The relationship between mental illness and addiction to drugs and alcohol is a complex one that has received a great deal of attention in recent years as a public health issue. Research consistently finds a correlation between substance use disorders (SUDs) and mental illness, with drug and alcohol abuse being more prevalent among individuals with mental health conditions.
Determining whether a mental health condition leads directly to substance abuse or vice versa is challenging, as a variety of factors are at play. Socioeconomic status, childhood trauma, family history and genetic predisposition are all predictors for both addiction and mental illness.
Mental health conditions are often diagnosed during the teen and preteen years, and this is also when the first illicit substance use often occurs. Young people experiment with drugs and underage drinking as early as middle school, and they are often self-medicating an undiagnosed or untreated illness. The earlier drug and alcohol use begins, the greater the likelihood of lifelong addiction and ongoing challenges with mental illness.
Talking to teenagers about addiction and mental illness is crucial, but the conversation needs to begin earlier, with younger children. Waiting until after the substance use disorder develops leaves it too late. Education needs to begin in elementary school or sooner, before the risks of drug addiction become significant.
Another scenario that a parent or other caring adult may face is the need to inform a child about an addiction or mental illness that is happening in a parent or other family member. This situation can be confusing and frightening for children, and addressing it promptly will aid in alleviating those fears, getting the issues into the open and beginning to reduce the stigma associated with substance abuse and mental illness.
Addiction and Mental Illness in Children and Teens
Adolescence is a complicated time for young people and their families. Children at this age are experiencing rapid change in physical and emotional development that is confusing and stressful. As they navigate these changes, they are also learning new ways to interact with peers and family, and discovering new interests, new friends and new freedoms.
This is a time to challenge boundaries, and it is when a child’s friends become more influential than members of their family. It is also a time when many experiment with underage drinking and drug use. A significant number of adults who develop a substance use disorder used cigarettes, alcohol or drugs for the first time during their teenage years.
Drug and alcohol use can be a way to relax or deal with problems, or it can be a result of peer pressure, low self-esteem, or simple curiosity. Whatever the reason, the behaviour is not uncommon among high school students, so it is important to understand the signs of an addiction problem.
Addiction is the body’s physical dependence on a substance, and it can occur after only one use. This leads to continued use as the body craves the substance, and to withdrawal symptoms whenever the substance is withheld. Eventually, a tolerance to the drug develops, and even larger doses are needed than before to achieve the same effects.
In addition to this physical dependence, a psychological one will also develop over time. Psychological addiction occurs when the cravings become emotional as well. The individual is overcome by a desire to have the drug, and feels as though they cannot function without it. They may lie or steal to obtain it.
When a young person feels that there is no choice but to take a substance, they are no longer experimenting or just having fun, they are addicted.
Addiction to Social Media
Addiction in adolescence can include a compulsive need to play video games and use social media. Smartphones and other devices have become ubiquitous, and being constantly connected through technology has become just a normal part of growing up for most young people.
Being online can be dangerous. Children and teenagers are often prey for criminals, and should be taught strategies for safe internet use. They are also very easily influenced, and may be introduced to drug and alcohol use for the first time through online chat or messaging platforms.
Another possible risk associated with excessive online exposure is that it can ultimately damage mental health. Addiction researchers are just beginning to investigate this, and more needs to be learned, but the importance of online connections, especially in the lives of teens and preteens, is clear.
Excessive use of social media or video games can exacerbate an existing sense of loneliness and isolation. It has been linked to feelings of envy, inadequacy, and dissatisfaction with life. Some studies have even suggested that unmonitored screen use can result in ADHD, anxiety, depression and sleep deprivation.
It is important for parents to help their children develop healthy online habits. Screen use should be monitored and balanced with time spent with real family and friends.
Recognizing an Addiction Problem
Indicators of a physical reliance on a substance include changes in sleeping habits, feeling shaky when trying to stop, needing to take increasingly more to get the same results, and changes in eating habits that may lead to weight loss or gain.
A psychological dependence can cause frequent mood swings, anxiety, depression, neglect of appearance and hygiene, eating disorders, increased absenteeism from school, changes in academic performance, a loss of interest in activities that used to be important, opposition to discipline, deterioration of family relationships, a constant need for money, lack of motivation, and aggressive or violent behaviour.
Other conduct that may be cause for concern includes changes in friendships, and only spending time with friends who use drugs. At this age, impulsive decision making and being easily influenced by peers are common tendencies that can lead to dangerous experimentation with alcohol and drugs. This can result in overdose.
Young people with a substance use disorder spend a great deal of time trying to obtain drugs or alcohol, and will sometimes steal or sell belongings to get money to purchase them, often from a dealer or one of the child’s friends or classmates. Drug abuse is also linked to violence and the use of weapons.
Involvement with the criminal justice system is very often an indicator of addiction.
In Canada, one in five children has a diagnosable mental illness. Examples include anxiety, depression, and eating disorders. In the United States, those numbers are higher. Much of this goes untreated, in spite of the fact that mental health conditions are eminently treatable.
Recognizing Mental Illness
Ensuring that children are mentally healthy, and ensuring that they have access to professional help if needed, is just as important as making certain they are physically healthy. Coughing and a fever are symptoms of a cold or the flu that every parent recognizes. There are equally signs that indicate issues with mental wellness: if a child or teenager shows changes in feelings, behaviour or thinking, a health care provider should be consulted immediately.
- Changes in feelings: consistently overreacting to minor situations, seeming very unhappy, worried, guilty, irritable, sad, or angry, and feeling helpless, hopeless, lonely or rejected.
- Behavioural changes: always wanting to be alone, crying easily, being quieter and less energetic than usual, showing less interest in favourite activities, trouble relaxing or falling asleep, spending a lot of time daydreaming, and difficulties getting along with friends.
- Changes in thinking: saying negative things about oneself, trouble concentrating, frequent negative thoughts, and changes in school performance.
Having the Conversation
Children have experience with having a cold or the flu, and of going to see a doctor. When talking to them about how mental illness affects a person, it may be helpful to make a comparison to a physical illness.
Many people get sick with a cold or the flu, but not many people get pneumonia. If they do, they will have to take medication and to go to the hospital. Similarly, most people experience occasional feelings of sadness, anxiety, worry and irritability, but when those feelings get very strong, last for a long time, or begin to interfere with relationships, activities, and school performance, that may indicate a mental illness that requires treatment.
With addiction, the goal is to set boundaries together, and work toward solutions. Like teaching children how to safely cross the road, parents must also teach them to embrace healthy attitudes and behaviours, and to make good choices on their own. Especially as children move into adolescence, a time of transition, it is important to nurture this area of their development as well.
When talking with children, parents need to be aware of their child’s needs, concerns, knowledge and experience with mental illness addiction, and communicate in a straightforward manner. They should have the conversation when the child feels safe and comfortable, and when the child is not under the influence of any substance. During the conversation, it is important to watch the child’s reactions, slow down or go back if the child looks upset, and communicate at a level that is appropriate for the child’s age.
Preschool Age Children
Very young children need less information and fewer details, because their understanding is at a basic, concrete level. They also focus on what they can see, and may ask questions about someone who is behaving in an unusual way, or is visibly upset. Using pictures, or concrete objects, may be helpful.
Elementary School Age Children
Older children should be given specifics, and more detailed information. They may ask more questions; these will tend to be fairly straightforward questions with relatively simple answers. A good place to start the conversation might be with important facts about medicine safety. Parents may want to talk to them about what is in the medicine cabinet, that what’s in there could hurt them and should never be taken without permission.
It is typical for children this age to worry about their own safety, and the safety of their family and friends. It is important to reassure them in order to manage those fears.
Youth are typically able to handle more specific information, and to ask more complex questions. They are also more comfortable confiding in their peers than in adults, and they may have misconceptions about mental illness or addiction as a result. It is important to correct any misunderstandings, but to do so in a non-judgemental way.
An important consideration is that youth respond better to conversations in which they feel heard and can ask questions than they do to lecture-style “talks”. It is important to express concerns, but it is normal for adolescents to experiment, and helping them understand the consequences of those choices in an open dialogue is more likely to lead to ongoing communication in the future.
Keeping emotions under control is very important for all participants, particularly for the parents, family members, or other caring adults. If necessary, the conversation should be paused and reopened when feelings have calmed enough for everyone to continue to speak with respect for one another.
Parents will want to plan the talk and keep it brief, as adolescents don’t typically stay focused on long conversations. Becoming involved without intruding is the challenge, so parents should offer to be available anytime to listen, without lecturing or imposing their own solutions.
A health care provider can offer support and resources, and work with the family to develop a plan to address the addiction and/or mental illness.
A Family Member’s Addiction or Mental Illness
Living in a home with a parent or sibling who has a substance use disorder and/or mental illness can be confusing and unpredictable. Children often receive mixed messages and an unspoken pressure not to tell anyone. They even blame themselves sometimes, and experience feelings of guilt and shame.
Often, the family will break up because of the substance abuse, or the children may be removed from the home. If this happens, it will have long lasting implications for their social and emotional development. They could either become withdrawn and quiet, or explosive and violent, and they are at risk of developing issues with low self-esteem, attachment, autonomy, and trust.
Having the conversation
Children of alcoholics, addicts and people suffering from a mental illness, need to hear that their parent is not a bad person, but that they have a disease and need help. This is also true of other family members who have a mental illness or addiction.
Children of parents with these challenges to know that they are not to blame. They did not cause the substance use disorder or mental health condition, and they cannot do anything to stop it. Children benefit from knowing that their situation is not unique, and that they are not alone.
Removing the shame as much as possible will help children of alcoholics and drug addicts begin to feel normal again, free of the guilt and secrets. It will also aid in reducing the stigma surrounding addiction and mental illness.
Children in homes with substance abuse and/or mental illness often feel scared, lonely and isolated from society. They need to be told that it is okay to talk about the problem, and may benefit from connecting with a caring adult, like a teacher, a counselor, or other family member. What is most important is getting the conversation started, and giving them someone with whom they can talk.
Talking About and Spotting Substance Abuse | CAMHCentre for Addiction and Mental Health, Copyright 2019
Talking With Teenagers About DrugsReport written for Health Canada, Date Modified: September 5, 2019
What to Do if Your Teen or Young Adult Has a Problem with Drugs National Institute on Drug Abuse (NIDA) Revised January 2016
Transforming Mental Health for Children and Youth CAMHCentre for Addiction and Mental Health, Copyright 2019
Depression in Children and TeensHealthLinks BC, February 20, 2019
When a Parent is Depressed…What kids Want to Know CAMH Centre for Addiction and Mental Health, Copyright 2019
Caring Together: Families as Partners in the Mental Health and Addiction SystemCanadian Mental Health Association (CMHA) Ontario, Copyright 2019
Substance Abuse in Canada: Concurrent DisordersCanadian Centre on Substance Abuse and Addiction, 2013
Picture Credit: Kids Help Line Feeling Sad and Depression