Psychiatric comorbidity with substance misuse in children and teenagers.

Substance misuse in children and young people is frequently associated with emotional and behavioural disorder not attributable directly to the effects of the substance. Such comorbid disorders include depression, suicidal behaviour, conduct disorder, attention deficit hyperactivity disorder, eating disorders, and psychosis. Some indication of causal links in specific samples has been found but there is not overall agreement. The heterogeneity of young people with comorbidity for psychiatric disorder and substance misuse suggest that some would better be considered as multiproblem children for whom the necessary conditions are vulnerability, lack of family protection and exposure to a source of drugs. Children who present with comorbidity are at very high risk. This may be reduced by early identification and treatment of the comorbid condition and vigilance for substance misuse in all cases. Development of specific services for young substance misusers, coordinating efforts from Health Social Services and Education is merited in view high risk for future physical and psychiatric disorder. Few such services currently exist in the UK.