Academic journal article Alcohol Research

Diagnosing Co-Morbid Drug Use in Patients with Alcohol Use Disorders

Academic journal article Alcohol Research

Diagnosing Co-Morbid Drug Use in Patients with Alcohol Use Disorders

Article excerpt

Alcohol and other drug (AOD) use disorders (i.e., AOD abuse and dependence) commonly co-occur. This co-morbidity has important social, psychiatric, and medical consequences. Although making an accurate diagnosis can be challenging, especially in the context of multiple disorders, clinicians can adopt practices to improve their diagnostic accuracy. These practices include an empathic, accepting, and nonjudgmental stance that encourages patients to be honest and forthcoming in their self-report of alcohol use; being sensitive to the prevalence of substance use disorders in all patient populations and settings; and being familiar with diagnostic criteria. KEY WORDS: Alcohol use disorder (AUD); alcohol and other drug disorder (AODD); substance use disorder (SUD); AOD abuse; AOD dependence; substance abuse; substance dependence; co-morbidity; multiple drug use; diagnosis; patient assessment and diagnosis; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)

As with alcohol and other drug (AOD) use, AOD use disorders (i.e., abuse and dependence) commonly co-occur and are associated with serious consequences. Making an accurate diagnosis can be complicated, but it is an important first step toward treatment and recovery. After reviewing the prevalence of AOD abuse and dependence co-morbidity and some of the negative social, psychiatric, and medical consequences of co-morbidity, this article presents an overview of how to accurately diagnose a substance use disorder, with a special emphasis on diagnosing drug use disorders in patients who have alcohol use disorders. In addition, it describes some barriers to making a diagnosis and techniques to overcome these barriers. The article focuses on the common drugs of abuse, such as cocaine, opiates, and cannabis. The diagnosis of alcohol use disorders is beyond the scope of this article. For this information, the reader is referred to the National Institute on Alcohol Abuse and Alcoholism's Helping Patients Who Drink Too Much: A Clinician's Guide1. In addition, nicotine use in patients with alcohol use disorders is not addressed because this co-morbidity was the focus of a past issue of Alcohol Research & Health (Vol. 29, No. 3, 2006). The recommendations included in this article are oriented toward men-tal health clinicians but address issues that pertain to most health care settings.

PREVALENCE OF CO-MORBID SUBSTANCE USE DISORDERS

AOD use disorders have a high preva-lence in the general population and fre-quently co-occur. In the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the 12-month prevalence of drug use disor-ders (i.e., the prevalence of those meet-ing the diagnosis for a drug use disorder in the previous 12 months) among those with 12-month alcohol use disorders was 13 percent (see figure 1). Conversely, the 12-month prevalence of alcohol use disorders among those with 12-month drug use disorders was 55.17 percent (Stinson et al. 2005). In the general population, the 12-month prevalence of drug use disorders was 2 percent (see figure 1) and the 12-month prevalence of alcohol use disorders was 8.46 percent (Stinson et al. 2005).

Among those with 12-month alcohol use disorders, NESARC reported the following 12-month prevalence rates of specific drug use disorders: sedatives (0.75 percent), tranquilizers (0.85 percent), opioids (2.41 percent), amphetamines (1.22 percent), hallucinogens (1.31 percent), cannabis (9.89 percent), cocaine (2.51 percent), and solvents/inhalants (0.17 percent) (Stinson et al. 2005). Rates of AOD use co-morbidity probably are even higher among patient populations. For instance, in a sample of 248 people seeking treatment for alcohol use disorders, 64 percent had a co-morbid drug use disorder at some point in their lifetime (see figure 2). Sixty-eight percent reported using one or more drugs in the past 90 days, including powder cocaine (33 percent), crack cocaine (29 percent), heroin (15 percent), and cannabis (24 percent) (Staines et al. …

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