Chapter 3

Psychiatric Disorders Among Drug-Dependent Subjects

Are They Primary or Secondary?

Wilson M. Compton, III, M.D.

Linda B. Cottler, Ph.D.

Deborah L. Phelps, Ph.D.

Arbi Ben Abdallah, M.S.

Edward L. Spitznagel, Ph.D.

Psychiatric disorders are much more common than expected among patients with substance use disorders. 1-18 While this finding may be interesting in and of itself, it also has important treatment and prognostic implications. For example, psychiatric symptoms among patients with substance use disorders have been shown to be associated with higher rates of drug relapse following treatment. 13,14,19 In addition, comorbidity has been shown to complicate treatment of both drug and nondrug problems. 20

Because of limited research, the causal link (if any) between drug dependence and other psychiatric disorders remains murky, especially where details on the progression from one illness to another are concerned. Lehman et al. 21 proposed several theoretical constructs: mental illness causes substance dependence; substance dependence causes mental illness; both diagnoses occur independently; and both could be caused by some common factor. These constructs are related to temporal association. For example, if mental illness results in substance dependence, then mental illness must, by definition, start first. If substance dependence

This study was supported by grants DA05619 (Dr. Cottler) and DA00209 (Dr. Compton) from the National Institute on Drug Abuse, Bethesda, MD.

-33-

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