Although knowledge gaps still exist, researchers are moving closer to a better understanding of the link between substance abuse and internalizing disorders.
When it comes to the study of substance abuse and internalizing disorders in adolescents, there are still significant gaps in knowledge, according to a presentation delivered on Wednesday, Oct. 27, at the AACAP 57th Annual Meeting in New York, NY.
According to Naomi R. Marmorstein, PhD, Rutgers University, Camden, NJ, research on adolescents has focused primarily on externalizing disorders, with the model of substance abuse disorder (SUD) as “self-medication,” which often is not the case. In her presentation, Marmorstein examined the associations between internalizing disorders (IDs) and SUDs in adolescents, using data from a community sample.
In her research, she has studied models that take into account factors including genetics, other comorbid disorders, early drug use, and gender. Some of the key findings are as follows:
It is critical, Marmorstein added, for providers to carefully asses the onset and patterns of symptoms in each individual patient, and to avoid the assumption that SUDs are due to self-medication.
In another presentation, Christian Thurstone, MD, University of Colorado Denver, discussed pharmacological treatments of co-occuring internalizing disorders and substance abuse disorders, a topic that has gained momentum in the child and adolescent psychiatry community.
Thurstone highlighted a study published by colleagues at University of Colorado that evaluated the effect of fluoxetine hydrochloride vs placebo on SUD, major depressive disorder (MDD), and conduct disorder (CD) in adolescents also receiving cognitive behavioral therapy (CBT). The CBT sessions included functional analysis of drug abuse, and interview sessions that focused on setting goals, coping with cravings, problem solving, and anger management.
Results from the study showed that fluoxetine plus CBT experienced demonstrated greater efficacy than placebo and CBT on one but not both depression measures and was not associated with greater decline in self-reported substance use or CD symptoms. Researchers noted that use of cognitive behavioral therapy may have contributed to higher-than-expected treatment response.
Other medications—including sertraline and bupropion—are being researched as possible treatments for depression, and may offer more options in the future, said Thurstone, who provided brief summaries of the recommendations provided by the AACAP and the American Psychiatric Association (APA):
AACAP Guidelines (2002)
Finally, Thurstone reminded all clinicians that “a tremendous opportunity exists” for research in this area, and encourages all who are interested to participate in studies.