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Aas CF, Vold JH, Gjestad R, Skurtveit S, Lim AG, Gjerde KV, Løberg EM, Johansson KA, Fadnes LT. Substance use and symptoms of mental health disorders: a prospective cohort of patients with severe substance use disorders in Norway. Subst Abuse Treat Prev Policy 2021; 16:20. [PMID: 33639969 PMCID: PMC7912462 DOI: 10.1186/s13011-021-00354-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is high co-occurrence of substance use disorders (SUD) and mental health disorders. We aimed to assess impact of substance use patterns and sociodemographic factors on mental health distress using the ten-item Hopkins Symptom Checklist (SCL-10) over time. METHODS Nested prospective cohort study of 707 participants with severe SUD across nine opioid-agonist-therapy outpatient clinics and low-threshold municipality clinics in Norway, during 2017-2020. Descriptive statistics were derived at baseline and reported by means and standard deviation (SD). A linear mixed model analysis was used to assess the impact of substance use patterns and sociodemographic factors on SCL-10 sum score with beta coefficients with 95% confidence intervals (CI). RESULTS Mean (SD) SCL-10 score was 2.2 (0.8) at baseline with large variations across patients. We observed more symptoms of mental health disorders among people with frequent use of benzodiazepines (beta 3.6, CI:2.4;4.8), cannabis (1.3, CI:0.2;2.5), opioids (2.7, CI:1.1;4.2), and less symptoms among people using frequent stimulant use (- 2.7, CI:-4.1;-1.4) compared to no or less frequent use. Females (1.8, CI:0.7;3.0) and participants with debt worries (2.2, CI:1.1;3.3) and unstable living conditions (1.7, CI:0.0;3.3) had also higher burden of mental health symptoms. There were large individual variations in SCL-10 score from baseline to follow-up, but no consistent time trends indicating change over time for the whole group. 65% of the cohort had a mean score > 1.85, the standard reference score. CONCLUSIONS People with SUD have a considerable burden of mental health symptoms. We found no association between substance use patterns and change in mental health symptoms over time. This could suggest that the differences observed were indicating flattening of effects or self-medication to a larger degree than medication-related decline in mental health. This call for better individualized mental health assessment and patient care.
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Affiliation(s)
- Christer Frode Aas
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Jørn Henrik Vold
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Aaron Guanliang Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Else-Marie Løberg
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Aas CF, Vold JH, Skurtveit S, Lim AG, Ruths S, Islam K, Askildsen JE, Løberg EM, Fadnes LT, Johansson KA. Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:68. [PMID: 32883319 PMCID: PMC7469909 DOI: 10.1186/s13011-020-00309-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/25/2020] [Indexed: 01/26/2023]
Abstract
Background Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up. Methods We conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from “no problems” to “extreme problems”). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100). Results Mean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively. Conclusion The average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.
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Affiliation(s)
- Christer Frode Aas
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Jørn Henrik Vold
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sabine Ruths
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Kamrul Islam
- Department of Social Sciences, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Economics, University of Bergen, Bergen, Norway
| | | | - Else-Marie Løberg
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Clinical Psychology, Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Ganesh S, Kandasamy A, Sahayaraj US, Benegal V. Behavioral activation and behavioral inhibition sensitivities in patients with substance use disorders: A study from India. Indian J Psychiatry 2018; 60:346-350. [PMID: 30405263 PMCID: PMC6201657 DOI: 10.4103/psychiatry.indianjpsychiatry_323_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Addictive disorders are an epiphenomenon of underlying vulnerabilities. Research over the past decades into these vulnerabilities has distinguished internalizing and externalizing spectra as two distinct personality factors underlying substance use disorders (SUDs). In this study, we explore the behavioral activation and inhibition factors in patients with SUD. MATERIALS AND METHODS A total of 240 patients with SUD were recruited for the study. Behavioral inhibition system-behavioral activation/approach system (BIS-BAS) scale was used to assess the three domains of the behavioral activation, namely drive, fun seeking and reward responsiveness, and the behavioral inhibition as a single domain. BIS and BAS subscale total scores, inter-domain correlation, factor structure, and difference in the early-onset and late-onset SUD subgroup scores were calculated. RESULTS The drive, fun seeking, and reward responsiveness showed a moderate degree of correlation among each other ranging from 0.30 to 0.36. The behavioral inhibition subscale had a modest correlation r = 0.26 with the reward responsiveness subdomain of behavioral activation. The factor structure remained valid at two- and four-factor solutions apart from few items with inconsistent loading. The early-onset n = 209 (87.1%) and late-onset n = 31 (12.9%) SUD subgroup analysis showed a statistically significant difference in the mean scores of drive and fun-seeking subscales with P < 0.05. DISCUSSION AND CONCLUSIONS Behavioral activation and inhibition remain two valid personality factors in patients with SUDs. Patients with early onset of SUD have a significantly higher behavioral activation scores in the drive, and fun-seeking subfactors suggesting a higher externalizing tendency.
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Affiliation(s)
- Suhas Ganesh
- SNRGY, Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Arun Kandasamy
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ubahara S Sahayaraj
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2016; 36:527-539. [PMID: 27786426 DOI: 10.1111/dar.12448] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/25/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
ISSUES The aim of this paper was to conduct a systematic review of the prevalence of comorbid mental health conditions in people accessing treatment for substance use in Australia. APPROACH A systematic review identified studies meeting the following eligibility criteria: reporting original data published in English; sample presenting for substance use treatment in Australia; assessing the prevalence of mental health and substance use conditions and reporting the percentage of participants with co-occurring mental health and substance use conditions. A narrative analysis was conducted because of the heterogeneity of methods used to assess key outcome variables and small number of studies assessing particular mental health outcomes. The abstracts of 1173 records were screened, and 59 full articles were assessed for eligibility. Eighteen studies were included in the review. KEY FINDINGS Prevalence estimates of current mental disorders in substance use treatment clients varied (47 to 100%). Mood and anxiety disorders were particularly prevalent, with the prevalence of current depression ranging from 27 to 85% and current generalised anxiety disorder ranging from 1 to 75%. IMPLICATIONS The high prevalence of mood and anxiety disorders in substance use treatment settings indicates a need for clinicians to screen and assess for these disorders as part of routine clinical care, and be familiar with evidence-based management and treatment strategies. CONCLUSION Although further studies are required to determine the prevalence of the full range of mental health disorders in this population, these findings emphasise the high prevalence of comorbid mental disorders are among individuals accessing substance use treatment in Australia. [Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2017;36:527-539].
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Affiliation(s)
- Rosemary E F Kingston
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Christina Marel
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Katherine L Mills
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Smith RV, Young AM, Mullins UL, Havens JR. Individual and Network Correlates of Antisocial Personality Disorder Among Rural Nonmedical Prescription Opioid Users. J Rural Health 2016; 33:198-207. [PMID: 27171488 DOI: 10.1111/jrh.12184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Examination of the association of antisocial personality disorder (ASPD) with substance use and HIV risk behaviors within the social networks of rural people who use drugs. METHODS Interviewer-administered questionnaires were used to assess substance use, HIV risk behavior, and social network characteristics of drug users (n = 503) living in rural Appalachia. The MINI International Psychiatric Interview was used to determine whether participants met DSM-IV criteria for ASPD and Axis-I psychological comorbidities (eg, major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder). Participants were also tested for herpes simplex 2, hepatitis C, and HIV. Multivariate generalized linear mixed modeling was used to determine the association between ASPD and risk behaviors, substance use, and social network characteristics. RESULTS Approximately one-third (31%) of participants met DSM-IV criteria for ASPD. In multivariate analysis, distrust and conflict within an individual's social networks, as well as past 30-day use of heroin and crack, male gender, younger age, lesser education, heterosexual orientation, and comorbid MDD were associated with meeting diagnostic criteria for ASPD. CONCLUSIONS Participants meeting criteria for ASPD were more likely to report recent heroin and crack use, which are far less common drugs of abuse in this population in which the predominant drug of abuse is prescription opioids. Greater discord within relationships was also identified among those with ASPD symptomatology. Given the elevated risk for blood-borne infection (eg, HIV) and other negative social and health consequences conferred by this high-risk subgroup, exploration of tailored network-based interventions with mental health assessment is recommended.
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Affiliation(s)
- Rachel V Smith
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky.,Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky
| | - April M Young
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Ursula L Mullins
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
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Harder VS, Ayer LA, Rose GL, Naylor MR, Helzer JE. Alcohol, moods and male-female differences: daily interactive voice response over 6 months. Alcohol Alcohol 2013; 49:60-5. [PMID: 23847021 DOI: 10.1093/alcalc/agt069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS The goal of this study was to better understand the predictive relationship in both directions between negative (anger, sadness) and positive (happiness) moods and alcohol consumption using daily process data among heavy drinkers. METHODS Longitudinal daily reports of moods, alcohol use and other covariates such as level of stress were assessed over 180 days using interactive voice response telephone technology. Participants were heavy drinkers (majority meeting criteria for alcohol dependence at baseline) recruited through their primary care provider. The sample included 246 (166 men, 80 women) mostly Caucasian adults. Longitudinal statistical models were used to explore the varying associations between number of alcoholic drinks and mood scores the next day and vice versa with gender as a moderator. RESULTS Increased alcohol use significantly predicted decreased happiness the next day (P < 0.005), more strongly for females than males. Increased anger predicted higher average alcohol use the next day for males only (P < 0.005). CONCLUSION This daily process study challenges the notion that alcohol use enhances positive mood for both males and females. Our findings also suggest a strong association between anger and alcohol use that is specific to males. Thus, discussions about the effects of drinking on one's feeling of happiness may be beneficial for males and females as well as anger interventions may be especially beneficial for heavy-drinking males.
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Affiliation(s)
- Valerie S Harder
- Corresponding author: Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA.
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Links PS, Eynan R. The relationship between personality disorders and Axis I psychopathology: deconstructing comorbidity. Annu Rev Clin Psychol 2012; 9:529-54. [PMID: 23157449 DOI: 10.1146/annurev-clinpsy-050212-185624] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this review is (a) to study and systematically review the recent literature examining the co-occurrence and relationships between Axis I psychiatric disorders and Axis II personality disorders, specifically the six originally proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, and (b) to consider the clinical utility of the current Axis I and Axis II approach in the DSM-IV-TR and apply findings to state a position on the issue of collapsing together Axis I and Axis II. Community surveys or prospective cohort studies were reviewed as a priority. Our review indicates that the associations between clinical disorders and personality disorders clearly varied within each disorder and across the six personality disorders. Our understanding has advanced, particularly related to the clinical utility of comorbidity, and there may be sufficient evidence to support moving borderline personality disorder to Axis I. However, it seems premature to conclude that comorbidity is best conceptualized by having all disorders in a single category or by deleting disorders so that comorbidity is reduced. Our review suggests some priorities for future research into comorbidity, such as including personality disorders in future multivariate comorbidity models.
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Affiliation(s)
- Paul S Links
- Department of Psychiatry, The University of Western Ontario, London, ON N6A 5W9 Canada.
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Mills KL, Deady M, Teesson M, Sannibale C, Proudfoot H, Burns L, Mattick R. Guidelines on the management of co-occurring mental health conditions in alcohol and other drug treatment settings: how useful are they? ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17523281.2011.631502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Richards JM, Stipelman BA, Bornovalova MA, Daughters SB, Sinha R, Lejuez CW. Biological mechanisms underlying the relationship between stress and smoking: state of the science and directions for future work. Biol Psychol 2011; 88:1-12. [PMID: 21741435 DOI: 10.1016/j.biopsycho.2011.06.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 03/07/2011] [Accepted: 06/22/2011] [Indexed: 01/01/2023]
Abstract
Theories of addiction implicate stress as a crucial mechanism underlying initiation, maintenance, and relapse to cigarette smoking. Examinations of the biological stress systems, including functioning of the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), have provided additional insights into the relationship between stress and smoking. To date, convergent data suggests that chronic cigarette smoking is associated with alterations in HPA and ANS functioning; however, less is known about the role of HPA and ANS functioning in smoking initiation and relapse following cessation. In order to organize existing findings and stimulate future research, the current paper summarizes the available literature on the roles of HPA axis and ANS functioning in the relationship between stress and cigarette smoking, highlights limitations within the existing literature, and suggests directions for future research to address unanswered questions in the extant literature on the biological mechanisms underlying the relationship between stress and smoking.
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Affiliation(s)
- Jessica M Richards
- Department of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, 2103 Cole Activities Building, College Park, MD 20742, USA.
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Iverach L, Jones M, O'Brian S, Block S, Lincoln M, Harrison E, Hewat S, Menzies RG, Packman A, Onslow M. Mood and substance use disorders among adults seeking speech treatment for stuttering. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:1178-1190. [PMID: 20643799 DOI: 10.1044/1092-4388(2010/09-0166)] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Stuttering has been associated with a range of anxiety disorders, including social phobia. In the general community, anxiety disorders are frequently associated with increased rates of mood and substance use disorders. Therefore, in the present study, the authors sought to determine the rate of mood and substance use disorders among adults who stutter. METHOD The study employed a matched case-control design. Participants included 92 adults seeking treatment for stuttering and 920 age- and gender-matched controls. Mental health assessments were conducted via a computerized psychiatric diagnostic interview. Conditional logistic regression models were used to estimate odds ratios for the prevalence of mood and substance use disorders in both groups. RESULTS When compared with matched controls, adults seeking treatment for stuttering had twofold increased odds of meeting criteria for a 12-month diagnosis of any mood disorder but were not found to report significantly higher lifetime prevalence rates for any substance use disorder. CONCLUSIONS Although adults who stutter in the present study were characterized by significantly higher rates of mood disorders than matched controls, they do not appear to self-medicate with substances such as alcohol. Results are discussed in terms of treatment implications and possible reasons why adults who stutter may avoid alcohol.
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Affiliation(s)
- Lisa Iverach
- Australian Stuttering Research Centre, Faculty of Health Sciences, The University of Sydney, Lidcombe NSW 2141 Australia
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Bohnert ASB, Miech RA. Changes in the association of drug use with depressive disorders in recent decades: the case of cocaine. Subst Use Misuse 2010; 45:1452-62. [PMID: 20438341 PMCID: PMC4109050 DOI: 10.3109/10826081003777550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The social meaning of cocaine changed during the 1980 s and 1990s. The present study examined changes in the psychological profile of cocaine users. We used Baltimore data of the National Institute of Mental Health-funded Epidemiologic Catchment Area study during 1981 (n = 3,006; 60% female) and 1993-1994 (n = 1,679; 52% female). The diagnostic interview schedule measured cocaine use and depressive disorders (dysthymia, major depressive disorder). The odds ratio of cocaine use for those with depression was 1.28 and 3.53 in 1981 and 1993-1994 respectively. The results suggest a historical period effect in the association of cocaine use and depression. Limitations and implications are discussed.
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Affiliation(s)
- Amy S B Bohnert
- VA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, Michigan 48105, USA.
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Erfan S, Hashim AH, Shaheen M, Sabry N. Effect of Comorbid Depression on Substance Use Disorders. Subst Abus 2010; 31:162-9. [DOI: 10.1080/08897077.2010.495311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ahmadi J, Pridmore S, Alimi A, Cheraghi A, Arad A, Parsaeyan H, Mohagheghzadeh MS, Kianpour M. Epidemiology of Opium Use in the General Population. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:483-91. [PMID: 17613976 DOI: 10.1080/00952990701301293] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS To evaluate the prevalence of opium use in the Fars province, Iran. METHOD A household survey of a representative sample of 3840 people aged 15 years and over. Researchers assessed opium use disorders using a semistructured interview and the Research Version of the Structured Clinical Interview for DSM-IV Axis I, during 2003. RESULTS Mean age of the sample was 33.9 years (SD = 15). Of the participants, 689 (17.9%) admitted use of opium one or more times during their lives (28.4% of men and 7.4% of women). Three hundred thirty-nine (8.8%) were current opium users (14.3% of men and 3.3% of women). Opium ever-use and current-use were not functions of marital status. Both opium ever-use and current-use are found across the educational, occupational and income spectrums. Both peaked in the 40-49 age category, suggesting that first use usually occurs before 40 years of age and that current use extends across all age groups. CONCLUSION Men are at greater risk than women. This report provides useful information for health planning. Prevention programs should focus on those under 40 years of age, and treatment is required across all age groups.
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Affiliation(s)
- Jamshid Ahmadi
- Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
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Flensborg-Madsen T, Mortensen EL, Knop J, Becker U, Sher L, Grønbaek M. Comorbidity and temporal ordering of alcohol use disorders and other psychiatric disorders: results from a Danish register-based study. Compr Psychiatry 2009; 50:307-14. [PMID: 19486728 DOI: 10.1016/j.comppsych.2008.09.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 09/03/2008] [Accepted: 09/11/2008] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Understanding the comorbidity of alcohol use disorders (AUD) and other psychiatric disorders may have important implications for treatment and preventive interventions. However, information on the epidemiology of this comorbidity is lacking. The objective of this study was to present results on lifetime psychiatric comorbidity of AUD in a large Danish community population. METHODS A prospective cohort study was used, comprising 3 updated measures of sets of lifestyle covariates and 26 years of follow-up data on 18,146 individuals from the Copenhagen City Heart Study, Denmark. The study population was linked to national Danish hospital registers and a greater Copenhagen alcohol unit treatment register to detect registrations with AUD and other psychiatric disorders. RESULTS Of the individuals invited to the study, 7.6% were registered with AUD, and among these, 50.3% had a lifetime comorbid psychiatric disorder. Personality disorders were the most common comorbid disorders (24%) together with mood disorders (16.8%) and drug abuse (16.6%). The risk of developing a psychiatric disorder in individuals who were already registered with AUD was larger than the risk of developing AUD in individuals who were already registered with another psychiatric disorder; these differences in risk were especially noticeable for anxiety disorders, personality disorders, and drug abuse. CONCLUSIONS AUD is frequently comorbid with other psychiatric disorders, and it is likely that AUD is both an etiologic factor in other mental disorders and a consequence of mental disease. However, in interpreting these complex and perhaps circular causal links, it is important to consider that AUD is registered before a comorbid psychiatric diagnosis more often than the reverse temporal order.
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Affiliation(s)
- Trine Flensborg-Madsen
- Centre of Alcohol Research, National Institute of Public health, University of Southern Denmark, Copenhagen K, Denmark.
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WEAVER TIM, HICKMAN MATTHEW, RUTTER DEBORAH, WARD JENNI, STIMSON GERRY, RENTON ADRIAN. The prevalence and management of co-morbid substance misuse and mental illness: results of a screening survey in substance misuse and mental health treatment populations. Drug Alcohol Rev 2009. [DOI: 10.1080/09595230120092724] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shrem MT, Halkitis PN. Methamphetamine abuse in the United States: contextual, psychological and sociological considerations. J Health Psychol 2008; 13:669-79. [PMID: 18519440 DOI: 10.1177/1359105307082461] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Emerging behavioral research on methamphetamine suggests a growing public health concern no longer limited to specific regions of the United States. Given that current evidence-based treatments for addressing methamphetamine addiction have had limited success, there remains a need to further examine the efficacy of these approaches. Here, we synthesize the psychological research literature regarding the prevalence and correlates of methamphetamine use across all segments of the US population, analyze the role that use of the drug plays in relation to sexual risk-taking and consider implications for therapeutic interventions to address this drug addiction.
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Treloar C, Holt M. Complex vulnerabilities as barriers to treatment for illicit drug users with high prevalence mental health co-morbidities. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280701759755] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cole M, Sacks T. When dual diagnosis means no diagnosis: co-occurring mental illness and problematic drug use in clients of alcohol and drug services in eastern metropolitan Melbourne. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280701747289] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lukassen J, Beaudet MP. Alcohol dependence and depression among heavy drinkers in Canada. Soc Sci Med 2005; 61:1658-67. [PMID: 15869834 DOI: 10.1016/j.socscimed.2005.03.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 03/03/2005] [Indexed: 02/07/2023]
Abstract
This article describes the prevalence of heavy drinking among the Canadian population and the prevalence of alcohol dependence among heavy drinkers aged 18 or older. It also examines the association of depression to alcohol dependence among the latter group and the correlates of depression and alcohol dependence comorbidity. The data are from a national representative sample of the Canadian population in 2000/01. One in five current drinkers aged 18 or older was classified as a regular heavy drinker. This constituted a significant increase of approximately 2% in the prevalence of heavy drinking from 1996/97 to 2000/01 in Canada (p<0.001). Although men were more likely to be regular heavy drinkers (29.0%) than women (11.1%), male and female heavy drinkers were about equally as likely to be classified as alcohol dependent (11.6% and 11.1%, respectively). While the prevalence of alcohol dependence among men has remained stable, it has decreased by almost 4% among women (p<0.05). Among persons who have experienced a depressive episode in the year prior to their 2000/01 interview, the prevalence of alcohol dependence was estimated at 32.3% while it was 9.5% for persons without depression. When several indicators believed to be risk factors for alcohol dependence including personal characteristics, psychosocial factors, lifestyle behaviours and physical health were included in the logistic regression models, the marked difference in alcohol dependence among depressed and non-depressed heavy drinkers remained. The former had 3.6 times the odds of being classified as alcohol dependent compared to the latter (CI=2.9, 4.3). When the same personal, psychosocial, lifestyle and physical health measures were used to explain comorbidity of depression and alcohol dependence, perceived stress was the only factor that was consistently associated with comorbidity among both men and women.
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Affiliation(s)
- Jennifer Lukassen
- Canadian Centre for Justice Statistics, Statistics Canada, Ottawa, Ont., Canada K1A 0T6
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Kay-Lambkin FJ, Baker AL, Lewin TJ. The 'co-morbidity roundabout': a framework to guide assessment and intervention strategies and engineer change among people with co-morbid problems. Drug Alcohol Rev 2005; 23:407-23. [PMID: 15763746 DOI: 10.1080/09595230412331324536] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper describes the nature and consequences of co-morbidity, as applied to co-occurring mental health and alcohol/other drug (AOD) use problems. The 'co-morbidity roundabout' is introduced as a useful metaphor for conceptualizing the current experiences of people with co-occurring mental health and AOD use problems. In order to successfully negotiate the 'roundabout', the 'drivers' (people with co-morbid mental health and AOD use problems) must consider a range of internal and external conditions (knowledge about services, support from family, friends, health providers, motivation to change, etc.), account for their vehicle's characteristics (other conditions and demands, including social/legal/financial issues), keep their travel itinerary in mind (plans for change including treatment) and navigate through the many detours and dead-ends that they may confront (eligibility for services, accessibility of treatments, etc.). Co-morbidity is a major contributing factor in 'drivers' failing to successfully negotiate, or even becoming 'stuck' on, the 'roundabout'. A summary of relevant treatment research is also presented, including descriptions of brief interventions and more intensive treatment approaches. Finally, the 'co-morbidity roundabout' metaphor is expanded to assist clinicians to translate the findings from this treatment research into clinical practice. Further suggestions are made for improved navigation through and exit from the 'roundabout', including recommendations for the use of a stepped-care approach to the assessment and treatment of clients with co-morbid mental health and AOD use problems.
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Abstract
AIMS The goal of this study was to assess the characteristics and treatment success rate (outcome) among Iranian opioid addicts. MEASUREMENTS The data were gathered from 437 opioid addicts (using DSM-IV criteria) seeking treatment in 1998. FINDINGS Their mean age was 35.6yr., and 72.8% were married. Of these subjects 34.1% listed secondary school, 25.9% primary school, and 23.6% listed high school as their level of education. Of these addicts 26.1% were unemployed, 24.5% miscellaneous workers, and 22.4% were drivers. About 49.4% reported opium, 31.8% heroin, 12.4% cooked dross, and 6.4% reported other opioids as the substance currently used. Of the 437 addicts, the majority (54%) did not complete detoxification phase, 35% had experienced abstinence at least for three months, and 11% relapsed prior to completion of three months of abstinence. The relation was statistically significant between outcome and type of used opioid and also between dose of used opioid and outcome. CONCLUSIONS The most commonly used opioids were opium, heroin, and cooked dross. During recent years, some demographic characteristics of the Iranian addicts have changed. Cultural attitudes toward drug use are quite likely to affect types and amount of use and also outcome of treatment. These findings can be considered when planning preventive and therapeutic programs.
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Treatment Success Rate Among Iranian Opioid Dependents. ADDICTIVE DISORDERS & THEIR TREATMENT 2002. [DOI: 10.1097/00132576-200209000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shakeshaft AP, Bowman JA, Sanson-Fisher RW. Community-based drug and alcohol counselling: who attends and why? Drug Alcohol Rev 2002; 21:153-62. [PMID: 12188994 DOI: 10.1080/09595230220139055] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In order to develop and tailor treatment approaches in drug and alcohol counselling accurately, it is necessary to identify characteristics of the relevant client group. This study describes the demographic and substance use characteristics of 1212 community-based drug and alcohol counselling clients from a regional Area Health Service in NSW, Australia. Findings identify these clients as predominantly young, unmarried, unemployed males with low incomes. Alcohol use is characterized by binge consumption (83%) and alcohol-related problems (94%). A substantial proportion use tobacco (74%), cannabis (61%), opiates (15%) and amphetamines (22%). Of those using illicit drugs other than marijuana, the incidence of sharing syringes (10%) is of concern. These data differ from those reported by both general practice patients in the same geographical area, as a treatment-seeking population in an alternative community-based setting, and a general community sample. It is argued that there is a need for interventions delivered in community-based drug and alcohol settings that are aimed specifically at polydrug use, attempt to minimize drug-related harm and are relevant to those of lower socio-economic status.
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Caldwell TM, Rodgers B, Jorm AF, Christensen H, Jacomb PA, Korten AE, Lynskey MT. Patterns of association between alcohol consumption and symptoms of depression and anxiety in young adults. Addiction 2002; 97:583-94. [PMID: 12033659 DOI: 10.1046/j.1360-0443.2002.00092.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS Recent epidemiological findings indicate that non-drinkers as well as hazardous/harmful drinkers experience higher levels of distress than moderate drinkers. Little is known about the age at which this develops. This paper examines levels of affect, depression and anxiety over the full range of alcohol consumption in young adults. DESIGN Cross-sectional findings from the first wave of a prospective, longitudinal study are presented. PARTICIPANTS The general population sample comprised of 2404 young adults (aged 20-24 years). living in the Canberra region. Measures included: the Goldberg Depression and Anxiety scales, the Positive and Negative Affect Schedule, and the Alcohol Use Disorders Identification Test. FINDINGS For men, both non/occasional and hazardous/harmful consumption were associated with lower levels of positive affect and higher levels of anxiety and depression. The higher levels of distress evident for male abstainers were related to being less extroverted and less healthy and not to past hazardous/harmful alcohol consumption, current tobacco or marijuana use. For women, only hazardous/harmful drinkers were found to have higher levels of depression and negative affect. Hazardous/harmful consumption was related to using marijuana, tobacco and recent stressful events in both men and women. CONCLUSIONS Higher levels of distress are already evident in male non-drinkers in early adulthood. The findings counter theories that distress in non-drinkers is due to past hazardous/harmful alcohol consumption, marijuana or tobacco use, or characteristics in common with hazardous/harmful drinkers. Alcohol use disorders and mental health problems are pertinent issues for young adults. However, more understanding is needed of the experiences of non-drinkers in an alcohol consuming culture.
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Affiliation(s)
- T M Caldwell
- Centre for Mental Health Research, Australian National University, Canberra, ACT.
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Colón HM, Robles RR, Sahai H. The validity of drug use responses in a household survey in Puerto Rico: comparison of survey responses of cocaine and heroin use with hair tests. Int J Epidemiol 2001; 30:1042-9. [PMID: 11689520 DOI: 10.1093/ije/30.5.1042] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite the widespread use of household surveys to assess the epidemiology of illicit drug use and abuse, there is very little information about the willingness of respondents to disclose their use of drugs in household studies outside the US. METHODS As part of a household study of substance use disorders in Puerto Rico, we collected hair specimens from a sub-sample of 114 respondents. Hair specimens were screened using a radio immunoassay. Screened-positive specimens were confirmed using gas chromatography/mass spectrometry. RESULTS Using hair-test results as the standard, specificity of self-reports was 98% or higher for both drugs. The sensitivity of all self-reports was low, although lifetime use reports had somewhat higher sensitivities. The sensitivity of self-reports of recent cocaine use was particularly low, 7.1%. The sensitivity of heroin use reports was somewhat higher, 33.3% for recent use and 66.7% for lifetime use. The estimate of recent cocaine use based on hair tests was 13.7 times the estimate generated from interview reports. For heroin use, the test-based estimate was 2.9 times the rate generated from the interview reports. A shift from the cut-off level of 0.2 ng/mg to 0.5 ng/mg had only a marginal improvement on validity, with sensitivity increasing from 7.1% to 11.1% for self-reported recent cocaine use. CONCLUSIONS The results suggest that drug users, for the most part, are not willing to disclose their use of drugs in household surveys in Puerto Rico. Methods to increase the willingness of respondents to disclose their use of drugs are needed.
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Affiliation(s)
- H M Colón
- Center for Addiction Studies, School of Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico.
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Callaly T, Trauer T, Munro L, Whelan G. Prevalence of psychiatric disorder in a methadone maintenance population. Aust N Z J Psychiatry 2001; 35:601-5. [PMID: 11551274 DOI: 10.1080/0004867010060507] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to examine the prevalence of psychiatric disorders in a group of patients who had recently entered a methadone maintenance programme. METHOD A total of 62 patients were interviewed using the Composite International Diagnostic Interview (CIDI) within 6 months of commencing methadone maintenance. The CIDI was used to establish symptoms of psychiatric illness at interview and in the 12 months prior. RESULTS In the 12 months prior to interview, 76% of the sample fulfilled ICD-10 criteria for a psychiatric disorder other than substance-use disorder. Over half of the group interviewed fulfilled ICD-10 criteria for an affective disorder, two-thirds fulfilled criteria for an anxiety disorder and just under half fulfilled diagnostic criteria for both an affective disorder and an anxiety disorder in the 12 months prior to interview. At the time of interview, 19% fulfilled ICD-10 diagnostic criteria for a moderate or severe affective disorder. Seventy per cent of males and 89% of females interviewed had a comorbid psychiatric illness. In 71% of the group who had a comorbid psychiatric illness, the onset of psychiatric symptomatology was reported to predate the use of heroin. CONCLUSION The prevalence of psychiatric disorder is up to 10 times higher in the population on methadone maintenance than in the general population and is two to three times higher than that found in community surveys of those with a substance-use disorder. These results are consistent with earlier findings and have implications for service planning.
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Affiliation(s)
- T Callaly
- Barwon Health: Community and Mental Health, Swanston Centre, Corner Swanston and Myers Streets, Geelong, Victoria 3220, Australia.
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Bovasso G. The long-term treatment outcomes of depression and anxiety comorbid with substance abuse. J Behav Health Serv Res 2001; 28:42-57. [PMID: 11329998 DOI: 10.1007/bf02287233] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The impact of the comorbidity of psychiatric disorder and substance abuse on treatment outcomes was estimated using data from a longitudinal survey of 1,920 individuals who were followed nearly 15 years. Individuals with anxiety or depression symptoms at baseline generally experienced increased distress at follow-up; those who received mental health treatment experienced decreased distress at follow-up. Individuals with substance abuse/dependence symptoms who received treatment at baseline had a higher risk of follow-up disability; treated individuals with substance abuse who had comorbid anxiety and depression symptoms at baseline were at lower risk of disability at follow-up. Individuals with anxiety and depression symptoms at baseline had a higher incidence of chronic illness during follow-up; those who received treatment or had substance abuse symptoms did not. The results may improve understanding of the degree to which treatment of a primary disorder may prevent the incidence or reduce the prevalence of a secondary comorbid disorder.
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Affiliation(s)
- G Bovasso
- Treatment Research Center, Philadelphia, USA.
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Teesson M, Hall W, Lynskey M, Degenhardt L. Alcohol- and drug-use disorders in Australia: implications of the National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2000; 34:206-13. [PMID: 10789525 DOI: 10.1080/j.1440-1614.2000.00715.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study reports the prevalence and correlates of ICD-10 alcohol- and drug-use disorders in the National Survey of Mental Health and Wellbeing (NSMHWB) and discusses their implications for treatment. METHOD The NSMHWB was a nationally representative household survey of 10641 Australian adults that assessed participants for symptoms of the most prevalent ICD-10 and DSM-IV mental disorders, including alcohol- and drug-use disorders. RESULTS In the past 12 months 6.5% of Australian adults met criteria for an ICD-10 alcohol-use disorder and 2.2% had another ICD-10 drug-use disorder. Men were at higher risk than women of developing alcohol- and drug-use disorders and the prevalence of both disorders decreased with increasing age. There were high rates of comorbidity between alcohol- and other drug-use disorders and mental disorders and low rates of treatment seeking. CONCLUSIONS Alcohol-use disorders are a major mental health and public health issue in Australia. Drug-use disorders are less common than alcohol-use disorders, but still affect a substantial minority of Australian adults. Treatment seeking among persons with alcohol- and other drug-use disorders is low. A range of public health strategies (including improved specialist treatment services) are needed to reduce the prevalence of these disorders.
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Affiliation(s)
- M Teesson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Ross HE, Lin E, Cunningham J. Mental health service use: a comparison of treated and untreated individuals with substance use disorders in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1999; 44:570-7. [PMID: 10497699 DOI: 10.1177/070674379904400605] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the prevalence of and factors associated with mental health service use in the past year among respondents with an alcohol or other drug use disorder in a general population survey of Ontario adults. METHOD Data were obtained from the 1990/1991 Mental Health Supplement to the Ontario Health Survey, which used the University of Michigan Composite International Diagnostic Interview (UM-CIDI). The current study examined 436 respondents aged 15-64 years who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for a substance use disorder in the past year. The 82 respondents who used services for a mental health or substance abuse problem during the past year were compared with the 354 nonusers. Illness severity, disability, health beliefs and attitudes, and predisposing or enabling factors were examined in bivariate and logistic regression analyses. RESULTS Twenty-two percent of respondents used services in the past year. Having concurrent disorders (comorbidity), troubled relationships with others, and dysfunction in main activity, feeling comfortable talking to a professional about mental health problems, being older and an urban resident, not working or being in school, and having a biological parent with an alcohol or drug problem were all associated with service use. CONCLUSIONS The results suggest that individual determinants, such as severity of illness, disability, attitudes, and predisposing or enabling variables, all have a role in predicting service use among individuals in the general population who suffer from alcohol and other drug disorders.
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Affiliation(s)
- H E Ross
- Department of Psychiatry, University of Toronto, Ontario.
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Farrell M, Howes S, Taylor C, Lewis G, Jenkins R, Bebbington P, Jarvis M, Brugha T, Gill B, Meltzer H. Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey. Addict Behav 1998; 23:909-18. [PMID: 9801725 DOI: 10.1016/s0306-4603(98)00075-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
There have been a number of national surveys of psychiatric morbidity which have included questions on drugs, alcohol and tobacco. These surveys have helped delineate the overlap between substance use and dependence and other psychological morbidity. There is a strong association reported between high substance consumption and other measures of psychological problems. This article provides an overview of a national household survey, a survey of institutional residents with psychiatric disorders and a national survey of a homeless population. All three surveys used comprehensive and complex sampling strategies and lay interviewers to conduct structured diagnostic interviews. The household survey included over 10,000 households, the institutional survey interviewed 755 individuals and the homeless survey of hostels, night-shelters, day centres and private-sector leased accommodation interviewed 1,061 individuals. This overview looks at patterns of nicotine, alcohol and other drug use in the different samples and examines interactions with other psychiatric morbidity. The survey reports that substance-related disorders are some of the commonest disorders in the community, with 5% of the household sample alcohol dependent, 7% alcohol dependent in the institutional sample and over 21% in the homeless sample recorded as alcohol dependent. Tobacco, alcohol and other drug use and dependence were dramatically higher in the homeless sample than in either of the other two samples. Substance use was significantly associated with higher rates of psychological morbidity as measured by the Clinical Interview Schedule Revised. Future service planning needs to take account of the striking disparity of prevalence of psychiatric disorders in different subsections of the population.
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Affiliation(s)
- M Farrell
- National Addiction Centre, Institute of Psychiatry, London, UK.
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Abstract
Previous research has highlighted the high prevalence (30-60%) of comorbid anxiety and mood disorders in clients with substance misuse disorders and, equivalently, a third of those with affective disorder report a history of substance use disorder (Kessler et al., 1994; Regier et al., 1990; Robins & Regier, 1991). This article reviews the management of such cases and identifies key issues in the assessment process, as well as potential avenues for treatment. Other articles have highlighted the increased service utilisation and the cost of care and treatment of comorbidity. This article will primarily focus on the management of individual cases and will briefly refer to issues of service organisation. Although antidepressant or anxiolytic pharmacotherapy may have a role in the treatment of severe disorders, the benefits of using these medications must be balanced against the increased risk of side-effects or adverse reactions in individuals who continue to engage in substance misuse or who have medical complications associated with drug or alcohol dependency. Effective psychosocial approaches largely focus on brief, empirically tested manualised therapies such as cognitive therapy (Carroll, 1998a). However, modifications are required to such approaches to ensure that the interventions are tailored to the needs of clients exhibiting comorbidity. The data available demonstrate some evidence for the benefits of structured psychological approaches, but more sophisticated randomized controlled trials are required to evaluate the efficacy of both psychological and pharmacological approaches.
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Affiliation(s)
- J Scott
- University Department of Psychiatry, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
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Abstract
This paper reviews recent literature on the prevalence of alcohol dependence and affective disorders (major depression, dysthymia), the comorbidity of these conditions and the effects of comorbid affective disorders on the outcome of treatment for alcohol dependence. Alcohol dependence and affective disorders co-occur at significantly higher rates than would be expected by chance within the general population. This comorbidity is further elevated in samples of people seeking treatment for alcohol dependence, suggesting that the co-occurrence of affective disorders may be an important determinant of treatment seeking. The results of a number of recent placebo-controlled studies have suggested that pharmacological treatment with anti-depressants may enhance the efficacy of treatment for alcohol dependence in individuals with comorbid affective disorders.
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Affiliation(s)
- M T Lynskey
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVE The aim of this paper is to critically review the literature on major mental illness and problematic substance use in order to provide clinicians and policy-makers with evidence to support proposed directions for management of the above. METHOD The available literature was accessed using computerised databases and manual searching. RESULTS The predominantly North American-based literature is largely descriptive. Those studies which attempt empirical evaluation are limited by methodological weaknesses which include small sample sizes, short follow-up periods, inadequate measurement of substance use, lack of experimental design, and treatment drift over time. However, there is consensus among most studies regarding prevalence rates and treatment. CONCLUSIONS Problematic substance use is the most common comorbid condition among people with a major mental illness and is associated with poorer patient outcomes. There is evidence to suggest that the integration of mental health and drug and alcohol services will result in improved detection, assessment and management of comorbidity. Integration refers to the provision of comprehensive services by a single service with staff who are competent in both mental health and drug and alcohol skills. A tolerant, non-confrontational approach to substance use is most appropriate for people with a major mental illness. Treatment programs need to recognise the longitudinal nature of substance abuse and dependence. More research needs to be conducted in this field in order to establish guidelines for effective management.
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Affiliation(s)
- N Siegfried
- Psychosis and Substance Use Project, Central Sydney Area Health Service, Rozelle Hospital, New South Wales, Australia
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