Dual Diagnosis and Chronology of Illness in Treatment-Seeking Italian Patients Dependent on Heroin

University of Pisa, Via Roma 67, 56100-PISA, Italy.
Journal of Addictive Diseases (Impact Factor: 1.46). 04/2011; 30(2):123-35. DOI: 10.1080/10550887.2011.554779
Source: PubMed


Although there are studies describing the prevalence of patients with drug addiction and dual diagnosis, there is a paucity of data regarding the progression from psychiatric disorders to drug addiction or vice versa. A total of 1,090 patients dependent on heroin were interviewed to examine the presence of dual diagnosis and the progression from psychiatric disorders to drug dependence or vice versa. A total of 574 patients met the criteria for a dual diagnosis. A total of 362 patients progressed from substance abuse disorders to psychiatric disorders (SUD-PR) and 144 patients progressed from psychiatric disorders to drug addiction (PSY-PR). SUD-PR patients are more frequently affected by mood disorders. PSY-PR patients were more frequently diagnosed as psychotic or affected by anxiety disorders. The authors' findings suggest that the self-medication theory of dual diagnosis was relevant only for those with existing diagnoses of schizophrenia or anxiety disorders. When treating patients with a dual diagnosis, clinicians should ensure that the same attention is given to the treatment of drug dependence as it is to the treatment of comorbid psychiatric conditions.

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Available from: Angelo Giovanni Icro Maremmani
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    • ") and has been extended from the fullblown disorders to the affective temperaments, which, according to Akiskal and Mallya's conceptualization, reflect the substrate genetic for manic-depressive illness (Akiskal, 1983; Akiskal, 1989; Akiskal et al., 1989; Akiskal and Mallya, 1987; Cassano et al., 1989; Maremmani et al., 1994; Maremmani et al., 2009), and possibly underlies the genetic predisposition, particularly for irritable and hyperthymic types (Greenwood et al., 2012). Psychosis and heroin addiction are associated with withdrawal psychosis (Levinson et al., 1995) as well as comorbid dual diagnosis (Maremmani et al., 2011). "
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    ABSTRACT: Recent celebrity deaths have been widely reported in the media and turned the public attention to the coexistence of mood, psychiatric and substance-abuse disorders. These tragic and untimely deaths motivated us to examine the scientific and clinical data, including our own work in this area. The self-medication hypothesis states that individuals with psychiatric illness tend to use heroin to alleviate their symptoms. This study examined the correlations between heroin use, mood and psychiatric disorders, and their chronology in the context of dual diagnosis.
    Full-text · Article · Apr 2015 · Journal of Affective Disorders
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    • "On the other hand, it is also frequent to observe heroin addicts that came to clinical setting looking for any kind of help when they are in the last stages of addiction. In these conditions, heroin addicts, who, like in our sample, luckily present a better awareness of illness, are frequently junkies or two worlders with multi-daily heroin intake, present previously unsuccessful treatments and have a dual diagnosis, presenting a mental illness, frequently belonged to the bipolar spectrum, that could be related to their addiction history (Maremmani et al., 2011). In other words insight came in the end and its presence correlate with a more severe clinical presentation. "
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    ABSTRACT: In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic, and clinical characteristics, between patients with different levels of awareness of illness (insight). The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behavior. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic, and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period.
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    • "Therefore, high scores tend to reflect elevated levels of emotional reactivity, proneness to stress, and negative affect. Of relevance to our findings is the high co-morbidity between anxiety disorders and addiction disorders (Kessler et al., 1994; Maremmani et al., 2011). There is also evidence that individuals' mental state influences their response to addictive drugs. "
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