Adolescence and young adulthood can be a difficult, turbulent time for many people, with issues of personal change, development, identity formation, experimentation, rebellion, and uncertainty impacting upon a person’s thoughts, feelings, and behaviour [389]. It is also a critical time for the development of AOD and mental health conditions. Mental and AOD use disorders are leading global causes of burden of disease in young people [1874]. The peak of this disability occurs in those aged 15-24 years and corresponds with the typical period of onset of these conditions [1875]. In Australia, at least five of the top 10 causes of disability-adjusted life-years are directly related to mental health or AOD use disorders [1876]. Added to this are concerns that we may see an increase in psychological distress and problematic AOD use among young Australians in response to the combined effects of recent national disasters (e.g., bushfires, floods), climate change anxiety, and the impacts of the COVID-19 pandemic [75, 1877], as young people are being disproportionately impacted by these events [1878, 1879]. Despite significant government investment in health services for young Australians (e.g., the expansion of headspace services), young people are commonly undertreated and there remains significant unmet need, particularly for young people who have more complex needs such as co-occurring AOD and mental health conditions [1880]. An Australian study conducted among young people aged 16-21 years attending specialist AOD treatment services reported that co-occurring depression (39%) and anxiety (34%) were common [1881]. Early intervention when symptoms of co-occurring conditions emerge is key to preventing a long-term chronic course of illness into adulthood [55] and addressing co-occurring mental health conditions has been identified as a key component to youth AOD treatment [1882].
It should be noted that the presentation of mental illness may be different in young people compared to adults. For example, children who have experienced trauma may not have a sense of reliving the trauma, but rather they may engage in repetitive play activities that re-enact the event. AOD workers who work with children or adolescents should refer to the DSM-5-TR [10] and be aware of possible variations of symptom expression. It is also important to recognise that AOD and mental health conditions take place in different physical, attitudinal, psychological, and social contexts for young people, and treatment needs to be tailored accordingly to meet the developmental challenges faced by young people [102, 1882, 1883]. For instance, Christie and colleagues [1882] suggest that young people may be more likely to present for treatment due to external pressures (e.g., family, school, legal issues), so a focus on engagement, building rapport, harm minimisation, and the use of motivational interviewing should be a key focus of care. Scare tactics and confrontational approaches on the other hand, should be avoided [389, 1884].
Other features of ‘youth friendly’ services include follow-up for missed appointments, ease of access, prompt screening and assessment, drop-in capability, flexibility, strong links to other relevant agencies to ensure holistic treatment (see Chapter B5), and interventions that recognise different cognitive capacities and developmental/maturational lags [776, 1882]. AOD workers may need to modify the treatment process to avoid client distraction and rebellion (e.g., creating a more active and informal environment) and place special emphasis on engagement, using appropriate language and questioning to relate to young people on their level. E-health interventions, described in Chapter B6, may also be particularly useful for engaging young people in treatment and overcoming some of the barriers to face-to-face engagement [109].
With regards to confidentiality, although there may be jurisdictional differences in relation to operationalisation, most young people would be considered ‘mature minors’ by the age of around 14 or 15 years. In this case, there is no obligation to provide information to the parents unless other legal and reporting constraints operate, and confidentiality must be respected [389]. In most circumstances, however, it is helpful to involve families (especially parents or carers) and this should be discussed with the young person at the outset of treatment and their consent for involvement sought [389, 1882]. Parents and carers may require support, education, and empowerment in order to assist with continued care and help prevent client relapse upon discharge [452, 1885].