Physical and Mental Comorbidity of Substance Use Disorders in Psychiatric Consultations

Abstract

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.

Integrating Primary Medical Care With Addiction Treatment

“…We identified a list of medical conditions from the literature described as "conditions related to drug and alcohol abuse." [1][2][3][4][5][6][7][8][9][10][27][28][29][30][31][32][33] Kaiser Permanente physicians (members of the American Society of Addiction Medicine) helped refine the list. We identified those acute or chronic physiologic or behavioral conditions related to alcohol or other drug abuse or that had higher prevalence in our sample than in a sample of health plan individuals matched on age, sex, and length of enrollment without substance abuse diagnoses or treatment.…”

Medical and Psychiatric Conditions of Alcohol and Drug Treatment Patients in an HMO

“…This is consistent with a large body of research indicating a high prevalence of psychiatric comorbidity among those with substance abuse problems. 2,18,33 The need for treatment of psychiatric comorbidities is important; female patients with higher levels of psychiatric severity are at increased risk of early dropout, 34 and patients with psychiatric problems have generally poorer treatment outcomes. 35,36 Conditions whose prevalences were not found to be different between cases and controls included cancer of the breast, lung, prostate, or colon, as well as diabetes, renal failure, cerebrovascular diseases, and benign conditions of the prostate.…”

Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies

“…[11][12][13][14][15] Similarly the overlap of substance misuse and medical burden is well recognised. [16][17][18][19] Given this clinically significant overlap, it is important to ask whether this comorbidity is appropriately recognised and treated in routine practice. National guidance in the UK and the USA highlights that the medical care of people with mental disorders is paramount.…”