• Article
  • August 31, 2017

Adolescent Care at the Intersection of Mental Health and Substance Abuse

Hospital's program combines substance abuse treatment with behavioral health care.

For Dave Atkinson, the inspiration for incorporating substance abuse treatment into behavioral health care began during his training as a child psychiatrist. "I noticed that 30 percent of my outpatients were using drugs," says Atkinson, M.D., medical director of the Teen Recovery Program at Children's Health in Dallas. "And they were never getting better."

Couple that experience with the trends that Atkinson and his colleagues were seeing at Children's Health—primarily, adolescents arriving at the hospital's emergency department (ED) or intensive care unit (ICU) due to drug abuse—and it became evident that a different approach to care was needed. The result: Children's Health's recently opened outpatient clinic, the Teen Recovery Program, which addresses both mental health and substance abuse issues in patients ranging from ages 13 to 17.

Sharing common ground

This integrated approach is not common—the hospital says the Teen Recovery Program is one of just a few in existence and the only one of its kind in north Texas. But Atkinson says there's a strong relationship between mental health issues and substance abuse:

  • Mood-altering: "Sometimes kids who are traumatized or abused don't feel good a lot of the time," Atkinson says, which can lead them to seek out things that will help them feel better and change their mood.
  • Drugs causing illness: Drug and alcohol abuse can drive mental health illnesses, such as depression, anxiety, and even psychotic symptoms and diseases, such as schizophrenia.
  • Genetic ties: "The same people who are vulnerable to developing mental health issues are also vulnerable to developing addictions," Atkinson says. "There's an inborne vulnerability to both problems."

Intensive outpatient program

Children's Health's Teen Recovery Program describes its approach as an intensive outpatient program. It incorporates medication management, cognitive behavioral therapy, motivational enhancement therapy, group and individual therapy, and family engagement to help patients end drug abuse and manage emotional or psychological problems.

And because it's an outpatient program, patients are able to receive care in their home environment while remaining engaged in their school and family lives.

"As an outpatient program, we have the advantage of seeing what kind of choices the individual is making," Atkinson says. "It allows the parents to work on different strategies with their kids, including how to communicate with them, how to set limits for them and how to help them make positive choices."

Importance of dual training

Atkinson heads up a team of clinicians and counselors at the clinic that, like Atkinson, have dual training in substance abuse and mental health. Atkinson says that combination of skill sets is somewhat rare and goes a long way when treating patients.

"It helps because you avoid the temptation of viewing it all as drugs or viewing it all as mental health," Atkinson says. "You have experience with both disorders and can figure out where each lies and how to treat each disorder."

Advice for children's hospitals

For children's hospitals looking to build their own clinics, Atkinson says it's important to study the current literature to determine the core curriculum that's right for your institution. Making the program financially feasible will require some creativity, but following the blueprint of existing clinics—including those at Children's Health, Boston Children's Hospital and the University of Colorado—can provide some guidance.

Despite the challenges, Atkinson stresses the importance of working to address these issues in a preventive—rather than a reactive—manner.

"Don't make the mistake of thinking this is too hard," Atkinson says. "While nothing in this build is routine, it's not too hard. It's certainly not harder than treating a kid who's overdosed in the ICU. It's certainly not harder than treating a kid who has gone psychotic from using drugs. And it's certainly not harder than dealing with a grieving family whose child has just died."

Send questions or comments to magazine@childrenshospitals.org.