Even More Complex…. When Mental Disorder Meets Addiction in Youth: Dual Pathology

Abstract

Background: The management of mental disorders in child and adolescent is challenging. In addition, when substance use disorders are associated with mental disorders, important complications are noted. Dual pathology and Substance-induced disorders should be distinguished in cases like this. Objective: To summarize the latest information on the epidemiology, etiology and management aspects of dual pathology in adolescents. Methods: PubMed, Web of Science, PsycINFO and SciELO databases were searched to perform a narrative review. Results: Dual pathology is the term used to designate the co-occurrence of an addictive disorder and at least one other mental health disorder, independently. To distinguish dual pathology from substance- induced disorders, the temporal association between the disorders in a longitudinal assessment should be emphasized. If the symptoms of the mental disorder appear prior to the substance use or after a long period of abstinence, a diagnosis of dual pathology should be considered. Patients with dual pathology present greater psychosocial issues, more medical problems, and worse prognosis than those with substance-induced disorders. The proposed etiological models agree that biological, psychological and social factors are shared in the development of these conditions. Conclusion: Healthcare systems should focus on creating policies that will allow early detection, preventive public health measures, and an integrated and coordinated care for these patients. Public health policies should create means to promote awareness and prevention of these pathologies since early initiation of treatment (pharmacological, psychotherapeutic, family therapy, education in schools, behavioral interventions and treatment of comorbidities) reduces the risks associated to substance use disorders and other negative consequences.