Abstract: Substance use disorders are extremely common and have high morbidity and mortality. There are more deaths, illnesses, and disabilities each year from substance use disorders than from any other preventable health condition. Substance use can harm health and family life, and it has an enormous impact on the economy and public safety. As such, this is an extremely costly and devastating illness with far-reaching implications. Epidemiologic data indicate that approximately 12.5% of men and 6.4% of women meet lifetime criteria for alcohol abuse, and 20.1% of men and 8.2% of women meet lifetime criteria for alcohol dependence.30 For drug abuse, lifetime prevalence estimates are 5.4% of men and 3.5% of women. For drug dependence, the estimates are 9.2% of men and 5.9% of women. Taken together, these data make substance use disorders the most prevalent of all psychiatric disorders in the United States today.30 The high comorbidity of substance use disorders with other psychiatric disorders is equally striking. Data from an epidemiologic study that focused on the comorbidity of substance use and psychiatric disorders, the National Comorbidity Study (NCS),31 indicate that 41% to 65% of individuals with an addictive disorder have an affective or anxiety disorder at some time in their lives. Similarly, approximately 50% of those with affective and anxiety disorders meet criteria for an addictive disorder at some time in their lives. The percentages and the odds ratios from the Epidemiologic Catchment Area Study (ECA)51 for the co-occurrence of the major Axis I psychiatric disorders with lifetime substance use disorders are displayed in Table 1. As can be seen, for all of these disorders, the odds ratios for co-occurrence with substance use disorders are greater than 1.0, indicating a significantly positive association with substance use disorders. These data are consistent with the analysis to date of the NCS data31 as well as data from treatment-seeking populations, which all point to the high comorbidity of psychiatric and substance use disorders. Of particular interest for this article is the comorbidity of bipolar affective disorder with substance use disorders. As can be seen in Table 1, in the ECA study, bipolar disorder had a higher odds ratio for co-occurrence with a substance use disorder than any other psychiatric disorder. The relationship between substance use disorders and psychiatric disorders is complex and has been the topic of much discussion. Although the term comorbidity connotes that two conditions exist together, the epidemiologic evidence cited previously as well as data from treatment-seeking samples reviewed subsequently, indicate that the association between psychiatric disorders and substance use disorders is far stronger than would be expected by chance alone. There are a number of potential explanations for this relationship. Meyer37 described several theories regarding the co-occurrence of substance abuse and psychopathology, including the notion that psychopathology may be a risk factor for the development of a substance use disorder. Psychopathology may modify the course of a substance use disorder, or psychiatric symptoms may emerge during the course of chronic intoxication and withdrawal. These and other issues are explored with specific reference to bipolar disorder.
Publication Year: 1999
Publication Date: 1999-09-01
Language: en
Type: review
Indexed In: ['crossref', 'pubmed']
Access and Citation
Cited By Count: 97
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