The Association Between Dual Diagnosis And Treatment Outcome

In both SUD and psychiatric treatment-seeking populations, dually diagnosed patients typically experience worse outcomes than their "singly diagnosed" peers (Ritsher et al., 2002; Schaar & Oejehagen, 2001). However, there are specific populations in which the evidence regarding this is mixed, such as the severely and persistently mentally ill (SPMI) (Farris et al., 2003; Gonzalez & Rosenheck, 2002) and ASPD populations (Cacciola, Alterman, Rutherford, & Snider, 1995; Kranzler, Del Boca, & Rounsaville, 1996). The effect of other psychiatric disorders on SUD outcomes may vary by SUD type. For example, co-occurring major depression appears to predict worse alcohol outcomes (Brown et al., 1998; Greenfield et al., 1998), while there is less evidence for its predicting worse cocaine outcomes (McKay et al., 2002; Rohsenow, Monti, Martin, Michalec, & Abrams, 2002).

There is also evidence (albeit somewhat inconsistent) that gender may play a role in mediating the effect of co-occurring psychiatric disorders on SUD outcome. Major depression in men has been associated with worse SUD outcome (Compton, Cottler, Jacobs, Ben-Abdallah, & Spitznagel, 2003; Rounsaville, Dolinsky, Babor, & Meyer, 1987), although this is not a consistent finding (Kranzler et al., 1996; Powell et al., 1992). In contrast, some studies suggest that female gender has been associated with similar or better SUD outcomes among patients with co-occurring psychiatric disorders (Compton et al., 2003; Rounsaville et al., 1987), except for phobia, which was associated in one study with worse SUD outcome in women (Compton et al., 2003). Finally, ASPD in men has been associated with worse outcomes (Compton et al., 2003; Kranzler et al., 1996); although, the evidence in women has been mixed (Compton et al., 2003; Rounsaville et al., 1987).

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