A new government report finds 10 percent of 16- and 17-year-olds had a major depressive episode in the past year. Almost 20 percent of young adults, ages 18 to 25, had a mental illness in the past year.
Four percent of young adults had a serious mental illness, according to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report also found 3 percent of older teens had both a major depressive episode and a substance use disorder; 6.4 percent had any mental illness and a substance use disorder; and 1.6 percent had a serious mental illness and a substance use disorder.
Older teens and young adults with emotional and behavioral health problems are much more likely to have significant problems with school, employment and housing, the report found. Almost 8 percent of older teens who suffer from depression and have a substance use disorder do not have a stable place to live. They moved an average of three or more times in the past year. Among older teens with depression and a substance use disorder who were enrolled in school, 13.5 percent struggled academically, with a “D” or lower average.
Young adults with a serious mental illness and a substance use disorder are less likely to graduate high school, compared with those without both disorders. They are also 1.4 times more likely to be unemployed. Young adults with a serious mental illness who receive treatment are more likely to graduate high school than those who do not receive any treatment.
“This new report demonstrates the critical need for treatment and other services that focus on older adolescents and young adults with mental and substance use disorders,” SAMHSA Administrator Pamela S. Hyde said in a news release.
Thom Kessler, LMFT, RAS
1. Peer Factors
2. Parent/Family Factors
3. Individual Factors
4. Biologic Factors
5. Community/Social/Cultural Factors
Thom Kessler, LMFT, RAS
A person with a High Conflict Personality (HCP) usually has an underlying personality disorder, generally viewed as one linked to the “dramatic, emotional or erratic” cluster (Cluster B) that includes antisocial, borderline, narcissistic and histrionic personality disorders. Personality issues are pervasive, which are longstanding patterns of behavior and experience that adversely affect a person’s interrelationships with others and ability to function effectively in the world. People with HCP do not necessarily fall neatly into one of these recognized categories. Instead, they can demonstrate symptoms from one or more of the Cluster B diagnostic categories, and they may by exclusion fit into the category of “Personality disorder not otherwise specified.”
HOW IS HIGH CONFLICT PERSONALITY TREATED?
In most cases, psychotherapy is the treatment of choice for HCP, whether in an individual or group setting. Since HCP clients have been helped by both psycho-dynamic and cognitive-behavioral treatment modalities, therapists have several tools at their disposal. One in particular, dialectical behavioral therapy (DBT), a method of psychotherapy originally developed to treat Borderline Personality Disorder, has been effective for clients with HCP, as the two disorders have many characteristics in common. While medication may not be the treatment of first resort, it can be appropriate for some clients, especially for those who may be suffering from other psychological issues, especially mood disorders, in addition to a HCP.
WHAT CAUSES HIGH CONFLICT PERSONALITY?
Like many psychiatric disorders, specific causes of HCP have not been clearly identified. In general, research has demonstrated an association between personality disorders and abuse or neglect early in life. There are many theoretical constructs that attempt to explain the circumstances that give rise to one disorder or another, but definitive causes are generally elusive. If nothing else, it is fair to say that there is no demonstrable link between these disorders and any genetic or physiological condition, although temperament may play a role in their development. It is believed that HCP is related to an insecure or disrupted attachment in childhood. Accordingly, the symptoms of HCP can clearly be exacerbated by situations like divorce or relationship difficulties (that are filled with conflict even for people without HCP).
WHAT ARE THE SYMPTOMS OF HIGH CONFLICT PERSONALITY?
HCP, given its overlap with the antisocial, borderline, narcissistic and histrionic personality disorders, may be more of a descriptive term than a specific diagnosis. People with HCP tend to have several things in common. They initiate and receive reward from conflict with others, and they are usually at the center of whatever conflict is occurring. They appear to treat conflict as normal and expected in their interactions, to a point at which conflict becomes a defining aspect of relationships. They are adept at escalating conflict and at blaming others. At the same time, they have great difficulty seeing things through the eyes of others and they are extremely reluctant to take responsibility in their lives or to accept blame when things go wrong. They are often referred to as “chronic blamers.” They tend to be emotional, aggressive, mistrustful and controlling. They easily see themselves as victims, and they are extremely resistant to acknowledging that they may have contributed, in even the smallest way, to making a situation difficult. For people with HCP, the world appears in black and white. Others are either with them or against them. They have little or no insight into their own behavior, and they are easily threatened by interpretations of behaviors that do not comport with their own worldview. Splitting is an important concept among persons with high conflict personalities. The people around them are perceived as all good (over-idealized) or all bad (devalued). Someone who has “split” off a family member or friend may refuse contact with that person and may speak very negatively about them.
FREQUENTLY ASKED QUESTIONS ABOUT HIGH CONFLICT PERSONALITY WHAT IS THE PROGNOSIS FOR HCP?
Clients with HCP are not naturally insightful. They can react with hostility to therapeutic intervention, often interpreting the therapist’s efforts as an attack. These qualities can make treatment difficult, but a trained therapist who understands HCP can work through these difficulties using specific techniques. Change may be gradual, but clients with HCP can ultimately adopt more effective ways of living. For persons more on the narcissistic spectrum, initiating therapy may be difficult to impossible. Forming a deep relationship with a therapist is also difficult for them.
ARE FAMILY AND FRIENDS INCLUDED IN TREATMENT PLANS?
Many of the symptoms of HCP are most pronounced in interactions with those closest to the client, so these relationships are especially important to effective treatment. The involvement of family and friends in treatment can be enormously helpful for all parties, encouraging them to understand the behaviors at issue and to adopt new, more productive ways of interacting.
Thom Kessler, LMFT, RAS
STEP 1: MONITOR
Parents are in an influential position to immediately help reduce teen access to prescription drugs because these drugs are found in the home. But how aware are you? Think about this: would you know if some of your pills were missing? From this day forward, make sure you can honestly answer, ‘yes.’
STEP 2: SECURE
Teens abuse prescription drugs because they are easily accessible and either free or inexpensive. In fact, in 2013, studies have indicated that 60-68 percent of kids age 12 to 17 who have abused pain relievers say they got them from their friends or relatives, typically without their knowledge. Approach securing your prescriptions the same way you would other valuables in your home, like jewelry or cash. There’s no shame in helping protect those items. The same holds true for your medications.
STEP 3: DISPOSE
Safely disposing of expired or unused prescription medications is a critical step in helping protect your teens. Here’s how to help safeguard your family and home, and decrease the opportunity for your teens or their friends to abuse your medications.
Thom Kessler, LMFT, RAS
Addiction impacts every aspect of your life, including your physical health, mental and emotional health, social life, and core values. The signs and symptoms of addiction can be biological, psychological, social and spiritual, and most people with a problem will exhibit signs in several if not all of these areas. These areas are often called the Four Pillars of Addiction and Healing.
BIOLOGICAL SIGNS AND SYMPTOMS
Biological signs include changes to physical health and appearance and include, but are not limited to, the following.
PSYCHOLOGICAL SIGNS AND SYMPTOMS
Addiction takes a real toll on emotional health and can result in many psychological symptoms. Here are some of the many signs and symptoms associated with problem behavior.
Thom Kessler, LMFT, RAS
Parents who provide their teens with alcohol and a place to consume it may think they are teaching their children "responsible drinking." A new review of studies concludes this view is misguided. Researchers found parental provision of alcohol is associated with increased teen alcohol use.
In some cases, parental provision of alcohol is also linked with increased heavy episodic (Binge) drinking and higher rates of alcohol-related problems, the researchers reported in an article found in the March 2014 edition of the Journal of Studies on Alcohol and Drugs.
“We suspect there is a surprising amount of ‘social hosting’ going on—parents providing alcohol for their teens and their friends,” said study co-author Ken C. Winters, Ph.D., Professor in the Department of Psychiatry at the University of Minnesota Medical School. “Parents probably aren’t aware that social hosting could have criminal implications in some states if things take a bad turn. I can appreciate that social hosting is often done with good intentions. Parents think they are preventing something worse by having their kids drink at home with their friends. But the risks are great.”
Senior author Dr. Övgü Kaynak and her co-authors reviewed 22 studies that examined the association between parental provision of alcohol and teen drinking. Based on their findings, they recommend that parents discourage drinking until their children reach the legal drinking age of 21.
Parents influence their children’s risk for alcohol use in both direct and indirect ways. Indirectly, parents can influence their teens’ behavior by failing to monitor their activities while their child still lives at home, having permissive attitudes toward underage drinking, expressing direct approval of underage drinking, or simply by providing unguarded access to alcohol at home. More direct ways of influencing teens’ drinking behavior include offering to buy alcohol for them, supplying alcohol for a teen party, or allowing their teen to drink at home, either supervised or unsupervised.
“The most worrisome things parents can do are to model poor behavior by drinking excessively in front of their teens, and to provide alcohol to their teens,” Winters said. “I’m not talking giving about a sip of alcohol or an occasional glass of an alcoholic beverage with a meal for an older teenager. I’m referring to parents who host a drinking party and provide alcohol, thinking they will be able to make it safe. It creates more problems than it solves.”
The researchers report there is little research to support the notion that it is possible to “teach” children to drink alcohol responsibly. Their review suggests that by allowing alcohol use at a young age, parents might increase the risk for progression toward unsupervised drinking more rapidly than it would otherwise have been. Allowing teens to drink may instill a sense of comfort in alcohol use, which could increase their tendency to drink, with or without their parents present.
Parents may be giving their teens subtle messages about drinking without even realizing it. For instance, they may not take the opportunity to say something negative about underage drinking if they see it in a movie or TV show they are watching with their teen. The researchers stated that they want parents to understand that allowing teens to drink underage, even when supervised by the parent, is always associated with a greater likelihood of drinking during adolescence over time. Social hosting is never a good idea, they emphasize. “Adolescents who attend parties where parents supply alcohol are at increased risk for heavy episodic drinking, alcohol-related problems, and drinking and driving,” they wrote.
Thom Kessler, LMFT, RAS
Marriage & Family Therapist and Registered Addiction Specialist