Psychiatry 2008 - September 2008 - (Page 34)

[PSYCHOTHERAPY ROUNDS] SERIES EDITOR: PAULETTE M. GILLIG, MD, PhD Professor of Psychiatry, Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio. Treatment of Comorbid Adolescent Cannabis Use and Major Depressive Disorder by YIFRAH KAMINER, MD, MBA; DANIEL F. CONNOR, MD; and JOHN F. CURRY, PHD Dr. Kaminer is with the Alcohol Research Center and the Division of Child and Adolescent Psychiatry at the University of Connecticut Health Center, Farmington, Connecticut; Dr. Connor is with the Division of Child and Adolescent Psychiatry at the University of Connecticut Health Center, Farmington, Connecticut; and Dr. Curry is with the Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina. Psychiatry (Edgemont) 2008;5(9):34–39 ABSTRACT The comorbidity of unipolar depression with substance use disorders (SUD) in adolescents is well established and accounts for 24 to 50 percent in clinical samples. Very little empirical data exist on the treatment of dually diagnosed youth. The objective of this paper is twofold: 1) We will review the literature on SUD and unipolar depression; and 2) we will provide guidelines for a combined pharmacological and psychosocial intervention based on a clinical case example. INTRODUCTION In populations of adolescents with substance use disorders (SUD), one of the largest subgroups comprises those with one or more comorbid psychiatric disorders, also known as dual diagnosis (DD). This group accounts for 70 to 80 percent of adolescent substance abusers in clinical samples.1 In particular, the comorbidity of SUD with depression in adolescents is well established,2 with comorbid unipolar depression ranging from 24 to 50 percent in clinical samples of SUD adolescents.3,4 Depression as a comorbidity during SUD treatment raises the risk of treatment dropout, poorer treatment response, and earlier relapse.5,6 SUDs among depressed youths are a risk 34 Psychiatry 2008 [ S E P T E M B E R ] EDITOR’S NOTE: All cases presented in the series “Psychotherapy Rounds” are composites constructed to illustrate teaching and learning points and are not meant to represent actual persons in treatment. FUNDING: The authors acknowledge the support of grant K24 AA013442-02 from the National Institute on Alcohol Abuse and Alcoholism. ADDRESS CORRESPONDENCE TO: Dr. Kaminer, Alcohol Research Center, Farmington, CT 06030-2103; E-mail: kaminer @psychiatry.uchc.edu KEY WORDS: adolescent substance use disorders, psychiatric comorbidity; depression; treatment factor for suicidal behaviors, including ideation, attempts, and completed suicide. Furthermore, even screened and triaged youth face barriers in finding treatment.1 This article aims to enhance practitioner knowledge of evidencebased approaches to treating adolescents with substance use disorder (SUD) and comorbid unipolar

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Psychiatry 2008 - September 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Letters to the Editor Use of Benzodiazepines in the Treatment of Anxiety Functional Neurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician Treatment of Comorbid Adolescent Cannabis Use and Major Depressive Disorder Risperidone Long-acting Injections: Successful Alternative Deltoid Muscle Injections for Refractory Schizophrenia Alcohol/Substance Misuse and Treatment Nonadherence: Fatal Attraction Transforming the Psychiatric Inpatient Unit from Short-term Pseudo-asylum Care to State-of-the-art Treatment Setting Journal Watch Classified Advertising Information for Authors

Psychiatry 2008 - September 2008

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