Psychiatric comorbidity in illicit drug users: Substance-induced versus independent disorders

https://doi.org/10.1016/j.drugalcdep.2010.07.013Get rights and content

Abstract

Background

Few studies have differentiated between independent and substance-induced psychiatric disorders. In this study we determine the risks associated with independent and substance-induced psychiatric disorders among a sample of 629 illicit drug users recruited from treatment and out of treatment settings.

Methods

Secondary analysis of five cross-sectional studies conducted during 2000–2006. Independent and substance-induced DSM-IV psychiatric diagnoses were assessed using the Psychiatric Research Interview for Substance and Mental Disorders.

Results

Lifetime prevalence of Axis I disorders other than substance use disorder (SUD) was 41.8%, with independent major depression being the most prevalent (17%). Lifetime prevalence of antisocial or borderline personality disorders was 22.9%. In multinominal logistic regression analysis (SUD only as the reference group), being female (OR 2.45; 95% CI 1.59, 3.77) and having lifetime borderline personality disorder (OR 2.45; 95% CI 1.31, 4.59) remained significant variables in the group with independent disorders. In the group with substance-induced disorders, being recruited from an out of treatment setting (OR 3.50; 95% CI 1.54, 7.97), being female (OR 2.38; 95% CI 1.24, 4.59) and the number of SUD (OR 1.31; 95% CI 1.10, 1.57) remained significant in the model. These variables were also significant in the group with both substance-induced and independent disorders, together with borderline personality disorder (OR 2.53; 95% CI 1.03, 6.27).

Conclusions

Illicit drug users show high prevalence of co-occurrence of mainly independent mood and anxiety psychiatric disorders. Being female, recruited from an out of treatment setting and the number of SUD, are risk factors for substance-induced disorders.

Section snippets

Background

Substance users with comorbid psychiatric disorders (i.e. non-substance use disorders (Non-SUD)) report greater psychosocial and medical problems and poorer prognosis than those without (Aharonovich et al., 2002, Burns et al., 2005, Curran et al., 2003, Hasin et al., 2002, Martín-Santos et al., 2006, Rosenberg et al., 2001). At present, great importance is given to distinguish between independent and substance-induced disorders, as they may have different clinical courses, treatment strategies

Design

A secondary analysis of 629 illicit drug users from five cross-sectional studies in Barcelona, Spain was conducted.

Participants, recruitment and settings

A total of 629 illicit drug users from Barcelona were included from studies conducted during 2000–2006. Three hundred and four subjects were recruited from treatment settings: 115 subjects were consecutive admissions (primarily for detoxification from cocaine, heroin and methadone) to an inpatient detoxification unit of a teaching hospital assessed on average 6 days following

General characteristics of sample

The majority of the sample was male 68.0%. The mean age of participants was 26.6 years (SD 7.1). Most lived with someone (71.6%), 23% were married or cohabiting and 17.2% were homeless or squatting. Over half the participants were unemployed or not studying (53.5%); and 53.1% reported that their highest education level attained was primary studies. A criminal history was present in 50% of the subjects. Twenty percent of participants were HIV positive, and 45.3% had hepatitis C infection.

Across

Discussion

The present study was the first to examine risk factors associated with the co-occurrence of substance-induced and independent psychiatric disorders among illicit drug users recruited from different treatment and non-treatment settings. Almost 42% of the illicit drug users met criteria for a lifetime Axis I disorder other than SUD; 36% of which were substance-induced.

Subjects recruited from non-treatment settings had a greater risk of psychiatric comorbidity, resulting mainly from the increased

Conclusion

Substance users recruited out of treatment settings had a greater risk of substance-induced disorders. This highlights the importance of increasing the accessibility to treatment for this population, especially for females and poly substance users.

Role of the funding sources

National funding for the original research studies was received from the Plan Nacional sobre Drogas (PNSD 2001, 2004, INT/2012/2002); FIPSE 3035/99 and 36253/01; Fondo de Investigación Sanitaria (FIS 98/0176; 00/0777; 00/810, G03/005 and RD 06/0001/1009). The funding organisations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Contributors

MT and AD conceived the secondary analysis. GG conducted the analysis. MT and GG prepared the initial draft of the paper and all authors contributed to its revision. All authors approved the final manuscript prior to submission.

Conflict of interest

None.

Acknowledgements

We would like to thank authors of the original studies from which these data were taken: C. Castillo, J. Tato, J.M. Vázquez, F. Fonseca, J.M. Ginés, D. Bergé, A. Nocon, T.C. Silva, A. Sánchez-Niubó, M. Farré, R. de la Torre and the ITINERE Investigators.

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    The PsyCoBarcelona Group includes: M.C. Rodriguez-Llera, M.J. Herrero, Drug Abuse Epidemiology Research Group, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain M. Astals, L. Díaz, Substance Use Disorders Research Group, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain and Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; R. Martin-Santos, Psychiatry Department, Institut Neurosciences, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain; M.T. Brugal, Barcelona Public Health Agency, Barcelona, Spain, e CIBER in Epidemiology and Public Health (CIBERESP), Spain.

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