Advancing an Integrated Approach to Prevention, Early Identification, and Intervention for Youth with Co-Occurring Substance Use and Mental Health Challenges.

Substance use and mental health challenges are common in youth and may result in co-occurring disorders. Yet prevention, screening, and treatment services for mental health and for substance use often are delivered separately, creating missed opportunities for effective integrated, co-occurring competent care. This Fresh Focus Policy and Practice commentary makes the case for a more intentional and systematic recognition of mental health drivers of substance use initiation and escalation to substance use disorder and of substance use drivers of mental health challenges and progression to mental health disorders, particularly among young people. A targeted, non-systematic review of relevant literature illustrates that the interplay between mental health and substance use often is recognized only in hindsight by people in treatment - and by those who care for them, which may limit the provision of appropriate interventions and the prevention of co-occurring disorders. An integrated approach to prevention, early identification, and intervention for both substance use and mental health challenges in youth is grounded in research, practical, and cost-effective, yet its implementation continues to lag behind the evidence. This commentary highlights concrete opportunities for prevention professionals, educators, clinicians, and policymakers to advance earlier, more integrated, co-occurring competent care.