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Seven Common Co-Occurring Disorders in Teens

Written by Rob Alston

& Medically Reviewed by Paula Holmes, LCSW

Medically Reviewed

Up to Date

This article was reviewed by a medical professional to guarantee the delivery of accurate and up-to- date information. View our research policy.

Last Updated - 08/16/22

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Teens with dual diagnosis disorders have both substance abuse and another diagnosed mental health condition simultaneously.

Perhaps you’ve heard the term before relating to mental health and wondered, what is a dual diagnosis?  A dual diagnosis refers to the presence of a substance use disorder and a mental health diagnosis simultaneously. An estimated 65% of teens with a substance use disorder have a dually diagnosed mental health condition. In the treatment of teen mental health, practitioners assess the potential of a dual diagnosis to ensure that the best treatment options are arranged to meet the patient’s needs.

Understanding the needs of teens and having a proper assessment of the presence of a dual diagnosis can result in better outcomes. If a teen has a substance use disorder and is dually diagnosed with depression, the symptoms of each of these conditions impact the other. A thorough diagnosis and the identification of dual conditions help struggling teens get the help they need. There are seven common diagnoses that can co-occur with substance use disorder in teens.

Antisocial Disorders

Antisocial personality disorder in teens is a diagnosis that manifests as:

Antisocial Personality Disorder Symptoms

Lack of empathy for others

Disregard for right and wrong

Limited ability to connect with people genuinely

Manipulating others

Teenage antisocial personality disorder poses a significant risk for substance use and addiction as a result of having fewer inhibitions about using substances. Causes of antisocial behavior in adolescents can vary. Genetic factors, maternal substance use, and environmental influences can all play a part in the development of an antisocial personality.

Anxiety Disorders

Anxiety disorder in teens is prevalent. Teens who have struggled with anxiety in childhood and don’t receive treatment are more likely to experience substance use disorder. Teens with anxiety may turn to substances as a method of self-medication or reducing distress caused by anxiety. Others may use substances as part of an impulse-related anxiety condition and become physiologically and psychologically addicted as a result. Teenage anxiety disorder symptoms include:

Anxiety Disorder Symptoms

Feeling overwhelmed and stressed

Restlessness, feeling jittery


Feeling a loss of control

Gastrointestinal upset

Headaches and fatigue

Social avoidance/changes

Excessive worry

Rising anxiety levels among youth is an important factor to pay attention to and treat early on. Doing so may help prevent some instances of substance use disorder during the teenage years and contribute to a more healthy lifestyle.

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD in teens and substance use disorder often co-occur. ADHD drug abuse and alcohol abuse sometimes emerge for teens who struggle with the condition. It can be difficult to manage ADHD, particularly in settings that are challenging for people with this condition, such as traditional classrooms and school settings. The impulsivity related to ADHD puts teens at a greater risk of substance use disorders. Social challenges, boredom, and behavioral issues can also reduce feelings of success in the school setting overall. Signs of ADHD in teens often manifest as:

Symptoms of ADHD

Problems concentrating





Bipolar Disorder

Bipolar disorder in teens impacts mood regulation, impulsivity and ability to function. The correlation between substance use disorder and bipolar disorder in youth is significant, in that substance use treatment is often sought before the diagnosis of bipolar disorder. Bipolar disorder co-occurs with a substance use disorder 60% of the time. Testing for bipolar disorder in teens can help determine if their symptoms meet the criteria for the diagnosis. Common symptoms include:

Bipolar Disorder Symptoms

Distinct episodes of mania and depression

Suicidal ideation

High energy with little need for sleep

Mood changes

Impulsive, erratic behavior


Excessive, inappropriate guilt

Fatigue and exhaustion

Borderline Personality Disorder

BPD in teens affects feelings of belonging, stability, and self-esteem. People with this disorder are at an increased risk of a substance use disorder as a result of the turmoil and feelings of rejection that the condition causes. BPD in teenagers can make it difficult to trust others and the disorder often causes teens and others with the condition to engage in risky behaviors, including substance abuse. Teenage BPD symptoms include:

Borderline Personality Disorder Symptoms

Intense fear of abandonment

Low self-esteem

A belief that people reject and abandon them routinely

Risky and self-injurious behaviors

Suicidal ideation

Intense anger and irritability

Feelings of emptiness


Teen depression is at an all-time high, particularly in women. Depression in young adults and teens, unfortunately, increases the likelihood of developing substance use disorder. The use of alcohol or drugs in response to depression only worsens the condition. Depression in adolescents can present a bit differently than in adults. Some of the more common symptoms of depression in this age group include:

Depression Symptoms


Shifts in mood

Changes in eating patterns

Preoccupation with death/dying

Low self-esteem

Changes in hygiene practices

Fatigue or restlessness

Changes in sleep patterns

Weight loss or gain

Inability to make decisions

Cognitive fog

Eating Disorders

Eating disorders in adolescence pose significant health problems, and these conditions frequently co-occur with substance use. Teens with eating disorders may go to great lengths to hide their condition from others. The negative self-evaluation and low self-worth that come with eating disorders can cause some teens to resort to substance use as a means of self-medication. The results are anything but therapeutic and usually result in greater feelings of self-loathing and loss of control. Some signs of teenage eating disorders can include:

Eating Disorder Symptoms

Perfectionist tendencies

Unrealistic standards for oneself

Excessive exercise

Frequently going to the bathroom following a meal

Mood changes

Obsessiveness about food intake/calories/carbohydrates

Low self-esteem

See More: Take a Mental Health Quiz

Helping Teens Cope with Dual Diagnosis Disorders

If you’re wondering how to talk to your teenager about drugs, help is available. The risk for teens with dual diagnosis is significant, as both conditions impact the other and will likely worsen over time if left untreated.

There are teen drug rehab programs that can help. Specialized dual diagnosis treatment centers in Florida can offer comprehensive treatment options that work with your teen’s specific needs. These programs offer strengths-based therapies to help your teen recover in a safe environment. Contact The Recovery Village Palm Beach at Baptist Health today to learn more about treatment options for co-occurring-disorders or addiction for your loved one.

View Sources “Substance Use & Mental Health in Teens and Young Adults.” Accessed October 11, 2019.