Background There are elevated rates of comorbid psychiatric disorders among individuals with substance dependence; however, little research examines these rates within inpatient settings, particularly in relation to gender and type of substance. The current study aimed to fill this gap. Method 465 patients (71.4% male) were recruited from an inpatient substance use treatment facility from 2006 to 2009. These patients were interviewed and diagnosed using the Structure Clinical Interview for DSM-IV and the Diagnostic Interview for Personality Disorders. Results 60.6% of patients with substance dependence had a current comorbid psychiatric disorder, and more than 30% had at least two psychiatric disorders. The most common current Axis I diagnosis was major depressive disorder (25.8%), followed by PTSD (14%). Comparable rates were found for Antisocial and Borderline Personality Disorders. Females were significantly more likely to meet diagnostic criteria for a psychiatric disorder than were males (73.7% versus 55.4%). When examining comorbidities across different substance dependences, the highest rates of comorbid psychiatric disorders were found among individuals with alcohol dependence (76.8%) and cannabis dependence (76%), although rates were above 60% for cocaine and opioid dependence. Rates of psychiatric diagnoses were significantly lower (27%) among patients who did not meet diagnostic criteria for substance dependence. Conclusions There are particularly elevated rates of psychiatric disorders among individuals with substance dependence in inpatient treatment. These rates differ as a function of substance dependence type and gender, making these factors important to consider when researching and treating this type of population.
Adults with substance use disorders (SUDs) report a high prevalence of childhood abuse. Research in the general population suggests specific types of abuse lead to particular negative outcomes; it is not known whether this pattern holds for adults with SUDs. We hypothesized that specific types of abuse would be associated with particular behavioral and emotional outcomes among substance users. That is, childhood sexual abuse would be associated with risky sex behaviors, childhood physical abuse with aggression, and childhood emotional abuse with emotion dysregulation. 280 inpatients (M age = 43.3; 69.7% male; 88.4% African American) in substance use treatment completed the Childhood Trauma Questionnaire (CTQ), HIV Risk-Taking Behavior Scale, Addiction Severity Index, Difficulties with Emotion Regulation Scale (DERS), Distress Tolerance Scale (DTS), and Affect Intensity and Dimensions of Affiliation Motivation (AIM). Consistent with our hypotheses, the CTQ Sexual Abuse subscale uniquely predicted exchanging sex for cocaine and heroin, number of arrests for prostitution, engaging in unprotected sex with a casual partner during the prior year, and experiencing low sexual arousal when sober. The Physical Abuse subscale uniquely predicted number of arrests for assault and weapons offenses. The Emotional Abuse subscale uniquely predicted the DERS total score, AIM score, and DTS score. Among substance users, different types of abuse are uniquely associated with specific negative effects. Assessment of specific abuse types among substances users may be informative in treatment planning and relapse prevention.
Background Adults with substance use disorders (SUDs) report higher rates of child abuse than adults without SUDs. Prior work suggests this abuse is associated with higher rates of psychosis, posttraumatic stress disorder, physical health problems, alcohol dependence, and cannabis dependence among substance users. Little is known about other problems associated with child abuse experienced by substance users. We hypothesized among adults with SUDs, child abuse would be associated with elevated rates of all Diagnostic and Statistical Manual (DSM-IV-TR) psychiatric disorders, substance dependencies, and comorbidities assessed. Method We assessed 280 inpatients in substance use treatment with the Structured Clinical Interview for the DSM-IV-TR, the Diagnostic Instrument for Personality Disorders, and Childhood Trauma Questionnaire (CTQ). We used chi-square and regression analyses to establish whether rates of psychiatric disorders, substance dependencies, and comorbidities differed as a function of child abuse. Results Consistent with our hypotheses, higher scores on the CTQ were associated with elevated rates of psychiatric disorders (mood disorders, anxiety disorders, psychotic symptoms, and personality disorders) and substance dependencies (alcohol dependence and cocaine dependence). Moreover, higher rates of all comorbidity patterns (e.g. comorbid alcohol dependence and anxiety) were observed among individuals who reported experiencing child abuse. Across all substance dependencies examined, individuals who had been abused had significantly higher rates of all psychiatric disorders assessed. Conclusions Individuals with substance use disorders who have been abused have particularly elevated rates of psychiatric and substance use disorders as a function of their abuse experiences. These findings have important treatment implications for individuals in residential substance use treatment settings.
This manuscript provides a comprehensive review of CBT treatments for PDs, including a description of the available treatments and empirical support, drawing on research published between 1980 and 2009. Research generally supports the conclusion that CBT is an effective treatment modality for reducing symptoms and enhancing functional outcomes among patients with PDs, thereby making it a useful framework for clinicians working with patients with PD symptomotology. However, there is clear need for further the development and evaluation to provide specific and more unambiguous treatment recommendations, with particular relevance for understudied PDs.
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