Treatment for illegal drug use disorders: the role of comorbid mood and anxiety disorders

BMC Psychiatry

Silvia S Martins³  Pamela J Surkan¹  Nadia Younès⁴  Elena Prokofyeva²  Maria Melchior² 

[1] Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;University of Versailles Saint-Quentin, UMRS 1018, F-94807 Villejuif, France;Department of Epidemiology, Columbia University Mailman School of Public Health, 10032 New York, NY, USA;Université de Versailles Saint-Quentin EA 4047, Centre Hospitalier de Versailles, Le Chesnay, France

关键词: General population sample;    Epidemiology;    Anxiety disorders;    Mood disorders;    Unmet need for treatment;    Treatment;    Illegal drug use disorder;   

Others  :  1123683
DOI  :  10.1186/1471-244X-14-89

 received in 2013-04-26, accepted in 2014-03-17,  发布年份 2014

【 摘 要 】

Background

Our aim was to examine whether comorbid mood and anxiety disorders influence patterns of treatment or the perceived unmet need for treatment among those not receiving treatment for illegal drug use disorders.

Methods

Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001–2002 and 2004–2005, n = 34,653). Lifetime DSM-IV illegal drug use disorder (abuse and dependence), as well as comorbid mood (major depression, dysthymia, manic disorder, hypomanic disorder) and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety) were ascertained by a standardized psychiatric interview. Treatment for illegal drug use disorders and perceived unmet need for treatment were assessed among individuals with illegal drug use disorder. Odds of treatment and odds of perceived unmet need for treatment were assessed using logistic regression, adjusting for socio-demographic characteristics, treatment for mood and anxiety disorders, and comorbid alcohol use disorder.

Results

Out of 34,653 participants, 1114 (3.2%) had a diagnosis of lifetime illegal drug use disorder: 21.2% had a comorbid mood disorder only, 11.8% a comorbid anxiety disorder only, and 45.9% comorbid mood and anxiety disorders. Comorbid mood and anxiety disorders were not related to treatment for illegal drug use disorders but were associated with an elevated likelihood of unmet need for treatment: compared to participants with no comorbidities, multivariate ORs were 2.21 (95% CI: 1.23- 4.10) for mood disorder only, 2.38 (95% CI: 1.27-4.45) for anxiety disorder only, and 2.90 (95% CI: 1.71-4.94) for both mood and anxiety disorders.

Conclusions

Individuals with an illegal drug use disorder and comorbid mood or anxiety disorders are disproportionately likely to report unmet need for treatment. Integrated mental health and substance use programs could prove effective in addressing their treatment needs.

【 授权许可】

   
2014 Melchior et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Compton WM, Thomas YF, Stinson FS, Grant BF: Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2007, 64:566-576.
• [2]Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) study. JAMA 1990, 264:2511-2518.
• [3]Dickey B, Normand SL, Weiss RD, Drake RE, Azeni H: Medical morbidity, mental illness, and substance use disorders. Psychiatr Serv 2002, 53:861-867.
• [4]Watkins KE, Hunter SB, Wenzel SL, Tu W, Paddock SM, Griffin A, Ebener P: Prevalence and characteristics of clients with co-occurring disorders in outpatient substance abuse treatment. Am J Drug Alcohol Abuse 2004, 30:749-764.
• [5]Watkins KE, Burnam A, Kung FY, Paddock S: A national survey of care for persons with co-occurring mental and substance use disorders. Psychiatr Serv 2001, 52:1062-1068.
• [6]McFarland BH, Gabriel RM: Datapoints: service availability for persons with co-occurring conditions. Psychiatr Serv 2004, 55:978.
• [7]Grant BF, Hasin DS, Stinson FS, Dawson DA, Goldstein RB, Smith S, Huang B, Saha TD: The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2006, 67:363-374.
• [8]Grant BF, Hasin DS, Stinson FS, Dawson DA, June RW, Goldstein RB, Smith SM, Saha TD, Huang B: Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 2005, 35:1747-1759.
• [9]Hasin DS, Goodwin RD, Stinson FS, Grant BF: Epidemiology of major depressive disorder: results from the national epidemiologic survey on alcoholism and related conditions. Arch Gen Psychiatry 2005, 62:1097-1106.
• [10]Hasin DS, Stinson FS, Ogburn E, Grant BF: Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the united states: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2007, 64:830-842.
• [11]Martins SS, Gorelick DA: Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. Population. Drug Alcohol Depend 2011, 119:28-36.
• [12]Mackenzie CS, Reynolds K, Cairney J, Streiner DL, Sareen J: Disorder-specific mental health service use for mood and anxiety disorders: associations with age, sex, and psychiatric comorbidity. Depress Anxiety 2012, 29:234-242.
• [13]Mericle AA, Belenko S, Festinger DS: Detection, advice, and referral to services (DARTS) procedures among clients with public defenders. Subst Use Misuse 2011, 46:1734-1744.
• [14]Cook BL, Alegria M: Racial-ethnic disparities in substance abuse treatment: the role of criminal history and socioeconomic status. Psychiatr Serv 2011, 62:1273-1281.
• [15]Bouchery EE, Harwood HJ, Dilonardo J, Vandivort-Warren R: Type of health insurance and the substance abuse treatment gap. J Subst Abuse Treat 2012, 42:289-300.
• [16]Elhai JD, Ford JD: Correlates of mental health service use intensity in the national comorbidity survey and national comorbidity survey replication. Psychiatr Serv 2007, 58:1108-1115.
• [17]Harris KM, Edlund MJ: Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatr Serv 2005, 56:954-959.
• [18]Grella CE, Karno MP, Warda US, Moore AA, Niv N: Perceptions of need and help received for substance dependence in a national probability survey. Psychiatr Serv 2009, 60:1068-1074.
• [19]Green-Hennessy S: Factors associated with receipt of behavioral health services among persons with substance dependence. Psychiatr Serv 2002, 53:1592-1598.
• [20]Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC: Twelve-month use of mental health services in the united states: results from the national comorbidity survey replication. Arch Gen Psychiatry 2005, 62:629-640.
• [21]Wu LT, Ringwalt CL, Williams CE: Use of substance abuse treatment services by persons with mental health and substance use problems. Psychiatr Serv 2003, 54:363-369.
• [22]Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ: The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatry 1996, 66:17-31.
• [23]Wu LT, Kouzis AC, Leaf PJ: Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the national comorbidity survey. Am J Psychiatr 1999, 156:1230-1236.
• [24]Mojtabai R, Olfson M, Mechanic D: Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry 2002, 59:77-84.
• [25]National Institute on Alcohol Abuse and Alcoholism: Alcohol use and alcohol use disorders in the United States: main findings from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). In Alcohol Epidemiologic Data Reference Manual. Bethesda, MD: NIH; 2006.
• [26]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychological Association; 1994.
• [27]Krauke F, Valliant R: A Survey on survey statistics: What is done and can be done in Stata. Stata J 2007, 7:1-21.
• [28]Kessler RC, Angermeyer M, Anthony JC, de Graaf R, Demyttenaere K, Gasquet I, DE Girolamo G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB: Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s world mental health survey initiative. World Psychiatry 2007, 6:168-176.
• [29]Fenton MC, Keyes KM, Martins SS, Hasin DS: The role of a prescription in anxiety medication use, abuse, and dependence. Am J Psychiatr 2010, 167:1247-1253.
• [30]Grant BF, Harford TC, Dawson DA, Chou PS, Pickering RP: The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug Alcohol Depend 1995, 39:37-44.
• [31]Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R: The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 2003, 71:7-16.
• [32]Mojtabai R, Crum RM: Perceived unmet need for alcohol and drug use treatments and future use of services: results from a longitudinal study. Drug Alcohol Depend 2013, 127:59-64.
• [33]Fucito L, Gomes B, Murnion B, Haber P: General practitioners’ diagnostic skills and referral practices in managing patients with drug and alcohol-related health problems: implications for medical training and education programmes. Drug Alcohol Rev 2003, 22:417-424.
• [34]Babor TF, Kadden RM: Screening and interventions for alcohol and drug problems in medical settings: what works? J Trauma 2005, 59:S80-S87.
• [35]McLellan AT, Meyers K: Contemporary addiction treatment: a review of systems problems for adults and adolescents. Biol Psychiatry 2004, 56:764-770.
• [36]McGovern MP, Clark RE, Samnaliev M: Co-occurring psychiatric and substance use disorders: a multistate feasibility study of the quadrant model. Psychiatr Serv 2007, 58:949-954.
• [37]Sacks S, Chaple M, Sirikantraporn J, Sacks JY, Knickman J, Martinez J: Improving the capability to provide integrated mental health and substance abuse services in a state system of outpatient care. J Subst Abuse Treat 2013, 44:488-493.
• [38]Sacks S, McKendrick K, Sacks JY, Cleland CM: Modified therapeutic community for co-occurring disorders: single investigator meta analysis. Subst Abus 2010, 31:146-161.
• [39]Sacks S, McKendrick K, Sacks JY, Banks S, Harle M: Enhanced outpatient treatment for co-occurring disorders: main outcomes. J Subst Abuse Treat 2008, 34:48-60.
• [40]Burnam MA, Watkins KE: Substance abuse with mental disorders: specialized public systems and integrated care. Health Aff 2006, 25:648-658.
• [41]Hoge MA, Paris M Jr, Adger H Jr, Collins FL Jr, Finn CV, Fricks L, Gill KJ, Haber J, Hansen M, Ida DJ, Kaplan L, Northey WF Jr, O'Connell MJ, Rosen AL, Taintor Z, Tondora J, Young AS: Workforce competencies in behavioral health: an overview. Adm Policy Ment Health 2005, 32:593-631.
• [42]Woltmann EM, Whitley R, McHugo GJ, Brunette M, Torrey WC, Coots L, Lynde D, Drake RE: The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatr Serv 2008, 59:732-737.
• [43]Sussman S, Valente TW, Rohrbach LA, Skara S, Pentz MA: Translation in the health professions: converting science into action. Eval Health Prof 2006, 29:7-32.
• [44]Gotham HJ, Brown JL, Comaty JE, McGovern MP, Claus RE: Assessing the co-occurring capability of mental health treatment programs: the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index. J Behav Health Serv Res 2013, 40:234-241.
• [45]Gotham HJ, Claus RE, Selig K, Homer AL: Increasing program capability to provide treatment for co-occurring substance use and mental disorders: organizational characteristics. J Subst Abuse Treat 2010, 38:160-169.
• [46]Matthews H, Kelly PJ, Deane FP: The dual diagnosis capability of residential addiction treatment centres: priorities and confidence to improve capability following a review process. Drug Alcohol Rev 2011, 30:195-199.
• [47]McGovern MP, Lambert-Harris C, Gotham HJ, Claus RE, Xie H: Dual diagnosis capability in mental health and addiction treatment services: an assessment of programs across multiple state systems. Adm Policy Ment Health 2012, 2:205-214.