Which of the following disorders are most commonly associated with substance abuse?

Many chronic drug abusers--the individuals we commonly regard as addicts--often simultaneously suffer from a serious mental disorder. Drug treatment and medical professionals call this condition a co-occurring disorder or a dual diagnosis.

Chronic drug abuse is the habitual abuse of licit or illicit drugs to the extent that the abuse substantially injures a person's health or substantially interferes with his or her social or economic functioning. Furthermore, any person who has lost the power of self-control over the use of drugs is considered a chronic drug abuser.

What are some serious mental disorders associated with chronic drug abuse?

Chronic drug abuse may occur in conjunction with any mental illness identified in the American Psychiatric Association (DSM-IV). Some common serious mental disorders associated with chronic drug abuse include schizophrenia, bipolar disorder, manic depression, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, and antisocial personality disorder. Some of these disorders carry with them an increased risk of drug abuse (see text box below).

Disorders With Increased Risk of Drug Abuse

DisorderRiskAntisocial personality disorder15.5%Manic episode14.5%Schizophrenia10.1%Panic disorder04. 3%Major depressive episode04.1%Obsessive-compulsive disorder03.4%Phobias02.1%

Source: National Institute of Mental Health.

How prevalent are co-occurring disorders?

Co-occurring disorders are very common. In 2002 an estimated 4.0 million adults met the criteria for both serious mental illness and substance dependence or abuse in the past year.

Which occurs first--chronic drug abuse or serious mental illness?

It depends. In some cases, people suffering from serious mental disorders (often undiagnosed ones) take drugs to alleviate their symptoms--a practice known as self-medicating. According to the American Psychiatric Association, individuals with schizophrenia sometimes use substances such as marijuana to mitigate the disorder's negative symptoms (depression, apathy, and social withdrawal), to combat auditory hallucinations and paranoid delusions, or to lessen the adverse effects of their medication, which can include depression and restlessness.

In other cases mental disorders are caused by drug abuse. For example, MDMA (3,4-methylenedioxymethamphetamine, commonly known as ecstasy), produces long-term deficits in serotonin function in the brain, leading to mental disorders such as depression and anxiety. Chronic drug abuse by adolescents during formative years is a particular concern because it can interfere with normal socialization and cognitive development and thus frequently contributes to the development of mental disorders.

Finally, chronic substance abuse and serious mental disorders may exist completely independently of one another.

Can people with co-occurring disorders be treated effectively?

Yes, chronic drug abusers who also suffer from mental illness can be treated. Researchers currently are investigating the most effective way to treat drug abusers with mental illness, and especially whether or not treating both conditions simultaneously leads to better recovery. Currently, the two conditions often are treated separately or without regard to each other. As a result, many individuals with co-occurring disorders are sent back and forth between substance abuse and mental health treatment settings.

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Households and group housing in the USA and District of Columbia, including Hawaii and Alaska; recruited 2001–2002.

Population:

43 093 people aged over 18 years randomly sampled from the general population. African-American, Hispanic and young adults aged 18–24 years were oversampled.

Assessment:

Trained interviewers conducted face to face interviews as part of the National Epidemiological Survey on Alcohol and Related Conditions. Alcohol and drug use disorders were assessed with the structured diagnostic Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). Current dependence required participants to satisfy at least three of seven DSM-IV criteria for dependence in the preceding 12 months. Alcohol abuse required at least one of four DSM-IV criteria for abuse, but not dependence. Drug specific abuse and dependence were derived in the same way. Personality disorders were also diagnosed by AUDADIS-IV. Participants were required to answer personality symptom questions about their lives, excluding times when they were ill, using drugs or medication, drinking heavily, experiencing withdrawal, anxious, depressed, or manic. Three of the 10 personality disorders defined by DSM-IV criteria were not assessed (borderline, schizotypal, and narcissistic).

Outcomes:

Alcohol or drug use disorder and personality disorder (AUDADIS-IV).

MAIN RESULTS

In the general population, the 12 month prevalence of alcohol use disorder was 8.5% and drug use disorder was 2.0%. Overall, 29% of people with a current alcohol use disorder and 48% of people with a current drug use disorder had at least one personality disorder (see http://www.ebmentalhealth.com/supplemental for table). Among people who had at least one personality disorder, 16% had current alcohol use disorder and 7% had current drug use disorder. Antisocial, dependent, and histrionic personality disorders were most strongly associated with alcohol and drug use disorders. There was a greater association between personality and drug use disorders than between personality and alcohol use disorders. Antisocial personality disorders were most strongly associated with alcohol and drug use disorders in women (alcohol: OR 6.2, 95% CI 4.7 to 8.2; drug: OR 17.9, 95% CI 12.5 to 25.5). Dependent personality disorders were most strongly associated with drug dependence in men (OR 48.4, 95% CI 20.6 to 113.5).

CONCLUSIONS

Personality disorders commonly occur together with alcohol and drug use disorders in the general population. Antisocial, dependent, and histrionic personality disorders are most strongly associated with alcohol and drug use.

NOTES

There is some degree of DSM-IV diagnostic overlap between antisocial, dependent, and histrionic personality disorders, which may explain why all three are strongly associated with alcohol and drug use disorders. Men with antisocial personality disorders who have drug and alcohol use disorders may be underrepresented in the study as they are more likely to be in prison or die younger than women.

Commentary

Researchers and clinicians are aware that alcohol and drug problems are prevalent in both clinical and community samples. Further, the comorbidity between substance use disorders and other Axis I disorders (for example, mood and anxiety disorders) is generally recognised by mental health professionals. In contrast, less attention has been focused on the prevalence of personality disorders (PDs) in the population as well as on the comorbidity of substance use disorders and Axis II PDs (the one exception being antisocial PD).

Grant et al make several unique and important contributions to the field. Firstly, their prevalence estimates of PDs and the comorbidity rates between PDs and substance use disorders in the general population were based on an extremely large and representative sample of US residents. Prevalence and comorbidity estimates using clinical samples are biased and can lead to faulty conclusions about corresponding rates in the general population. Secondly, unlike previous epidemiological studies, this study assessed a range of PDs in addition to antisocial PD. Finally, this study examined whether prevalence rates and comorbidity patterns differed as a function of gender.

There are several important clinical and public health implications that can be drawn from this study. Firstly, PDs are relatively prevalent in the population; 15% of the sample met criteria for at least one of the PDs assessed (borderline, narcissistic, and schizotypal PD were not assessed but will be assessed in a follow up survey). Because of the significant disability associated with PDs, clinicians and researchers should routinely screen for these conditions. Secondly, PDs were quite prevalent among those with substance use disorders, especially dependence syndromes. Treatment providers need to be trained to recognise and treat PDs because their comorbidity could complicate treatment efforts and presage poorer outcomes. This can be a significant challenge because many substance use treatment programmes are staffed by specialists with minimal training in personality pathology. Finally, many of the associations between PDs and substance use disorders were stronger for women than for men. This highlights the need to consider PDs an important part of the clinical picture when treating substance dependent women, perhaps indicating specialised treatment approaches.

What disorders are often associated with substance use disorders?

Substance use disorders also co-occur at high prevalence with mental disorders, such as depression and bipolar disorder,^6,9–11 attention-deficit hyperactivity disorder (ADHD),^12,13 psychotic illness,^14,15 borderline personality disorder,¹⁶ and antisocial personality disorder.

Which of the following is the most common substance use disorder?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the most common substance use disorders include alcohol, cannabis, tobacco, stimulants, hallucinogens and opioids.

What are 3 substance use disorders?

Types of Substance Use Disorders.

Opioid Use Disorder..

Marijuana Use Disorder..

Nicotine Use Disorder..

Stimulant Use Disorder..

Sedative Use Disorder..

Hallucinogen Use Disorder..

Alcohol Use Disorder..

What is the most likely cause of substance abuse disorders?

Risk factors.

Family history of addiction. Drug addiction is more common in some families and likely involves an increased risk based on genes. ... .

Mental health disorder. ... .

Peer pressure. ... .

Lack of family involvement. ... .

Early use. ... .

Taking a highly addictive drug..