Academic journal article Alcohol Research

Prevalence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Academic journal article Alcohol Research

Prevalence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Article excerpt

Background: Uncertainties exist about the prevalence and comorbidity of substance use disorders and independent mood and anxiety disorders. Objective: To present nationally representative data on the prevalence and comorbidity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol and drug use disorders and independent mood and anxiety disorders (including only those that are not substance induced and that are not due to a general medical condition). Design: Faceto- face survey. Setting: The United States. Participants: Household and group quarters residents. Main Outcome Measures: Prevalence and associations of substance use disorders and independent mood and anxiety disorders. Results: The prevalences of 12-month DSM-IV independent mood and anxiety disorders in the U. S. population were 9.21 percent (95 percent confidence interval [CI], 8.78 percent-9.64 percent) and 11.08 percent (95 percent CI, 10.43 percent-11.73 percent), respectively. The rate of substance use disorders was 9.35 percent (95 percent CI, 8.86 percent-9.84 percent). Only a few individuals with mood or anxiety disorders were classified as having only substance-induced disorders. Associations between most substance use disorders and independent mood and anxiety disorders were positive and significant (p < .05). Conclusions: Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States. Associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant, suggesting that treatment for a comorbid mood or anxiety disorder should not be withheld from individuals with substance use disorders.

Substance use disorders and mood and anxiety disorders are widespread among the general population1-3 and are associated with substantial societal and personal costs.4-7 Furthermore, national epidemiologic surveys1-3 and numerous clinical studies8-12 consistently indicate that substance use disorders and mood and anxiety disorders have strong associations when considered on a lifetime basis. However, consensus has not been achieved on the meaning and implications of the lifetime association of these widespread disorders. Recent work in the general population separating past and current disorders has clarified that intoxication or withdrawal effects do not entirely account for the association,13 as had been asserted earlier.14-17 However, the nature of current or recent co-occurrence of substance and mood or anxiety disorder remains largely unexamined and poorly understood. Relative to lifetime disorders, current co-occurrence has much more salience in its public health and clinical implications. Thus, an important gap in knowledge about comorbidity remains.

One factor that has persistently hindered a better understanding of the relationship between substance use disorders and mood and anxiety disorders is diagnosis. The diagnosis of current mood or anxiety disorders among active substance abusers is complicated by the fact that many symptoms of intoxication and withdrawal from alcohol and other substances resemble the symptoms of mood and anxiety disorders. The diagnostic challenge among individuals with current substance use disorders has been to devise diagnostic criteria and measurement techniques that differentiate between intoxication and withdrawal symptoms and the symptoms of psychiatric disorders. This distinction is potentially crucial for etiologic research and treatment studies.

The DSM-IV18 represented a major departure from previous nomenclature in the importance placed on the independent and substance-induced distinction and the clarity and specificity of the guidelines for making the distinction. Among individuals with substance use disorders, independent DSM-IV diagnoses of mood or anxiety disorders can be made two ways. …

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