Revised October 2007
When two disorders or illnesses occur simultaneously in the same person, they are called comorbid. Surveys show that drug abuse and other mental illnesses are often comorbid. Six out of ten people with a substance use disorder also suffer from another form of mental illness. But the high prevalence of these comorbidities does not mean that one condition caused the other, even if one appeared first. In fact, there are at least three scenarios that we should consider:
In reality, all three scenarios can contribute, in varying degrees, to the establishment of specific comorbid mental disorders and addiction.
Compared with the general population:
The rates of specific comorbidities also vary by gender. Among men and women in drug treatment, antisocial personality disorder is more common in men, while women have higher rates of major depression, posttraumatic stress disorder, and other anxiety disorders.
The high rate of comorbid substance abuse and mental illness points to the need for a comprehensive approach that identifies, evaluates, and simultaneously treats both disorders. Patients with co-occurring disorders often exhibit more severe symptoms than those caused by either disorder alone, underscoring the need for integrated treatment. Careful diagnosis and monitoring will help ensure that symptoms related to drug abuse (e.g., intoxication, withdrawal) are not mistaken for a discrete mental disorder. Even in people whose comorbidities do not occur simultaneously, research shows that mental disorders can increase vulnerability to subsequent drug abuse and that drug abuse constitutes a risk factor for subsequent mental disorders. Therefore, diagnosis and treatment of one disorder will likely reduce risk for the other, or at least improve its prognosis. The need to develop effective interventions to treat both conditions concurrently is strongly supported by research, but has been difficult to implement in practice because:
Still, behavioral treatment options customized for a given age group or gender have shown promise for treating drug abuse and mental disorder comorbidities, and research is under way to identify medications targeting both disorders. Clinicians and researchers generally agree that broad-spectrum diagnosis and concurrent therapy (pharmacological and behavioral) will lead to better outcomes for patients with comorbid disorders.
The stigma attached to substance abuse and mental disorders often hinders early diagnosis and proper treatment. Greater understanding resulting from recent scientific findings that substance abuse and mental illness disrupt some of the same brain functions will reduce the social stigma that hinders treatment seeking, quality, and access by patients with either or both conditions.