Behavioral Matters: A Risky Age—Mental Health and Substance Use Disorders Among Young Adults

DMEC Staff@Work, Resources

Recently mental health and substance use disorders among young adults, ages 18 to 25, are front-and-center in the national conversation. Many mental illnesses—depression, bipolar disorder, schizophrenia, eating disorders, and substance use—first emerge in the teenage and young adult years.

Did You Know?

  • 75% of mental health and substance use disorders start prior to age 24.1
  • Young adults have the highest prevalence of alcohol and illicit drug use.2
  • Since 2011, six to seven million 19 – 25 year-olds joined their parents’ health plans as allowed by a provision of the Patient Protection and Affordable Care Act; since then, health plans have seen a 23% increase in costs for substance use disorder treatment.3

How do parents, teachers, peers and employers get young adults the help they need? One way is to intervene as soon as possible, because age is a significant predictor of substance use and recovery. Individuals initiating substance use at younger ages are typically at higher risk for substance disorders and longer pathways to recovery. Young people who have a stable home environment, including a strong relationship with a healthy adult, positive self-esteem and positive peer relationships, outside interests and success in school are less likely to engage in substance use.4

For a young adult, there are high social and economic costs related to having a mental health and substance use disorder. They have difficulty with friends, school, work, and with their families. Also, many disorders can develop into even more disabling conditions later in life. Therefore, social support is essential for treatment, but also for prevention of disorders with severe consequences. Psychotherapy and treatment are other critical components to mitigate the consequences of their disorder. The evidence supporting the effectiveness of substance use treatment is quite compelling. Research suggests that individuals who participate in some form of substance use treatment are more likely to be in remission and less likely to have relapsed three years after treatment completion.2

So what does this mean? Early identification, intervention and timely treatment can prevent or reduce the impact of mental health and substance use by young adults. These strategies help to decrease the overall burden on families, workplaces and the health care system. While these strategies place a short-term burden on employers—to provide health coverage for young adult dependents, employee assistance programs, and FMLA leave for parents to care for adult children meeting the disability definition—they help employees support their children during these difficult times.


  1. Kessler R, P Berglund, O Demler, R Jin, K Merikangas, E Walters. Lifetime Prevalence And Age-of-Onset Distributions of DSM-IV Disorders In The National Comorbidity Survey Replication. Arch Gen Psychiatry. 62:593 – 602. 2005.
  2. Recovery. Recovery Research Institute.
  3. Collins S, R Robertson, T Garber, M Doty. Young, Uninsured, And In Debt: Why Young Adults Lack Health Insurance And How The Affordable Care Act Is Helping. The Commonwealth Fund. 1 – 23. 2012.
  4. The 2010 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department Of Health And Human Services. Substance Abuse And Mental Health Services Administration. 63 – 67. 2011.

By Douglas A. Nemecek, MD, MBA, Chief Medical Officer, Cigna Behavioral Health. This article first appeared in the May 2014 issue of @Work magazine.

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