Adolescent substance abuse and internalizing disorders

Clinical observation suggests that anxiety and affective disorders are important in the development and course of psychoactive substance abuse in some adolescents. These internalizing disorders sometimes precede and may contribute to the development of psychoactive substance-use disorders, Screening for internalizing disorders, suicide risk, and trauma history is important in the clinical evaluation of all adolescents with psychoactive substance-use disorders. Depression and anxiety symptoms may be caused, however, by chronic alcohol or drug consumption or withdrawal. Therefore, a period of abstinence and reevaluation should precede specific treatments. Specific treatment for anxiety disorders or depression may be appropriate in some substance-abusing adolescents. Focused psychotherapeutic techniques or psycho-pharmacologic treatments can sometimes be useful adjuncts to psychoactive substance-abuse programs.