Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment

Abstract

As the field follows recommendations to introduce standardized assessments on substance, mental and behavioral problems, a consistent picture has emerged that co-occurring disorders are common, that there is heterogeneity in the type of disorder, and that the pattern varies by age. This paper examines the prevalence of self-reported substance use and mental health problems, the pattern of comorbidity, and how both vary by age among people presenting to substance abuse treatment. Data are from 4,939 adolescents and 1,958 adults presenting to substance abuse treatment in multi-site studies who were assessed with the Global Appraisal of Individual Needs (GAIN) and categorized into five age groups: age <15, 15-17, 18-25, 26-39, and 40+. Two thirds of clients had a co-occurring mental problem in the year prior to treatment admission. Across all ages, clients self-reporting criteria for past-year substance dependence were more likely than those who did not to have other cooccurring mental health problems (odd ratios of 2.9 to 8.8). The prevalence and patterns of cooccurring mental health problems however varied by age. Young adults (age 18-25) were found to be most vulnerable to co-occurring problems.

Prevalence of Co-Occurring Substance Use and other Mental Disorders in the Canadian Population

“…Further, these rates of co-occurring disorders in the general population are much lower than what has been observed in clinical populations. [40][41][42] Both population and clinical perspectives need to be brought to bear in establishing the relative priority for policies and programs for people with co-occurring disorders. Our analyses set the stage for more in-depth Canadian interdisciplinary work on this topic.…”

Analyse comparative du point de vue des mères, des pères et des enseignants dans l'évaluation des problèmes de comportement d'enfants d'âge scolaire ayant une déficience intellectuelle /

“…Le terme psychopathologie est utilisé par certains auteurs pour décrire deux phénomènes cliniques indépendants, les troubles psychiatriques classiques qui incluent les pathologies comme la schizophrénie et les troubles de l'humeur, et une variété de problèmes de comportement comme les comportements agressifs, destructeurs, stéréotypés ou les comportements retournés contre soi (Campbell, 1995;Chan, Dennis, & Funk, 2008 …”

Development and Validation of Short Versions of the Internal Mental Distress and Behavior Complexity Scales in the Global Appraisal of Individual Needs (GAIN)

“…1,2 Among those who enter treatment for alcohol and drug abuse, it is estimated that close to 80% also present with one or more co-occurring psychiatric disorders. 3,4 There is an extensive literature on adults and adolescents entering substance abuse treatment demonstrating that internalizing psychological disorders (e.g., depression and other mood disorders, suicide attempts, generalized and other anxiety disorders, including trauma related disorders) are prevalent and can interact with treatment effectiveness. [5][6][7][8][9] While certainly some of these conditions are substance induced, others result from childhood maltreatment and other forms of victimization that often lead to serious distress which interferes with functioning but does not necessarily fit neatly into diagnostic categories.…”

“…[7][8][9] These include childhood disorders [or continuing disorders for adults; e.g., attention deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD)], other impulse control (e.g., pathological gambling), and cluster B [e.g., antisocial personality disorder (ASPD), borderline personality disorder (BPD)] personality disorders. 4,12,13 Crime and violence also fall under the rubric of externalizing behavior problems, and reductions in delinquency, crime, and their associated costs to society have historically been one of the major impetuses behind public funding for substance abuse treatment. 14 Higher rates of externalizing disorders are associated with higher substance use severity and resistance to treatment.…”

“…14 Higher rates of externalizing disorders are associated with higher substance use severity and resistance to treatment. 4,15,16 Given that comorbidity is highly intertwined with the severity of substance use disorders and response to treatment, simultaneous screening for co-occurring mental health disorders and behavioral problems is essential. Although several longer scales exist, the need for a thorough yet brief assessment of co-occurring problems has been repeatedly identified as one of the key gaps in the field of substance abuse treatment.…”