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How Can Comorbidity Be Diagnosed?
The high rate of comorbidity between drug use disorders and other mental illnesses argues for a comprehensive approach to intervention
that identifies, evaluates, and treats each disorder concurrently.
The needed approach calls for broad assessment tools that are less likely to result in a missed diagnosis. Accordingly, patients entering treatment for psychiatric illnesses should also be screened for substance use disorders and vice versa. Accurate diagnosis is complicated, however, by the similarities between drug-related symptoms such as withdrawal and those of potentially comorbid mental disorders. Thus, when people who abuse drugs enter treatment, it may be necessary to observe them after a period of abstinence
in order to distinguish the effects of substance intoxication or withdrawal from the symptoms of comorbid mental disorders–this would allow for a more accurate diagnosis.
Exposure to Traumatic Events Puts People at Higher Risk of Substance Use Disorders.
Emotionally traumatized people are at much higher risk of abusing licit, illicit, and prescription drugs. The strong association between PTSD and substance abuse is particularly
frequent and devastating among military veterans, among whom 38,000 PTSD cases have been documented in the past 5 years alone. Epidemiological studies
suggest that as many as half of them may have a co-occurring substance use disorder (SUD). The growing incidence of PTSD among returning veterans poses an enormous challenge for a health care system in which PTSD programs don't accept individuals with active SUDs while traditional SUD clinics defer the treatment of trauma-related issues. However, there are treatment options for PTSD and SUD at different stages of clinical validation; these include various combinations of psychosocial
(e.g., exposure therapy) and pharmacologic (e.g., mood stabilizers,
antianxiolitics, and antidepressants)
interventions. However, more research is urgently needed to identify the best treatment strategies for addressing PTSD comorbidities, in particular depression
and SUD, and to explore the notion that different treatments might be needed in response to civilian vs. combat PTSD.
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