Methodological considerations in the diagnosis of coexisting psychiatric disorders in substance abusers. British Journal of the Addictions, 78, 179-187

Alcohol and Drug Abuse Program, McLean Hospital, Belmont, MA 02178.
British journal of addiction 03/1992; 87(2):179-87. DOI: 10.1111/j.1360-0443.1992.tb02691.x
Source: PubMed


The authors reviewed the diagnostic methodology in 14 studies that examined the prevalence of coexisting psychiatric disorders in substance abusers. There was widespread variation among the studies in the timing of patient interviews, the nature of the interviews themselves, and abstinence criteria required before another psychiatric disorder could be diagnosed. These differences were reflected in some of the study results. The authors describe how variations in methodology can affect the diagnoses patients receive. They also suggest more specific abstinence criteria, based on the substances of abuse and the specific disorders being diagnosed.

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Available from: Steven Mirin, Apr 01, 2015
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    • "In some studies, diagnoses are based only on screening instruments; in others, the diagnostic interviews used have not been validated for both SUDs and mental disorders. Diagnoses drawn from different diagnostic interviews give different results, to varying extents [33-35], and even the same diagnostic interview, used in different groups, can poorly differentiate psychiatric symptoms from symptoms of intoxication or withdrawal [36]. Structured instruments have been shown to increase the diagnostic validity of SUD diagnoses compared with clinical judgments, but psychiatric comorbid diagnoses show poor validity, regardless of the method used [37,38]. "
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    ABSTRACT: The optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described. First-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms. This study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.
    Full-text · Article · Feb 2011 · BMC Psychiatry
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    • "This finding has been supported by two reviews, concluding that positive evidence exists for integrated treatment with motivational interviews, cognitive behavioral therapy (individual or group-based), and a harm-reduction approach [23,24]. Group-based treatments are arguably less expensive, and in a literature review, Weiss et al. concluded that specialized group therapy could reinforce the effect of an existing treatment [25]. However, there is currently insufficient evidence to show that group-based interventions for cannabis use are superior to individual treatment [26,27]. "
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    ABSTRACT: A number of studies indicate a link between cannabis-use and psychosis as well as more severe psychosis in those with existing psychotic disorders. There is currently insufficient evidence to decide the optimal way to treat cannabis abuse among patients with psychosis. The major objective for the CapOpus trial is to evaluate the additional effect on cannabis abuse of a specialized addiction treatment program adding group treatment and motivational interviewing to treatment as usual. The trial is designed as a randomized, parallel-group, observer-blinded clinical trial. Patients are primarily recruited through early-psychosis detection teams, community mental health centers, and assertive community treatment teams. Patients are randomized to one of two treatment arms, both lasting six months: 1) specialized addiction treatment plus treatment as usual or 2) treatment as usual. The specialized addiction treatment is manualized and consists of both individual and group-based motivational interviewing and cognitive behavioral therapy, and incorporates both the family and the case manager of the patient. The primary outcome measure will be changes in amount of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. Trial registration NCT00484302.
    Full-text · Article · Feb 2008 · Trials
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    • "A pesar del consenso existente en cuanto a la frecuente sintomatología psicopatológica en los alcohólicos , se desconoce con exactitud la tasa real de comorbilidad, ya que las investigaciones aportan datos muy diferentes (Casas y Guardia, 2002). Estas divergencias se relacionan, probablemente, con distintos problemas metodológicos, como el tipo de instrumento empleado (Weiss, Mirin y Griffin, 1992), la selección de la muestra (Valbuena, Largo, Quintero, García y Correas, 2001) y, sobre todo, el tiempo transcurrido desde el inicio de la abstinencia (Schuckit et al., 1997; Wetterling y Junghanns, 2000). Esta variabilidad de resultados se observa también con respecto al tipo concreto de psicopatología que concurre en el alcoholismo (Driessen et al., 2001; Ross et al., 1988; Tomasson y Vaglum, 1995). "
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    ABSTRACT: RESUMEN. En este estudio se lleva a cabo un análisis del perfil de bebida y de la comorbilidad psicopatológica en 50 pacientes alcohólicos que acuden en busca de tratamiento a un programa ambulatorio de Proyecto Hombre de Navarra. Para ello, se lleva a cabo un estudio ex post facto, de carácter retrospectivo y con un grupo cuasi control. Se utilizan los criterios diagnósticos del DSM-IV-TR para la dependencia alcohólica, el Müncher Alkoholismus Test (MALT) para valorar la gravedad del alcoholismo y el SCL-90-R como medida de la sintomatología asociada. Los resultados obtenidos muestran la presencia de numerosa sintomatología psicopatológica, con elevaciones significativas en la mayoría de las dimensiones del SCL-90-R, tanto en los hombres como en las mujeres de la muestra. La comparación con las muestras normativas refleja que los alcohólicos de la muestra presentan más síntomas psicopatológicos que la población normal, pero menos que la población psiquiátrica. Asimismo, la gravedad del alcoholismo se relaciona de forma significativa con la mayor presencia e intensidad de comorbilidad. Por último, se comentan las implicaciones de este estudio para la práctica clínica y para la investigación futura.
    Full-text · Article · Jan 2006 · International Journal of Clinical and Health Psychology
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