CoOccurring Substance Use Disorders and Other Psychiatric Disorders

ALISA B. BUSCH ROGER D. WEISS LISA M. NAJAVITS

Determining better ways to identify and treat individuals with co-occurring substance use disorders (SUDs) and other psychiatric disorders has become increasingly important from clinical, research, and policy perspectives. Several observations have driven this imperative: (1) Co-occurring SUDs with other psychiatric disorders are prevalent (Kessler et al., 1996; Regier et al., 1990) and associated with worse clinical and functional outcomes than either SUDs or other psychiatric disorders alone (Mueller et al., 1994; Ritsher, McKellar, Finney, Otilingam, & Moos, 2002); (2) many people with these co-occurring disorders do not receive adequate treatment (Substance Abuse and Mental Health Service Administration, 2002); and (3) compared to psychiatric patients without co-occurring SUDs, patients with a dual diagnosis tend to use more costly treatments, such as emergency and hospital care (Dickey & Azeni, 1996; Mark, 2003). Together, these observations have led to the development of specific new treatments designed or adapted for this population—although this research is at an early stage.

Within SUD populations, multiple substance use disorders are common (Kessler et al., 1997; Regier et al., 1990). While these individuals can also be considered "dually diagnosed," this chapter focuses exclusively on patients who have an SUD plus a (non-SUD) co-occurring Axis I or II psychiatric disorder.

Additionally, non-SUD Axis I and II psychiatric disorders are here referred to simply as "psychiatric disorders" to distinguish them from substance use disorders.

In this chapter, we review psychosocial and psychopharmacological treatments for dual-diagnosis populations. While increasing methodological rigor is being employed in many of these studies, this research is still at an early stage. Thus, some of the available evidence is from pilot or noncontrolled trials. When evidence from blinded and/or controlled trials is not available for a particular treatment, we review the level of evidence that is available.

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