Addication session 4 – Comorbidity and behavioural
addictions:
Literature:
- 4.1: Comorbidity
o Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin,
F. K. (1990). Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse.
The journal of the American Medical Associaton, 264(19), 2511–2518.
doi:10.1001/jama.1990.03450190043026
o Horsfall, J., Cleary, M., Hunt, G. E., & Walter, G. (2009). Psychosocial Treatments for
People with Co-occurring Severe Mental Illnesses and Substance Use Disorders (Dual
Diagnosis): A Review of Empirical Evidence. Harvard Review of Psychiatry, 17(1), 24–
34. doi:10.1080/10673220902724599
- 4.2: Internet, seks, and food
o Grant, J.E., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to
Behavioral Addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–
241. doi:10.3109/00952990.2010.491884
o Ziauddeen, H., & Fletcher, P. C. (2012). Is food addiction a valid and useful concept?.
Obesity Reviews, 14(1), 19–28. doi:10.1111/j.1467-789X.2012.01046.x
o Yau, Y. H. C., & Potenza, M. N.,. (2015). Gambling Disorder and Other Behavioral
Addictions. Harvard Review of Psychiatry, 23(2), 134–146.
doi:10.1097/HRP.0000000000000051
o Kuss, D. (2013). Internet gaming addiction: current perspectives. Psychology
Research and Behavior Management, 6, 125–137. doi:10.2147/PRBM.S39476
- 4.3: Addiction as part of an externalizing disorders
o Galanter, M., Kleber, H. D., & Brady, K. T. (Eds.). (2015). Textbook of substance abuse
treatment. Arlington: American Psychiatric Publishing. Chapter 52 Forensic Addiction
Psychiatry
o Krueger, R. F., & South, S. C. (2009). Externalizing disorders: Cluster 5 of the
proposed meta-structure for DSM-V and ICD-11. Psychological medicine, 39(12),
2061–2070. doi:10.1017/S0033291709990328
Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990).
Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse. The journal of the American
Medical Associaton, 264(19), 2511–2518. doi:10.1001/jama.1990.03450190043026
Abstract:
- Estimated US population lifetime prevalence: 22.5% for any non-substance abuse mental
disorder, 13.5% alcohol dependence-abuse, 6.1% other drug dependence-abuse
- When having a mental disorder, there was 29% for developing an addictive disorder
o 22% for alcohol, 15% for any other disorder
- Substance disorder is 7 times greater chance of getting another addiction disorder
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, - Alcohol disorder 37% had a comorbid mental disorder, especially drug disorders 53%
- Those treated in specialty mental health and addictive disorder clinical settings have higher
odds of having comorbid disorders.
Introduction:
- The finding of a statistically significant association between two disorders in epidemiology
studies suggests that one disorder may cause the other or that an underlying biologic
vulnerability to these disorders exists in affected individuals. Only viable if risk of developing
a second disorder is significantly higher in the presence of the other disorder
Previous comorbidity studies:
- In the general population mental disorders are more prevalent than alcohol disorders, which
in turn are more prevalent than drug disorders.
- Use Odds ratios: a measure of association, not causation
- Life time prevalence of alcoholism 6.7%, of whom 70% had a mental disorder
o 44% depression, 6% bi-polar disorder, 9% generalized anxiety, 3% phobia, 12% drug
misuse (other than alcohol)
Results:
- Prevalence rates:
o ADM prevalence: one month 15.7%, 6 months 19.5%, lifetime 32.7%
o Mental disorders had a lifetime prevalence of 22.5%
o Alcohol abuse-dependence 13.5% and drug abuse-dependence was 6.1%
- Institutional prevalence rates:
o 71.9% for ADM disorder in the institutionalized population (twice as high compared
to the community population)
o Of the three types of institutions: 82.2% in mental hospitals, 82.0% in prisons, 65.5%
in nursing homes
o 18% of mental hospital patients have no lifetime history of substance abuse or
mental disorder
o Mental hospitals had 39.6% substance abuse, of which 34.1% alcohol abuse, 16.1%
drug abuse
o Prisons: 72% lifetime prevalence of substance abuse, of which 56.2% alcohol, 53.7%
other drugs, other mental disorders were 55.7%
o Addictive disorders nursing homes 14.8%
- Comorbidity of Major Groups
o Mental disorders had a lifetime prevalence of 22.5%
Mental disorders only 16.2%, Mental and alcohol disorders 3.1%, mental and
other drug disorders 1.5%, mental disorders, drug disorder & alcohol
disorder 1.7%
Lifetime history of alcohol abuse and lifetime mental disorder 22.3%, other
drug abuse-dependence and lifetime mental disorder 14.7%, life time mental
disorder and addictive disorder 28.9%
Significantly higher than the base line, up to two to four times
o Alcohol abuse-dependence 13.5%
Alcohol only 7.6% alcohol another drugs 1.1% (Double)
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, 36.6% a mental disorder in their lifetime, and 21.5% had another drug
disorder (6x higher)
o Drug abuse 6.1% with other drugs is 1.8%
Lifetime drug dependence with a mental disorder 53.1% (4x higher), 47.3%
for drugs and alcohol (almost halve), 71.6% drugs with at least one of these
two disorders
- Comorbidity with specific mental disorders
o Schizophrenia: 47.7% had a substance disorder 4.6x higher (33.7 alcohol, 27.5 drugs)
o Antisocial Personality Disorder: 83.6% had a SUD, yet substance abuse is one of the
major criteria for ASP. Only 16% do not have a substance use disorder. (30x)
o Anxiety disorders: 23.7% (1 in 4)
phobias SUD is 12.6, panic disorder 35.8, OCD 32.8
o Affective mood disorders: 32.0% have SUD, alcohol 21.8%, 19.4 for drugs
Bipolar 1: 60.7 SUB, alcohol 46.2%, drugs 40.7 (11x)
- Comorbidity with specific substance Abuse disorders:
o Alcohol disorders: anxiety disorders 19.4%, ASP 14.3, mood disorders 13.4,
schizophrenia 3.8%
o Drugs Disorders: one or more mental disorders 53.1, anxiety 28.3, mood disorder
26.4%, ASP 17.8%, Schizophrenia 6.8%
o Higher rates of anxiety, affective, asp, and schizophrenia are found among those who
use drugs instead of those who use alcohol and marijuana.
- Mental health and substance abuse:
o 20% of individuals with mental disorders who come to specialty treatment setting
will have a SUD, 29% of all persons with a mental disorder will have a lifetime
diagnosis of a SUD
47% Schizophrenia, 56% Bipolar
Conclusion:
- These data make it clear that mental disorders must be addressed as a central part of
substance abuse
- Common neurotransmitters have been identified for some mental and addictive disorders;
o dopamine system for schizophrenia and SUD
o Serotonin system for affective disorders
- Antidepressants have been useful for cocaine addicts
Horsfall, J., Cleary, M., Hunt, G. E., & Walter, G. (2009). Psychosocial Treatments for People with
Co-occurring Severe Mental Illnesses and Substance Use Disorders (Dual Diagnosis): A Review of
Empirical Evidence. Harvard Review of Psychiatry, 17(1), 24–34. doi:10.1080/10673220902724599
Abstract:
- Research on psychosocial interventions for people with both a substance use disorder and
psychosis are non-conclusive but encouraging
- Treatments include motivational interviewing, cognitive-behavioural therapy, contingency
management, relapse prevention, case management, and skills training
Introduction:
- Four categories of people who are likely to require a combination of mental health and
substance abuse services:
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