Being a teenager can be difficult. Indeed, in this period of life, there are substantial changes that determine how they’ll turn out in adulthood. In fact, being a teen implies cutting some of the ties that bind them to childhood and building new ones.

However, teens can often perceive life as stormy, dramatic, and unstable. This occurs because, in Western culture, unlike in others, there are no rites, rituals, or practices that indicate to the adolescent that they’ve ceased to be a child and become a fully-fledged adult (Madruga, 2019).

“Adolescence is a time in which you experience everything more intensely.”

-Edward Zwick-

A dangerous cocktail in adolescence

Teens experience many difficulties. For example, there are changes, both in their body and their social relationships. In addition, their brains are far from fully developed, and they tend to experience emotions more intensely. A percentage of them find drugs a way of coping to reduce their short-term discomfort. But, this means they’re likely to fall into a really painful trap.

The term multi-problem adolescents is used when, in said vital period, the individual deals with problems such as drug addiction, as well as other problems such as mental health and legal issues. Currently, in Europe, more than two million adolescents experience these problems.

The figures for mental disorders in developed countries, such as Spain or the US, show that close to 15 percent of people between the ages of four and 17 have a diagnosed mental disorder (Ribas-Siñol, 2015). Therefore, there are increasingly more cases of adolescents who consume multiple substances and develop other comorbid clinical pictures. In other words, they present several clinical entities at the same time.

“Up to 88% of adolescents who start treatment for substance use have other associated disorders.”

-María Ribas-Siñol-

Drugs, a springboard to other mental disorders

In adolescence, more and more substances are abused. In fact, 25 percent confess to having done so in recent weeks. Among the most consumed substances in this population are alcoholic beverages and cannabis. In addition, cocaine use is growing exponentially, something that alarms specialists.

This dramatic increase in substance use has serious consequences. For example, multi-problem adolescents tend to be more violent and engage in criminal behavior more frequently. Often their goal is to obtain money to pay for drugs. As a result, they find it difficult to integrate into society and experience serious legal problems.

When an adolescent presents, in addition to drug addiction, another clinical entity, such as depression or trauma, it’s known as dual pathology. This type of condition makes any intervention more complex because health problems are combined with problems at the judicial level.

“Dual pathology and mental illnesses in adolescents are increasing more and more and many crimes are associated with the consumption of toxins.”

-María Ribas-Siñol-

Frequent disorders in multi-problem adolescents

The fact that health problems in adolescence start earlier and are more numerous is noteworthy. In fact, it’s been found that almost half of the adolescents suffering from dual disorders exhibit more than three disorders at the same time.  The data varies depending on the type of study. However, there are some clinical entities that appear more frequently in multi-problem adolescents.

All of these can be interrelated. However, it’s difficult to know which of them has been developed first and has strengthened the others. For this reason, great clinical expertise is required when addressing the problems presented by these adolescents.

“Youth is quick in feeling but weak in judgment.”

-Homer-

Behavior problems: a workhorse

The most frequent disorders in this population are conduct disorders. They’re often manifested in hostile behaviors. For example, theft, lying, or disobeying socially established norms.

The American Psychiatric Association (2014) alims that a characteristic of these adolescents is their low capacity to tolerate frustration. The repercussions vary depending on the sex of the adolescent:

• Girls tend to lie more. They also tend to miss school more often and use more drugs, compared to boys. The aggressions they commit occur in the relational context, being of a more psychological than physical nature. For example, verbal harassment.
• On the other hand, boys commit more physical aggression. Thus, they tend to commit acts of vandalism and fight. Behaviors related to the theft of objects are also more characteristic in males. In effect, they exhibit a more intense opposition to social norms.

According to the ontogenetic model proposed by McDonough (Fonseca, 2021), substance use is a contextual predisposing factor for the development of conduct disorders. In addition, other elements such as punishment-based upbringing and exposure to violent environments are relevant factors in dual pathology.

The shadow of depression

In order of frequency, depression is the second most common clinical entity in multi-problem adolescents. In fact, it’s currently known that almost five percent of adolescents suffer from depression. It’s one of the most prevalent disorders.

Among males, it’s especially associated with conduct disorders and drug use. This cocktail makes them more likely to commit suicide, which is the third most common factor of mortality in this population (Ribas-Siñol, 2015).

One theory is known as the self-medication hypothesis. It could explain why adolescents are using substances such as cocaine, which is a stimulant drug, with the aim of reducing their depressive symptoms. It could also be the reason for the cases of adolescents consuming this particular substance to be on the increase.

“Drugs are a waste of time. They destroy your memory and your self-respect and everything that goes along with your self-esteem.”

-Kurt Cobain-

Minds wounded by trauma

Trauma is another disorder that’s commonly described in the context of multi-problem adolescents. In adolescence, it arises from continuous situations of abuse. In fact, substance abuse can be carried out by adolescents to face hostile and abusive environments.

As a matter of fact, the APA (2014) mentions that substance abuse and conduct disorders are strongly linked to childhood trauma. More particularly, oppositional defiant disorder. In addition, it points out that drugs can be a way of avoiding dealing with extraordinarily intense memories from an emotional point of view.

“We live without knowing that our traumas rule our lives.”

-Sandra Barneda-

Overlapping conditions

As you can see, the clinical entities that emerge in the context of drug abuse frequently overlap. Considering the fact that we’re going through a decade marked by economic instability, a pandemic, and war, it’s understandable that the feelings of insecurity and emptiness that adolescents may experience intensify.

Therefore, it’s increasingly common to find adolescents in health clinics who have an extensive history of drug addiction, depression, behavior problems, and trauma. This increase is extremely worrying and alarming to the health systems. Indeed, they’re constantly striving to continue research and develop prevention programs that help the adolescent population lead healthy lives.

“In Europe, one in six school students (17 percent) reported having used an illicit drug at least once in their life.” 

-ESPAD-

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