Co-Occurring Mental and Substance Use Disorders
Among Tennessee Adolescents
Article prepared by Craig Anne Heflinger Ph.D.- Principal Investigator
with Andrea Flowers - Data Disseminator

Co-occurring mental and substance use disorders are typically not recognized or treated as a distinct problem among adolescents in TennCare or in publicly-funded treatment programs. One quarter (27%) of youth entering Tennessee’s publicly-funded treatment programs for substance use problems met the criteria for a co-occurring substance abuse and serious emotional disorder (SED), according to findings from the IMPACT Study ¹. The study also found that 12% of TennCare adolescents, which is equivalent to 12,000 individuals, were found to have potentially co-occurring substance use and mental disorders and were in need of at least a screening.

In order to determine the number of persons affected by both substance abuse/dependency and a serious emotional disorder, researchers calculated numbers for co-occurrence by identifying adolescents with one issue and then determined how many of them were affected by the other as well. Two groups of adolescents were included in this aspect of the IMPACT Study. First, in a randomly selected representative sample of adolescents who were on TennCare, the youth were first classified as having/not having SED based on information from parent interviews. In order for an individual to have been classified as having SED, he/she had to meet the two-part definition required by the federal mental health block grant funding and the Tennessee Department of Mental Health. 30% of all TennCare adolescents met the criteria for being classified as SED. Of this group, 39% reported alcohol or drug use within the six months prior to the interview, and were considered substance users. It was determined that this group of youth could benefit from a screening for a co-occurring substance abuse and mental health disorder.

In a second part of the IMPACT Study, adolescents entering publicly-funded substance abuse treatment programs in Tennessee were referred by Tennessee behavioral health providers who served youth with substance abuse problems. Based upon the youth’s reported level of alcohol or drug use and their consequences of substance use, the adolescents included in the study were classified as having substance abuse, substance dependence, or no/possible abuse. 92% of the adolescents involved in the study met criteria for either substance abuse or substance dependence. Of this group, 27% were classified as SED, according to the same criteria as was used in determining whether the TennCare adolescents had SED. From the data collected from the interviews of youth in the publicly-funded treatment system, some of the other preliminary findings are as follows:

· 100% of youth reported use of alcohol or other drugs at some point in their life.
· The most frequently reported concerns of use were interpersonal problems related to use, dangerous behavior, interference with role obligations (such as family, school, work), and excessive use.
· Over one-fourth (29%) of these youth had previously taken medication for emotional or behavioral problems.

These findings were further supported by information from interviews with providers who served adolescents with co-occurring substance abuse and mental health problems. Providers reported that approximately 80% of youth who were court-ordered to treatment in regional mental health institutes also had substance abuse problems. All but one of the providers interviewed indicated that the majority of the youth who were receiving substance abuse treatment also had mental health issues that needed to be addressed.

The IMPACT Study found that training, funding, and coordination are the major issues that need to be addressed by the current service system. Very few providers are cross-trained to treat both mental health and substance abuse problems. One Tennessee adolescent treatment unit, Western Mental Health Institute, served as a model agency at the time of the study that modified its treatment program to identify and treat substance abuse disorders among adolescents with mental health problems. Even when providers are cross-trained, however, Tennessee’s current system does not often provide funding for providers to treat co-occurring disorders. Through TennCare, the funding is typically available to treat substance abuse problems or mental health problems, not both. In addition, there is no system in place to coordinate services at the state or provider levels.

¹ This article is based on one of several reports from the IMPACT Study, conducted by Vanderbilt University's Center for Mental Health Policy in conjunction with Tennessee Voices for Children, the Tennessee Commission on Children and Youth, and Mississippi Families as Allies. The IMPACT Study focused on mental health and substance abuse issues of school-aged Medicaid children and adolescents in Tennessee and Mississippi, and was funded by the United States Department of Health & Human Services (USDHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) as part of a national study to examine the impact of Medicaid managed care on vulnerable populations.

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