Dual Psychiatric, Substance Use Disorder Warrants Tailored Treatment

Adults with dual diagnoses of psychiatric and substance use disorders experience more severe symptoms and have worse treatment outcomes, greater risks for homelessness, and more frequent inpatient and emergency department (ED) use according to past studies. A group of researchers conducted a more detailed epidemiologic study of this group. They published their results in Psychiatry Research.

Using data from the restricted version of NESARC-III, a US nationally representative cross-sectional survey sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the researchers conducted a probability sampling of adults aged 18 years and older. They identified those with substance use disorder who had either a lifetime or past-year diagnosis of major depressive disorder, dysthymia, bipolar I disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), panic disorder, phobias and eating disorders. Researchers also evaluated data on behavior, homelessness, and quality of life, among other factors.

Researchers found dually diagnosed adults represented about 17.8% of all adults with either a psychiatric or substance use disorder (SUD) (n=11,870 representing 75.6 million adults). Those with dual diagnosis were substantially more likely than the other 2 groups to report a history of incarceration, past-year trouble with police, violent behavior, and past-year homelessness, as well as alcohol use, drug use, incarceration, psychiatric hospitalization, suicide attempt, and death by suicide.

The dually diagnosed were also more likely to have experienced childhood neglect, sexual abuse, and/or repeated trauma than those with SUD alone. The dually diagnosed experienced higher rates of racial discrimination than those with a single diagnosis. They also had less social support and reported worse quality of life.

Of the clinical characteristics, adults with a dual diagnosis reported substantially higher rates past-year opioid, cannabis, cocaine, and sedative use disorders than adults with SUD alone. All groups reported that they had received treatment for their disorders.

Researchers noted the cross-sectional nature of the data set limits their ability to make certain conclusions. Researchers also didn’t have information on schizophrenia and other psychoses.

“The provision of medical, psychiatric, and addiction services along with a broad range of psycho-social services targeting specific psycho-social adversities may need to be provided in an integrated setting that can coordinate care for all these problems if the effectiveness of treatment for this population is to be improved,” the researchers concluded.

Reference

Jegede O, Rhee TG, Stefanovics EA, Zhou B, Rosenheck RA. Rates and correlates of dual diagnosis among adults with psychiatric and substance use disorders in a nationally representative US sample. Psychiatry Res. 2022;315:114720. doi:10.1016/j.psychres.2022.114720