Teen Mental Wellness

What is Mental Wellness?

Mental wellness is the ability to adapt to changes, deal with trauma, and bounce back from the significant stressors that life presents, and it is just as important as physical health. Mental wellness can help children manage unpleasant feelings and the uncertainties of life, as well as protect them from risky substance use as they grow.

Of course, every young person is different in his or her responses to life's challenges. While some embrace obstacles as opportunities, others may dwell on challenges or be consumed by setbacks. How a person responds to life is contingent upon many factors, including, at times, mental health status.

As adults, we should never assume that a child has mastered a difficult situation just because they have been through it before. When a traumatic life event occurs, including a personal struggle with a mental health condition, physical and psychological distress can disrupt a child's overall well being and ability to make healthy decisions. At these points, our young people's mental wellness is at risk.

For even the healthiest kids, experiencing challenges is unavoidable, and can put young people at risk for substance use, worsening mental health, or other conditions. However, coming through these challenges with the aid of adult support, whether a young person struggles with mental health concerns or not, can be an excellent way of building resiliency and mental toughness for the future.

Mental Health and Teens with a Substance Use Disorder

Over 95% of the young clients with a primary substance use disorder that addiction treatment professionals see also have a coexisting mental health diagnosis. Working with adolescents, professionals like those within the Hazelden Betty Ford Foundation often discuss the phenomenon of a client having a "dual diagnosis," but even that term can be misleading. In many cases, an individual will have more than two, and sometimes three or four, different mental health diagnoses: "co-occurring disorders" is more accurate.

A discussion of the developmental underpinnings of substance use disorders can help adults who do not have clinical training to gain an understanding of mental wellness and illness in teens with substance use disorders.

Links between Substance Use and Mental Health

Genetics
Recent research indicates that there are over 300 genes positively correlated with substance use disorders. There seem to be five main regions of the brain that are different for most people who develop substance use disorders, and through identical twin studies, it has been discovered that these brain structures exist prior to significant chemical use.

Geneticists have uncovered that the same 300 genes that are positively correlated with substance use disorders are also positively correlated with difficulties with mood and behavioral regulation.

This is an important point to understand. It is not that individuals with emotional difficulties start using substances as a way to medicate their emotions, nor is it that individuals who struggle with substance use disorders find themselves developing more significant emotional and behavioral regulation issues as a result of their substance use.

Instead, it appears that individuals with these genetic predispositions are significantly at risk for both emotional and behavioral dysfunction, simultaneously with predisposition to have difficulty with alcohol or other drug use.

Current research indicates that approximately 60% of individuals who eventually develop substance use disorders have first- or second generation family members who have also struggled with chemical use.

Environment
Mental health professionals, including those at the Hazelden Betty Ford Foundation, find it rare to have young clients whose background does not indicate both mental health and substance use risk in their family of origin. In the field, of course, we are used to looking for a family history of chemical dependency on the initial assessment for a young person entering substance use disorder treatment.

It is also important, however, to look not only for history of chemical dependency, but for a history of difficulty with emotional behavioral regulation as well. Both are likely to be found, as individuals with substance use disorders tend to struggle emotionally and behaviorally, related to genetic predisposition and environment alike.

Mental Health Challenges for Otherwise Healthy Kids

Change can be difficult at any age. If mental health is a continuum and teen substance use behaviors and attitudes also vary, many young people without either a substance use or mental health disorder will still be at risk for challenges to their mental wellness. The most common changes that occur for healthy young people include:

• bullying and friendship issues
• life transitions
• puberty and physical changes
• changing families
• loss
• over-scheduling
• self-identity

The internet adds another layer of challenges. Children have an accelerated exposure to unhealthy attitudes, images, and ideas that are glamorized and unrealistic. At Hazelden Betty Ford's Prevention Solutions, we effectively assess and address the evidence-based social norms approach to substance use prevention through our prevention programs and services, more can be done in homes and in the community to look at how false normative beliefs shape students' broader mental wellness.

Untreated traumatic experiences and these false perceptions can distort a child's view of normal development and lead to problems including:

• depression
• anxiety, nervousness, and worry
• interference with school achievement
• relationships with family and peers
• self-esteem and self-confidence
• procrastination, motivation, and time management
• concentration
• irritability
• major life decisions

There are children in every community who are in the midst of mental health situations and deserve their best chance at success. Whether you are a parent, a teacher, a school counselor or any other adult living or working with teens, you can create an environment of mental wellness that promotes healthy decisions by young people in regard to alcohol and other drugs.

Our Role as Adults

In our work in classrooms around the world, we hear that students have many well-meaning adults in their lives who talk with them about important pieces of adolescent development like integrity, honesty, and values. Yet, when these same kids are faced with conflicts in life, they appear confused about what to do to maintain their mental wellness and promote their best chance at a healthy future. Indeed, when teens are forced to put into context the values that are presented to them, they may struggle to find the adult support they need through this process.

Helping children reach their full potential, cope with changes in life, and be engaged with their surroundings is an ongoing process that should begin in the earlier stages of learning. Here, adults can play an active role.

Risks to Mental Wellness for Children

Mental health is imperative to quality of life and future success for children. Identifying early warning signs of a mental health stressor or problem presents an opportunity for caring adults to help growing teens develop resiliency and avoid alcohol and other drug use, as well as sustain a safer learning environment for everyone too.

In academics
Paying attention to high-stress times during the school year can reduce the tension associated with school-hosted social events, holiday breaks, testing, and transitions at the beginning and end of the year. School by itself, at any age, can put enough stress on a child that it may begin to interfere with daily functioning. It is fundamental to create learning environments that are physically and emotionally safe, in order to help students be more engaged, have positive attitudes, and avoid conflicts and isolation.

In the brain and body
The complex hormonal changes and ongoing brain development during adolescence make teens more susceptible to depression and more likely to engage in higher-risk behaviors. In fact, about 20% of 13- to 18-year-olds suffer from a diagnosable mental disorder. If left untreated, negative consequences can develop over a lifetime. Quality of life as well as academic performance decreases, the risk of substance use and chronic illness increases, and relationships deteriorate and suffer.

More than half of teens with untreated mental conditions drop out of school, and over 75% of students with diagnosable mental disorders do not receive adequate treatment. Right now, suicide is the third leading cause of death for adolescents. When we examine mental illness, many signs are present in early childhood.

Best Practices for Adolescents with Mental Health and Substance Use Disorders

Given the extremely high incidence of co-occurrence between substance use and other mental health disorders, individuals with substance use disorders simultaneously also must receive high quality mental health treatment.

We know that, particularly with young adults, if we simply treat substance use disorders without addressing mental wellness, it is likely that concurrent behavioral or emotional issues will be a trigger for a substance use relapse, especially among young people in early recovery.

Self-esteem
One of the primary concerns in early recovery is dealing with the often devastated self-esteem of the person in early recovery from addiction. As substance use progresses, a person experiences a slow but steady deterioration in his or her ability to do the things that are important to them, spending more and more time planning for substance use, actually using alcohol or other drugs, recovering from intoxication, and trying to hide the problem. This leaves less and less time for studying, work, school, and extracurricular interests.

Slowly, the kinds of identifying markers that individuals use to frame self-esteem have been lost. In a psychological sense, self-esteem and healthy self-concept reflect the ability to have accurate thinking, behavior, and emotions.

Young people with a substance use disorder—whether progressing to addiction or early in recovery—desperately need individuals in their lives who can give them accurate feedback, help them to understand the mistakes that they are making, and guide their way back to accurate thinking, behavior, and emotions.

This is essentially good mental health treatment, but not all feedback of this sort need come from children's professional treatment providers. Any caring adults in a child's life should understand the importance of this kind of self-esteem improvement for that child and lend moral support.

Adults can reinforce the young person's drive to be well by providing feedback to them that will help them see themselves in a more accurate way, learn to be more effective in relationships, and ultimately learn to earn the trust of important people in their life.

Value-setting
Research indicates that individuals who are emotionally vulnerable are much more likely to become anxious and depressed and often are not clear about their fundamental values. By contrast, individuals who tend to be emotionally resilient usually have a firm and concrete set of values.

This is one of the primary goals of the seminar work in FCD's upper school Intensive Student Education curriculum—to help students identify their personal values and how those values can be strengthened and remain unthreatened by alcohol and other drugs as they grow.

If teens do not have fundamental values in day-to-day life, they essentially are left to compare themselves against others to determine how they're doing, a risky proposition. The more closely they can move towards their own values, the better and more secure they will feel. FCD encourages adults to help drive the value-formation of your teens, with and without substance use disorder, to maintain a healthy environment of mental wellness for all.

What helps the whole
Building resiliency is one of the most important skills an adult can help a child develop toward their mental wellness. It is an ongoing journey of conversations, role modeling, and guidance. At any age, it is appropriate for children to engage in healthy risks such as making new friends, trying new sports, or learning something new.

However, these steps—challenging for kids with or without a diagnosis—can lead to unwanted feelings and uncertainty. There are ways, though, that healthy, trusted, and supportive adults can help.

Best Practices for All Adolescents

Problem solving
Teaching a child how to solve problems allows them to embrace challenges with confidence. Rather than asking a child "why" something happened, asking them "what" they could do differently promotes positive solution-building.

In a child that develops confidence, self-efficacy and trust in their future decisions will follow. Teaching resiliency begins young.

Normalizing mental health
Fear, anger, excitement, and frustration can feel isolating to a young person. Help children recognize their emotions and learn healthy ways to express themselves.

Children in the middle and high school years tend to identify school as their number one stressor, with family relationships a close second or third. Work to change this for your young people by working toward receptive and safe relationships at home while advocating for and prioritizing a balanced school life in your community, where stress is recognized and mental wellness is given its due.

Mindfulness
Building an environment of educators and professionals who can address mental health promotion through mindfulness can greatly improve the mental wellness of teens. Simply incorporating a minute of mindfulness into each day, with exercises including breathing, visualizations, positive reflections, or quiet listening, can be impactful, and can help establish balance and presence in one's life.

Kids often catastrophize situations and in turn feel overwhelmed. Engaging a child in thoughtful questioning can develop alternative thought patterns and broaden a child's perspective. A child with limited views can often become anxious and fearful.

Allow space for kids to create their own solutions. Inevitably, they will make mistakes, but in doing so, the consequences that they encounter can be great building blocks for future decisions.

Other skill building
Teaching children concrete skills can help them navigate future situations. A shy child may learn to make eye contact or practice appropriate greetings. Role-playing life scenarios and providing teens with the language to make healthy choices in life may seem repetitive, but is absolutely necessary.

Helping kids connect positive reasons for their choices increases their chances at overcoming obstacles in life. Practicing these skills can build confidence. Teens repeatedly rehearse for music, sports, and academics, but how often do they get to practice life situations like confronting a friend with a social concern?

Role-modeling healthy behaviors is essential for children to see. Young people today are surrounded by media that has normalized unhealthy coping skills. Effective early interventions and ongoing communication with children can improve academic outcomes and nourish the mental health of a child.

Growing Mental Wellness in Teens

The growing years are critical to the social, emotional, and physical development of our children. Friends shift, bodies change, and myriad other circumstances provide stress and challenges within the lives of our children.

As adults, we work to provide our teens with the life skills essential to be victorious in these daily battles. For some, these battles may appear transient, necessary steps to wade through to begin a healthy adulthood. For others, mental health issues are ongoing and may require intervention, treatment, and monitoring so that they may thrive in life with a mental health disorder diagnosis. In either case, we care for our kids and want to prevent any barriers to success that we can, including the risk of substance use that is so inherent for teens who also undergo mental stress.

For these and other reasons, we embrace the idea of mental wellness, and encourage you to actively look for ways to promote it in your homes and communities.