Co-occurring Disorders and Trauma-Informed Care for Adolescents
Domain 5: Co-occurring Disorders and Trauma-Informed Care for Adolescents
This domain tests integrated treatment of substance use and mental health conditions, trauma-informed practice, and safe sequencing of trauma-focused work.
Co-occurring disorders
Treat SUD and psychiatric disorders concurrently, not sequentially. Common co-occurring conditions include anxiety, depression, ADHD, PTSD, and conduct problems. Distinguish substance-induced symptoms from independent disorders using timeline, collateral, and reassessment during abstinence. Screen for suicide risk at every contact.
Trauma-informed principles (SAMHSA)
Safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and attention to cultural, historical, and gender issues. Screen universally but do not require disclosure. Offer choice, predictable routines, grounding skills, and clear explanations to avoid retraumatization.
Trauma-specific treatment
TF-CBT, Seeking Safety, DBT-A, and EMDR are used with adolescents. Requirement of prolonged abstinence before trauma therapy is not supported; readiness and safety, not sobriety, guide timing.
Worked example
A 15-year-old with nightmares, hypervigilance, and cannabis use to sleep. Integrate care: sleep hygiene and CBT-I, trauma-focused therapy, harm-reduction messaging, and coordination with the prescriber. Do not require 30 days of abstinence before starting trauma work; do not force a detailed trauma narrative in an early group.
Traps that cost marks
- Sequential 'treat addiction first' rules.
- Mandatory disclosure in group or intake.
- Confrontational approaches that shame.
- Attributing all symptoms to substance use and missing PTSD or psychosis.
- Ignoring vicarious trauma and staff support.