifying philosophies and practices needed to advance appropriate care.     

Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders

Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.     

Alexithymia and Eating Disorder Symptoms in Adolescents

An increasing amount of evidence indicates an association between alexithymia and eating disorder symptoms. This possible association was evaluated in a non-clinical sample of late adolescents. Seven hundred and twenty nine adolescents completed the questionnaire and formed the final sample. Alexithymia was measured using the 20-item Toronto Alexithymia Scale and eating disorder symptoms were assessed using the SCOFF questionnaire. The rate of alexithymia was 8.2%, without any gender difference. The mean SCOFF scores differed significantly between alexithymic and non-alexithymic subjects, and the share of SCOFF positive subjects was significantly higher among alexithymics. The results suggest that eating disorder symptoms are more common in alexithymic adolescents.     

Relationship between Clinical Symptoms and EEG Findings in Borderline Personality Disorder

Abstract: Borderline personality disorder (BPD) was diagnosed in female patients (N=41) between the ages of 18 and 30 using the Diagnostic Interview for Borderline Patients (DIB) and DSM-III. Comparing the EEG findings of BPD (N=18) and non-BPD (N=21) groups, there were no EEG findings characteristic of BPD. We also assessed the relationship between the EEG findings and DIB items. Positive spikes appeared in patients with high scores for Impulse Action Patterns, while wave and spike phantoms were observed in patients with high scores for Interpersonal Relations. Dividing the patients into BPD and non-BPD groups, a similar tendency to that observed from an analysis of all patients was observed in the non-BPD group, but no such tendency was observed in the BPD group. The results suggest that BPD patients include those in whom vulnerability of cerebral function plays an important role in the development of these two clinical symptoms as well as those in whom vulnerability of cerebral function plays almost no pathogenic role.     

Self-Disclosure and Mental Health Service Use in Socially Anxious Adolescents

Social anxiety disorder is highly prevalent in adolescence, persistent into adulthood, and associated with multiple impairments. Despite the development of efficacious treatments for socially anxious youth, few affected adolescents receive such treatment. This study examined service use in a sample of high school students (n?=?1,574), as well as predictors of treatment delay and factors associated with adolescents?? disclosure of social difficulties. Self-report measures of social anxiety and service utilization were administered by study staff to 10th- and 11th-grade classrooms across three public high schools. Consistent with the literature, results indicated low treatment utilization (14?%) and lengthy delays in treatment initiation. Symptom severity, impairment, and disclosing anxiety to school personnel were significant predictors of service utilization. Several demographic and illness-specific factors were associated with a higher likelihood of disclosing social discomfort. These findings underscore the important role of school personnel in identifying and referring youth with anxiety disorders. Implications are discussed for increasing access to services, including school-wide screenings and training of school personnel to recognize and provide intervention for anxious youth.     

Internalizing and Externalizing Personality Dimensions and Clinical Problems in Adolescents

Ostensible psychiatric comorbidity can sometimes be explained by shared relations between diagnostic constructs and higher order internalizing and externalizing dimensions. However, this possibility has not been explored with regard to comorbidity between personality pathology and other clinical constructs in adolescents. In this study, personality pattern scales from the Millon Adolescent Clinical Inventory in a sample of 492 adolescent inpatients were subjected to a principal components analysis to yield oblique internalizing and externalizing dimensions. Relations between personality dimensions and well-established measures of psychopathology (depression, alcohol abuse, drug abuse) and other indicators of clinical dysfunction (self-esteem, suicidality, violence) were assessed before and after controlling for these higher-order personality dimensions. Associations between personality scales and indicators of psychopathology and clinical dysfunction were minimal with these higher order components controlled. These results suggest that internalizing and externalizing personality dimensions explain most of the associations between personality patterns and indicators of psychopathology and clinical dysfunction in adolescent patients.     

Co-Occurring Non-Suicidal Self-Injury and Firesetting Among At-Risk Adolescents: Experiences of Negative Life Events,Mental Health Problems,Substance Use,and Suicidality

Co-occurring internalizing and externalizing problem behaviors in adolescence typically marks more severe psychopathology and poorer psychosocial functioning than engagement in a single problem behavior. We examined the negative life events, emotional and behavioral problems, substance use, and suicidality of school-based adolescents reporting both non-suicidal self-injury (NSSI) and repetitive firesetting, compared to those engaging in either behavior alone. Differences in NSSI characteristics among self-injurers who set fires, compared to those who did not, were also assessed. A total of 384 at-risk adolescents aged 12–18 years (58.8% female) completed self-report questionnaires measuring NSSI, firesetting, and key variables of interest. Results suggest that adolescents who both self-injure and deliberately set fires represent a low-prevalence but distinct high-risk subgroup, characterized by increased rates of interpersonal difficulties, mental health problems and substance use, more severe self-injury, and suicidal behavior. Implications for prevention and early intervention initiatives are discussed.     

Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009–2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.     

Assessing and Treating Co-occurring Disorders in Adolescents: Examining Typical Practice of Community-Based Mental Health and Substance Use Treatment Providers

Co-occurring mental health and substance use disorders in adolescents are common. However, limited efforts have been directed at understanding how treatment providers in community settings deal with this frequent challenge. In this study, treatment providers from both substance use and mental health settings were interviewed to examine their common practices regarding the assessment and treatment of co-occurring depression and substance use disorders in adolescence. About 93% of treatment providers reported treating adolescents with these co-occurring conditions. However, few providers reported using formal assessment practices (23–30%) or treatment protocols for co-occurrence (10%). Providers in mental health settings (particularly psychologists) were more likely than those in substance use settings to formally assess for depression [Χ ²(1, N = 30) = 3.62, P = .065] but less likely to do so for substance use [Χ ²(1, N = 30) = 9.46, P = .004]. Findings are considered with regard to implications for assessment and treatment outcomes in this high-risk population.     

Diagnosis and Treatment of Borderline Personality Disorder in the College Mental Health Setting

Purpose of Review

The impact of borderline personality disorder (BPD) on college students is not well studied, and there is currently little data about its phenomenology or treatment in this population. We review the available literature regarding evidence-based treatment for BPD on college campuses, as well as best-practice guidelines for the treatment of mental illness in the college setting. Diagnostic disclosure and psychoeducation are proposed as practical first steps in improving the treatment landscape.

Recent Findings

Preliminary studies of targeted treatment for BPD on college campuses are promising. They suggest that even pared-down interventions have the potential to help students feel better and function better. Experts in college mental health treatment emphasize the importance of gathering data, intervening early, communicating across treatment environments, appropriately marshaling resources, and providing psycho-education.

Summary

To bring the on-campus treatment of BPD in line with best-practice guidelines, improved diagnostic practices are needed. Disclosing the diagnosis of BPD and educating students about this disorder are simple yet powerful interventions that can set the stage for further treatment and provide symptom relief.

     

Provider and Consumer Perceptions of Trauma Informed Practices and Services for Substance Use and Mental Health Problems

Both trauma-informed practices and trauma-specific services have been developed to meet the needs of individuals seeking services for mental health and substance use disorders. These approaches involve an acknowledgement of an individual’s inter-related experiences of trauma, mental health, and substance use problems in all aspects of service delivery, and focus on enhancing consumer safety and control. Although trauma-informed practices and trauma-specific interventions have been repeatedly identified as critical to service provision in this area, there is little understanding of how these practices and interventions are delivered and experienced from the perspectives of service users and providers. The purpose of this study was to explore facilitators and barriers in implementing trauma-informed practices and delivering trauma-specific services in mental health and addiction service settings through qualitative interviews with service providers, consumers and research experts. Based on thematic analysis of in-depth interviews with 19 participants (including service providers, research experts and consumers), a number of key facilitators and challenges to implementation of trauma-informed practices and services emerged. Key facilitators included: organizational support, community partnerships, staff awareness of trauma, a safe environment, peer support, the quality of consumer-provider relationships, consumer and provider readiness to change, and staff supports. Challenges included: provider reluctance to address trauma, lack of accessible services, limited funding for programs/services, and staff burnout. Key areas of change identified in the study point to the need for increased intersectoral collaboration and support, greater system-wide trauma awareness and provider training in order to enhance the ability of trauma-informed practices and -specific services to meet the complex needs of this population.     

Adolescents with Substance Diagnoses in an HMO: Factors Associated with Medical Provider Referrals to Substance Abuse and Mental Health Treatment

This study examines the factors related to referrals of adolescents with substance use disorders to substance abuse or mental health treatment by their medical providers. Administrative and chart review data from the membership of a large private health maintenance organization (HMO) were collected from a probability sample of 400 adolescents, ages 13-18, who were diagnosed with a substance use disorder in 1999. Logistic regression analyses examined referral to substance abuse treatment and referral to mental health treatment in the aggregate and stratified by gender. Documented use of both alcohol and another illicit drug, and legal problems increased likelihood of referral to substance abuse and mental health treatment, whereas diagnoses of alcohol and marijuana use disorders decreased likelihood of referral to substance abuse treatment. Mental health diagnoses played a limited role in both types of referrals, although specific psychosocial problems were associated with increased likelihood of referrals. Treatment history and location of first mention of problem were significant predictors of referral. There were no gender differences in referral rates to either substance abuse or mental health treatment; however predictors of referral differed by gender. These findings extend our knowledge about factors that influence clinicians' treatment referrals of adolescents with substance abuse diagnoses and have implications for influencing clinician referral behavior within health plans.