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CORK Bibliography: Psychiatric Co-morbidity, Epidemiology

47 citations. January 2009 to present

Prepared: September 2012

Assanangkornchai S; Edwards JG. Clinical and epidemiological assessment of substance misuse and psychiatric comorbidity. Current Opinion in Psychiatry 25(3): 187-193, 2012. (16 refs.)

Purpose of review: The purpose of our review was to select, summarize and express opinions on a range of research studies published in 2011 on the clinical assessment, screening and monitoring of patients with substance use and psychiatric comorbidity, together with epidemiological and other relevant studies. Recent findings: There was a wide range of publications on many aspects of comorbidity. The research was carried out on different populations in different treatment settings, including an alcohol and drug treatment centre, an emergency medical department, a community mental health centre, a methadone maintenance programme and inpatient unit, and in the community. Several structured or semi-structured interviews and self-administered instruments were used for the assessments of psychiatric disorders, substance use disorders and related problems. Each study has its strengths and weaknesses, with some studies reporting interesting new methodology or results, and others confirming what was already known about the subject. Summary: The results of most studies support a high prevalence of substance misuse among individuals with psychiatric disorders and vice versa. Various aspects of the relationship between the two conditions are discussed.

Blazer DG; Wu LT. Patterns of tobacco use and tobacco-related psychiatric morbidity and substance use among middle-aged and older adults in the United States. Aging & Mental Health 16(3): 296-304, 2012. (36 refs.)

Objectives: To examine prevalence of tobacco use and identify psychiatric symptoms and substance use correlates of tobacco use comparing adults 50-64 years of age with those 65+ years of age (N=10, 891). Methods: Data were from the 2008-2009 US National Surveys on Drug Use and Health. Results: Past-year tobacco use was one-half as frequent among adults aged 65+ years (14.1%) compared to adults aged 50-64 years (30.2%); the latter group surpassed the former in rates of cigarette smoking (24.8% vs. 10.6%), daily cigarette smoking (16.5% vs. 7.1%), cigar smoking (7.4% vs. 2.3%), and smokeless tobacco use (2.5% vs. 1.7%). Increased odds of cigarette smoking were noted among men, whites, African Americans, and those who had less education, had lower income, were not currently married, or were binge drinkers or illicit/non-medical drug users. In controlled analyses, odds ratio in those 65+ years of age who had smoked during the past year was 2.2 for binge drinking and 3.5 for illicit or non-medical drug use. Odds ratio of binge drinking among those 65+ years of age for cigar smokers during the past year was 3.1. Past-year cigarette smoking was not associated with reports of symptoms of depression or anxiety in the 65+ age group. Conclusions: Tobacco use is less prevalent among adults 65+ years of age yet continues to be strongly associated with binge drinking and illicit or non-medical drug use. Preventive efforts to decrease these substance use problems should include programs to decrease tobacco use.

Botega NJ; Mitsuushi GN; de Azevedo RCS; Lima DD; Fanger PC; Mauro MLF et al. Depression, alcohol use disorders and nicotine dependence among patients at a general hospital. Revista Brasileira de Psiquiatria 32(3): 250-256, 2010. (32 refs.)

Objective: To determine prevalence rates and identify patient characteristics associated with depression alcohol use disorders and nicotine dependence among individuals admitted to a general teaching hospital. Method: Using the Hospitalital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test we assessed 4 352 consecutive medical and surgical patients admitted over a 13-month period. The patients were also asked to report their daily cigarette smoking habits during the last month. Multiple logistic regression analyses were performed and odds ratios (ORs) were calculated. Results: The mean age of the sample was 49.3 years, and 56.6% were male. Prevalence rates of depression alcohol use disorders and nicotine dependence were, respectively, 14%, 9.8% and 16.9% In the multivariate analysis depression was associated with previous suicide attempts (OR = 8.7), lower level of education (OR = 3 6), prior use of psychotropic medications (OR = 3 1) cancer (OR = I.7) and pain (OR = I 7). Alcohol use disorders were associated with male sex (OR = 6 .3), smoking (OR = 3.5), admission for an external cause of injury such as a traffic accident (OR = 2.4), and previous suicide attempts (OR = 2 3) Nicotine dependence was associated with alcohol use disorders (OR = 3.4) young adulthood (OR = 2.3) widowhood (OR = 2.2) and previous suicide attempts (OR = I 8) Conclusion This is the largest sample of medical and surgical patients ever surveyed with standardized screening Instruments in a general hospital in Brazil. The high prevalence rates of psychiatric disorders and the profiles of the patients evaluated in this study underscore the need to develop methods that are more effective for detecting and managing such disorders. Hospital admission should be considered a major opportunity for the detection of psychiatric disorders and the subsequent implementation of the appropriate specific treatment strategies

Brook JS; Zhang CS; Brook DW; Koppel J; Whiteman M. Psychosocial predictors of nicotine dependence among women during their mid-sixties. American Journal on Addictions 21(4): 302-312, 2012. (56 refs.)

Although there is considerable research demonstrating the prospective association between earlier maladaptive personal attributes and later nicotine dependence, there is less work on the psychosocial mediators of this relationship. Maladaptive personal attributes appear in the form of depression, anxiety, and interpersonal sensitivity. This study was designed to assess the prospective relationship between earlier maladaptive personal attributes (mean age = 40) and later nicotine dependence ((X) over bar age = 65.2) within an understudied female community sample. The participants were given self-administered questionnaires. The results supported a model by which earlier maladaptive personal attributes predicted later nicotine dependence through several indirect pathways. In addition to cigarette smoking, several domains mediated the relation of earlier maladaptive personal attributes and later nicotine dependence. These domains included internal factors (ie, later maladaptive personal attributes), interpersonal factors (ie, marital/partner conflict), later contextual factors (ie, family financial difficulty). Our multidimensional longitudinal findings have important implications for the prevention and treatment of nicotine dependence. The results identify earlier and later significant psychosocial risk factors to be targeted, and suggest the timing of interventions to reduce or eliminate nicotine dependence.

Campbell G; Darke S; Popple G. Effects of Client Characteristics and Mental Health on Treatment Completion and Retention in a Therapeutic Community. NDARC Technical Report No. 316. Sydney: National Drug and Alcohol Research Centre, 2010

Background: One of the key predictors of treatment outcome is retention in treatment. Previous research, however, has produced inconsistent results about factors that might influence this. This research was undertaken to examine client characteristics that might influence retention and completion in residential drug-free services and residential opioid-based treatment services. Methodology: A sample of 249 clients were recruited from We Help Ourselves (WHOS) Sydney-based therapeutic community (TC) treatment services. One-hundred and ninety-one were from the drug-free services and fifty eight clients were recruited from the opioid-based services. Clients completed a face-to-face interview that asked about demographics, criminal history, lifetime and current drug use, mental health history and current mental health, and readiness to change. Treatment cessation data was collected on clients once they had left the service. Key findings Demographics: The mean age of entrants was early to mid-thirties; approximately two-thirds were male. Mean years of education was approximately 10 years. Over half had not completed any tertiary education. The vast majority were receiving their main source of income from a temporary benefit. One-third of clients from the drug-free services and two-thirds of clients from the opioid-based services reported that they had been prison. A lifetime of heavy and poly drug was found in clients from both services. Over half had been diagnosed with a mental health problem. Treatment completion and early drop-out: High proportions of clients from both the drug-free TC services and the opioid-based services completed treatment. Only a small minority dropped out very early. Despite this, the current study found that there were very limited results with regards to the effect of mental health on treatment completion and early drop-out. Paradoxically, among the opioid-using clients, a. A lifetime diagnosis of a mental health problem was associated with a higher likelihood of completion, but a Borderline Personality Disorder was associated with a lower rates. Effect of other client characteristics on treatment completion and early drop-out: There was a limited effect of other client characteristics on treatment completion and early drop-out. Among opioid-using clients there were no predictors of treatment completion. There was no effect of past, current, frequency or quantity of drug use on retention. Differences between gender: There were differences between the males and females from the drug-free services, but not from the opioid-based services. Women were more likely to have a university degree, were more likely to have ever engaged in sex work, less likely to have a prison history, and were suffering from more severe mental health problems. Women in the drug-free service also had lower completion rates than the males. Conclusions: The major finding was that psychopathology had no relation to either treatment completion or early drop-out in the drug-free services, and only a limited effect in the opioid-based services. Clients with psychopathology should be not be seen as treatment "risks"

Public Domain

Carra G; Johnson S. Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK: A systematic review. (review). Social Psychiatry and Psychiatric Epidemiology 44(6): 429-447, 2009. (108 refs.)

Background: Comorbid substance misuse in psychosis is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for such 'dual diagnosis'. Evidence has now been accumulating in the UK since the early 1990s, and allows a relatively comprehensive comparison of rates between service settings, geographical areas and social contexts in terms of ethnic background. Methods: A literature search was carried out with the aim of investigating: (a) comorbid alcohol and drug misuse rates in people with established psychosis in different mental health and addiction settings in the UK, (b) variations in such rates between different population groups. Results: There are wide variations in reported drug and alcohol misuse rates in psychosis. Most recent UK studies report rates between 20 and 37% in mental health settings, while figures in addiction settings are less clear (6-15%). Rates are generally not as high as in US studies, but appear to be especially high in inpatient and crisis team settings (38-50%) and forensic settings. In terms of geography, rates appear highest in inner city areas. Some ethnic groups are over-represented among clinical populations of people with dual diagnosis. Conclusions: Rates of substance misuse in psychosis are likely to be influenced by service setting, population composition and geography. Acute and forensic settings are especially appropriate for the development of targeted interventions.

Dakwar E; Nunes EV; Bisaga A; Carpenter KC; Mariani JP; Sullivan MA et al. A comparison of independent depression and substance-induced depression in cannabis-, cocaine-, and opioid-dependent treatment seekers. American Journal on Addictions 20(5): 441-446, 2011. (16 refs.)

Depressive symptoms often coexist with substance use disorders (SUDs). The DSM-IV has identified two distinct categories for depression coexisting with SUDs-independent depression and substance-induced depression. While this distinction has important therapeutic and prognostic implications, it remains difficult to make in clinical practice; the differentiation is often guided by chronological and symptom severity criteria that patients may be unable to precisely provide. Furthermore, it is unclear whether the various substances commonly abused-cannabis, cocaine, and opioids-are equally associated with the two types of depression. Predictors, associations, and other markers may be helpful in guiding the diagnostic process. We, therefore, examined the differences between cannabis-, cocaine-, and opioid-dependent individuals contending with independent depression and those contending with substance-induced depression in regard to several variables, hypothesizing that independent depression is more commonly found in females, and that it is associated with higher symptom severity and psychiatric comorbidity. Cocaine-, cannabis-, and/or opioid-dependent, treatment-seeking individuals underwent a structured clinical interview for DSM-IV-TR disorders after providing consent at our clinical research site; those with coexisting primary depression or substance-induced depression diagnoses were provided with further questionnaires and were entered into this analysis (n = 242). Pair-wise comparisons were conducted between the groups classified as independent versus substance-induced depression with 2-by-2 tables and chi-square tests for dichotomous independent variables, and t-tests for continuous variables. Binomial logistic regression was performed in order to ascertain which of the variables were significant predictors. Women were more likely than men to have independent depression (p < .005). Cannabis dependence was highly associated with independent depression (p < .001), while cocaine dependence was highly associated with substance-induced depression (p < .05). Independent depression was associated with higher Hamilton depression scale scores (16 vs. 10, p < .005), and was more highly associated with the comorbid diagnosis of posttraumatic stress disorder (p < .05). Cannabis dependence (p < .001) and female gender (p < .05) were highly significant predictors of major depression specifically. Gender, cannabis dependence, psychiatric severity, and psychiatric comorbidity have variable, statistically significant associations with independent and substance-induced depression, and may be helpful in guiding the diagnostic process.

Demetrovics Z. Co-morbidity of drug addiction: An analysis of epidemiological data and possible etiological models. Addiction Research & Theory 17(4): 420-431, 2009. (75 refs.)

This review summarizes the literature on psychiatric co-morbidity of substance use. The author overviews general population epidemiological surveys as well as clinical studies, and discusses both DSM axis I and axis II disorders. After presenting epidemiological data the author analyzes the nature of relationship between psychoactive substance use and other mental disorders, and -- through examples -- four possible models of this relationship are examined. Despite the lack of precisely determined prevalence rates, some definite tendencies could be observed along the consistent results of the studies. Due to methodological problems, however, many questions remain unanswered. Although there are relatively comprehensive studies on psychiatric disorders associated with drug use and drug addiction, the question of causality is relatively unresolved. Theoretically possible relations regarding causality seem to overlap in practice, and in most cases linear type connection is unlikely. It can be concluded that general questions, such as which disorders have a great significance in connection to drug use, can be answered. Additional research is needed, however, to examine the effects of different drug types, race, and gender. Understanding causality also requires further research.

Duffy SA; Kilbourne AM; Austin KL; Dalack GW; Woltmann EM; Waxmonsky J et al. Risk of smoking and receipt of cessation services among Veterans with mental disorders. Psychiatric Services 63(4): 325-332, 2012. (60 refs.)

Objective: The purpose of this study was to determine rates of smoking and receipt of provider recommendations to quit smoking among patients with mental disorders treated in U.S. Department of Veterans Affairs (VA) treatment settings. Methods: The authors conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients (N=224,193). Logistic regression was used to determine the independent association of mental health diagnosis and the dependent variables of smoking and receipt of provider recommendations to quit smoking. Results: Patients with mental disorders had greater odds of smoking, compared with those without mental disorders (p<.05). Those with various mental disorders reported similar rates of receiving services (more than 60% to 80% reported receiving selected services), compared with those without these disorders, except that those with schizophrenia had more than 30% lower odds of receiving advice to quit smoking from their physicians (p<.05). Moreover, those who had co-occurring posttraumatic stress disorder or substance use disorders had significantly greater odds of reporting that they received advice to quit, recommendations for medications, and physician discussions of quitting methods, compared with those without these disorders (p<.05). Older patients, male patients, members of ethnic minority groups, those who were unmarried, those who were disabled or unemployed, and those living in rural areas had lower odds of receiving selected services (p<.05). Conclusions: The majority of patients with mental disorders served by the VA reported receiving cessation services, yet their smoking rates remained high, and selected groups were at risk for receiving fewer cessation services, suggesting the continued need to disseminate cessation services.

Flood M; Buckwater KC. Recommendations for mental health care of older adults. Part 2. An overview of dementia, delirium, and substance abuse. Journal of Gerontological Nursing 35(2): 35-47, 2009. (59 refs.)

Expansion and diversification of the older adult demographic group is a key indication that nurses need to be aware of current recommended practice related to the most common mental health diagnoses in this age group. Such conditions include depression, anxiety, dementia, delirium, and substance abuse/dependence. This article, the second in a two-part series, focuses on key assessment components and suggested interventions for dementia, delirium, and substance abuse/dependence.

Frisher M; Crome I; Martino O; Croft P. Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005. Schizophrenia Research 113(2-3): 123-128, 2009. (30 refs.)

A recent systematic review concluded that cannabis use increases risk of psychotic outcomes independently of confounding and transient intoxication effects. Furthermore, a model of the association between cannabis use and schizophrenia indicated that the incidence and prevalence of schizophrenia would increase from 1990 onwards. The model is based on three factors: a) increased relative risk of psychotic outcomes for frequent cannabis users compared to those who have never used cannabis between 1.8 and 3.1, b) a substantial rise in UK cannabis use from the mid-1970s and c) elevated risk of 20 years from first use of cannabis. This paper investigates whether this has occurred in the UK by examining trends in the annual prevalence and incidence of schizophrenia and psychoses, as measured by diagnosed cases from 1996 to 2005. Retrospective analysis of the General Practice Research Database (GPRD) was conducted for 183 practices in England, Wales, Scotland and Northern Ireland. The study cohort comprised almost 600,000 patients each year, representing approximately 2.3% of the UK population aged 16 to 44. Between 1996 and 2005 the incidence and prevalence of schizophrenia and psychoses were either stable or declining. Explanations other than a genuine stability or decline were considered, but appeared less plausible. In conclusion, this study did not find any evidence of increasing schizophrenia or psychoses in the general population from 1996 to 2005.

Gunewardene R; Lampe L; Ilchef R. Prevalence of hepatitis C in two inpatient psychiatry populations. Australasian Psychiatry 18(4): 330-334, 2010. (29 refs.)

Objective: Psychiatric populations may be particularly at risk of hepatitis C (HCV), less likely to receive appropriate interventions and at greater risk of liver damage due to comorbid substance abuse. This study sought to determine the prevalence of HCV in two inpatient psychiatric populations of seriously mentally ill patients and the relationship to risk factor screening. Method: Two inpatient units were chosen in similar socio-economic areas. Persons admitted to these wards over the course of the study were invited to participate and provided with pre-test counselling. Where informed consent was obtained, individuals were included in the study. It was planned to screen all consenting patients. However, funding was reduced for one site meaning that only patients with identified risk factors could be screened there. Results: Around 18% of psychiatric inpatients admitted to risk factors for HCV. The prevalence of HCV with screening of all consenting patients in unit A was 3.2%. With selective screening in unit B, 41.7% of those with identified risk factors tested positive. These results compare to the Australian community rate of approximately 1.1%. Conclusion: Results are consistent with elevated rates of HCV in mentally ill populations elsewhere in the world, and provide support for selective screening.

Hadland SE; Marshall BDL; Kerr T; Zhang R; Montaner JS; Wood E. A comparison of drug use and risk behavior profiles among younger and older street youth. Substance Use & Misuse 46(12): 1486-1494, 2011. (48 refs.)

Among 559 street youth recruited between 2005 and 2007 in Vancouver, Canada, young drug users (<21 years of age) were compared with older drug users (>= 21 years) with regard to recent drug use and sexual practices using multiple logistic regression. Older youth were more likely to be male and of Aboriginal ancestry, to have more significant depressive symptoms, to have recently engaged in crack smoking, and to have had a recent history of injection drug use. Young drug users, by contrast, were more likely to have engaged in recent binge alcohol use. Efforts to reduce drug use-related harm among street youth may be improved by considering the highly prevalent use of "harder" drugs and risk for depression among older youth.

Hasin D; Kilcoyne B. Comorbidity of psychiatric and substance use disorders in the United States: Current issues and findings from the NESARC. (review). Current Opinion in Psychiatry 25(3): 165-171, 2012. (49 refs.)

Purpose of review: The comorbidity between psychiatric and substance use disorders remains an important phenomenon to understand, and an active area of investigation. The purpose of this review is to highlight key 2011 issues and novel findings on psychiatric and substance disorders comorbidity from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large national survey of the US general population. Recent findings: Topics of active investigation included the internalizing/externalizing meta-structure of common mental disorders; the 10 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) personality disorders; the 3-year incidence and persistence of disorders; treatment of major depression; and many other topics not as easily categorized. Summary: Meta-structure may increasingly offer a parsimonious way of addressing comorbidity, although adding new disorders adds complexity and the value of etiologic analyses utilizing broad dimensions of psychopathology rather than individual disorders is not yet fully known. Expanding the range of personality disorders beyond antisocial personality disorder appears essential in understanding the incidence and persistence of substance use disorders. Substance use disorders have low rates of treatment relative to major depression, but increase the likelihood of depression treatment among comorbid cases, a phenomenon that needs to be understood. These comorbidity studies provide much novel information, and indicate many potentially fruitful directions for new research.

Hazen AL; Connelly CD; Roesch SC; Hough RL; Landsverk JA. Child maltreatment profiles and adjustment problems in high-risk adolescents. Journal of Interpersonal Violence 24(2): 361-378, 2009. (43 refs.)

The purpose of this article is to identify profiles of maltreatment experiences in a sample of high-risk adolescents and to investigate the relationship between the derived profiles and psychological adjustment. Participants are 1,131 youth between the ages of 12 and 18 years involved with publicly funded mental health and social services. Information on physical, sexual, and emotional maltreatment and psychological symptoms are obtained in interviews with adolescents and their primary caregivers. Using latent profile analysis, three maltreatment profiles are identified: "sexual + physical + emotional maltreatment," "physical + emotional maltreatment," and "low maltreatment." Adolescents in the two maltreatment profiles generally have significantly higher scores on symptom scales compared with those in the "low maltreatment" profile, but scores in the two maltreatment profiles do not differ. Findings highlight the need for agencies to identify and provide appropriate intervention for youth who experience multiple types of maltreatment.

Helseth V; Lykke-Enger T; Johnsen J; Waal H. Substance use disorders among psychotic patients admitted to inpatient psychiatric care. Nordic Journal of Psychiatry 63(1): 72-77, 2009. (42 refs.)

Previous epidemiological and clinical studies have shown high rates of substance use disorders in patients with psychotic disorders. There are few studies from the Scandinavian countries. The aim of this study was to investigate the rate of substance use disorders in a group of Norwegian psychotic inpatients from a specific catchment area. Sixty patients, aged 18-40 years, were interviewed through standardized methods: the Addiction Severity Index (EuropASI) and the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I). Urine toxicology screens confirmed patients' self-report of recent substance use. The lifetime rate of substance use disorders was 70% when all psychotic disorders were included and 62.5% when substance-induced psychotic disorders were excluded. Fifty percent of all the patients studied had current substance use disorders. The majority of substance use disorders were dependence disorders. Alcohol, amphetamine and cannabis were the dominant substances. The level of comorbidity found in this study is comparable with that found in American studies, despite lower prevalence of substance use in the Norwegian population. The high rate of substance use disorders in psychotic inpatients has implications for the treatment and the organization of psychiatric care for these patients.

Hubicka B; Kallmen H; Hiltunen A; Bergman H. Personality traits and mental health of severe drunk drivers in Sweden. Social Psychiatry and Psychiatric Epidemiology 45(7): 723-731, 2010. (59 refs.)

The present study was intended to investigate personality characteristics and mental health of severe driving under influence (DUI) offenders in a Swedish cohort. More specifically the aim was to investigate the personality traits as assessed by The NEO personality inventory (NEO-PI-R) and aspects of mental health as assessed by the symptom checklist (SCL-90) as compared to the general population. The subjects were 162 severe DUI offenders (with the BAC > 0.099%) with an age range of 18-88 years, 143 males and 19 females. It was found that the openness to experience and conscientiousness scales of NEO-PI-R differentiated Swedish DUI offenders from Swedish norm population. The differences between the DUI group and the general population on the on SCL-90 scales were all significant except on the Hostility scale. Two main subtypes of DUI offenders identified were roughly comparable to types I and II alcoholics, as in Cloninger's typology. Among all the scales used (personality traits, psychiatric comorbidity and alcohol use), the only factor that was predictive for future relapses to drunk driving was the factor of depression.

Iskandar S; Kamal R; De Jong CA. Psychiatric comorbidity in injecting drug users in Asia and Africa. (review). Current Opinion in Psychiatry 25(3): 213-218, 2012. (68 refs.)

Purpose of review: The prevalence of psychiatric co-morbidity in injecting drug users (IDUs) in the Western countries is high and is associated with lower quality of life and reduces the effectiveness of treatment programs. The aim of this study is to provide a review about psychiatric comorbidity in IDUs in Asia and Africa, where HIV prevalence is high and still increasing. Recent findings: Studies focusing on psychiatric comorbidity in Asia and Africa are scarce. The prevalence of psychiatric comorbidity is comparable with the prevalence in western countries. Psychiatric disorders can occur before or during drug abuse and are also associated with substance abuse and physical comorbidity and its treatments. Childhood trauma followed by post-traumatic disorders is a significant risk factor for substance abuse. Psychiatric co-occurring disorders influence the adherence to the physical and drug use treatment. Evidence-based treatment for psychiatric comorbidity in IDUs is still limited. Summary: A better understanding of the prevalence of psychiatric disorders in IDUs and its impact on the overall treatments is growing. However, more studies focusing on the treatment for psychiatric comorbidity in IDUs in Asia and Africa are needed.

Jessup MA; Dibble SL; Cooper BA. Smoking and behavioral health of women. Journal of Women's Health 21(7): 783-791, 2012. (64 refs.)

Background: Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. Methods: Using a convenience sample (n = 1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. Results: One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. Conclusions: Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for women's health.

Kaminer Y; Winters KC, eds. Clinical Manual of Adolescent Substance Abuse Treatment. Washington DC: American Psychiatric Association, 2011. (Chapter refs.)

This book in 16 chapters with a total of 45 contributors is a comprehensive work on adolescent substance use problems and treatment. It begins with consideration of adolescent substance use, with data on the prevalence and natural history of substance use and substance use disorders. In respect to etiology and prevention, both protective and risk factors are discussed. Attention then turns to screening, assessment and brief interventions, and includes a chapter on the use of biomarker testing in adolescents. In turning to treatment, there are chapters dealing with treatment planning and placement criteria for different treatment settings, discussion of adolescent behavioral changed, and the use of pharmacotherapy in treatment of substance use disorders. A chapter is directed to club drugs, prescription drugs, and over-the-counter medication, and the diagnosis of treatment and intervention. Individual chapters are directed to specific treatment approaches: brief motivational interventions, cognitive-behavioral therapy, and contingency management; adolescents community reinforcement approach and mutidimensional family therapy, as well as relapse prevention; and twelve-step programs. Several chapters consider co-occurring problems: attention deficit/hyperactivity; internalizing disorders (depression, anxiety disorders, and PTST; assessment and treatment of suicidal behavior; and assessment and treatment of psychotic disorders and bipolar disorder. The final chapter addresses the care of adolescents in the juvenile system with substance use problems.

Keizer I; Gex-Fabry M; Eytan A; Bertschy G. Smoking in psychiatric inpatients: Association with working status, diagnosis, comorbid substance abuse and history of suicide attempts. Addictive Behaviors 34(10, Special Issue): 815-820, 2009. (45 refs.)

The present cross-sectional study investigates the association between smoking and psychopathology (ICD-10 diagnosis), history of suicide attempts and socio-demographic characteristics in a sample of 180 adult hospitalized patients. Results confirmed a high frequency of Current smokers (63.3%) and heavy smokers with >= 20 cigarettes/day (47.4%). Smoking was significantly associated with being on invalid pension, social welfare or unemployed (>70% of smokers, p = 0.008), a history of suicide attempts (73.2%, p = 0.04) and the primary mental health diagnosis (p = 0.004). A majority of patients (57.8%) presented at least one comorbid condition. Multivariate logistic regression indicated that disorders due to psychoactive substances, either as a primary diagnosis or as a comorbid condition, were significantly associated with smoking, in addition to significant effects of age group, financial resources and history Of Suicide attempts. Investigation of health beliefs showed that psychopathology did not compromise a realistic appreciation of smoke-related health risks. These results underline the importance of taking into account socio-demographic factors and substance use comorbidity in designing targeted interventions to reduce smoking in psychiatric patients.

Kerfoot KE; Petrakis IL; Rosenheck RA. Dual diagnosis in an aging population: Prevalence of psychiatric disorders, comorbid substance abuse, and mental health service utilization in the Department of Veterans Affairs. Journal of Dual Diagnosis 7(1-2): 4- 13, 2011. (16 refs.)

Objective: In the context of an aging baby boom cohort with higher rates of substance use disorders than previous cohorts, the abuse of substances and dual diagnosis represent growing areas of concern among older adults. The aims of this study were to determine the current treated prevalence of major psychiatric illnesses, substance use disorders, and dual diagnosis across multiple age groups in a national sample of mental health patients and to examine associated service utilization. Methods: Using administrative data from specialty mental health clinics in the Department of Veterans Affairs (N = 911,725), treated prevalence of major psychiatric illnesses, substance use disorders, and dual diagnosis across multiple age groups were determined over a 1-year interval (FY 2009). Associated mental health service utilization was examined. Results: Treated prevalence of almost all major psychiatric and substance use disorders decreased with age, while dementias increased with age. Across all major psychiatric illnesses, documented comorbid substance abuse decreased with age. Those with dual diagnoses had higher utilization of outpatient services compared to those without substance use disorders. With older age, patients had fewer outpatient visits and reduced likelihood of psychiatric hospitalization, but incurred more inpatient days per episode. Conclusions: Treated prevalence of substance use disorders and dual diagnosis decreases with age, falling to approximately 10% in those older than 65. Questions remain regarding the possibility of underdiagnosis of substance use disorders in the elderly.

Kosten TR; Newton TF. Epidemiology and psychiatric comorbidity. IN: Kosten TR; Newton TF; De La Garza R; Hale CN, eds. Cocaine and Methamphetamine Dependence: Advances in Treatment. Washington DC: American Psychiatric Association, 2011. pp. 1-12

This first chapter in a book dealing with advances in the treatment of cocaine and methamphetamine dependence sets forth the epidemiology of stimulant abuse and dependence, and the related psychiatric comorbidity. Globally there is wide variation in the distribution of these problems. In the United States there has been a growing number of stimulant users and problems associated with abuse and dependence. This is evidenced by emergency room visits as well as increasing presence in the criminal justice system. Frequently occurring psychiatric illnesses include schizophrenia, major depression and post-traumatic stress disorder; smoking is also more common than in the general population.

Lai HMX; Huang QR. Comorbidity of mental disorders and alcohol- and drug-use disorders: Analysis of New South Wales inpatient data. Drug and Alcohol Review 28(3): 235-242, 2009. (28 refs.)

Introduction and Aims. Alcohol- and other drug-use disorders have been found to be associated with mental disorders, however, complete characteristics of these comorbid mental disorders are not completely clear in early population based studies. This study aimed to explore the extent and profiles of comorbid mental disorders with alcohol- and other drug-use disorders using a large inpatient dataset. Methods. The data source was the New South Wales (NSW) Inpatient Statistic Data Collection which collects the clinical data of hospital admissions in NSW, Australia. The data were coded using the International Classification of Diseases-10th Revision (ICD-10). The data were from 1 July 2005 to 30 June 2006 the Australian financial year and statistical analysis was performed using SAS. Results. Of 1,592,156 patients admitted, 91,510 (6%) had at least one mental disorder diagnosis and 18,283 (1.1%) had at least one alcohol- or other drug-related diagnosis. Of these patients, an overall 9.6% had dual diagnoses. Comorbidity was nearly five times higher in alcohol- and other drug-use disorders than in mental health disorders (52.4% vs. 10.5%). Comorbidity was higher in males than females (12% vs. 7.1%) and was the most common in patients aged from 20 to 49 regardless of sex. There was a significantly increased risk of developing a comorbid condition in all age groups above 10 years. The most common mental health disorders were major depressive disorders, followed by dementia, anxiety and severe stress. Alcohol-use disorder was the most common diagnosis, followed by cannabis and opioids. Discussion and Conclusion. This study shows the characteristics of comorbid mental and alcohol- or other drug-use disorders. The study extends our understanding of issues addressed in previous population studies.

Langas AM; Malt UF; Opjordsmoen S. Comorbid mental disorders in substance users from a single catchment area: A clinical study. BMC Psychiatry 11: e-article 25, 2011. (105 refs.)

Background: The optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described. Methods: First-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms. Discussion: This study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.

Lasser KE. Update in smoking and mental illness: A primary care perspective. Journal of Dual Diagnosis 5(2): 191-196, 2009. (20 refs.)

This article will review population-based nationally representative data on rates of smoking and tobacco cessation in adults with and without mental illness. We begin with a review of the methods and findings from the 1991-1992 National Comorbidity Survey. This study found that 41% of persons who had a mental illness in the past month were current smokers, that persons with mental illness are twice as likely to smoke as persons without mental illness, and that heavy smoking is rare in persons without mental illness. Persons with a current mental illness smoked 44% of all cigarettes in the United States. We then explore the reasons that persons with mental illness smoke at such high rates and examine the directions of causality between smoking and mental illness. We review tobacco companies' marketing activities that have targeted mentally ill smokers. The health consequences of smoking in this vulnerable group are dire. An estimated 200,000 smokers with mental illness or addiction die each year from smoking. Despite their high rates of smoking, a substantial proportion of persons with psychiatric disorders are able to quit.

Lynskey MT; Agrawal A; Heath AC. Genetically informative research on adolescent substance use: Methods, findings, and challenges. (review). Journal of The American Academy of Child and Adolescent Psychiatry 49(12): 1202-1214, 2010. (104 refs.)

Objective: To provide an overview of the genetic epidemiology of substance use and misuse in adolescents. Method: A selective review of genetically informative research strategies, their limitations, and key findings examining issues related to the heritability of substance use and substance use disorders in children and adolescents is presented. Results: Adoption, twin, and extended-family designs have established there is a strong heritable component to liability to nicotine, alcohol, and illicit drug dependence in adults. However, shared environmental influences are relatively stronger in youth samples and at earlier stages of substance involvement (e.g., use). There is considerable overlap in the genetic influences associated with the abuse/dependence across drug classes, and shared genetic influences contribute to the commonly observed associations between substance-use disorders and externalizing and, to a lesser extent, internalizing psychopathology. Rapid technologic advances have made the identification of specific gene variants that influence risks for substance-use disorders feasible, and linkage and association (including genomewide association studies) have identified promising candidate genes implicated in the development of substance-use disorders. Conclusions: Studies using genetically informative research designs, including those that examine aggregate genetic factors and those examining specific gene variants, individually and in interaction with environmental influences, offer promising avenues not only for delineating genetic effects on substance-use disorders but also for understanding the unfolding of risk across development and the interaction between environmental and genetic factors in the etiology of these disorders.

Ma X; Xiang YT; Cai ZJ; Li SR; Xiang YQ; Guo HL et al. Smoking and psychiatric disorders in the rural and urban regions of Beijing, China: A community-based survey. Drug and Alcohol Dependence 100(1-2): 146-152, 2009. (28 refs.)

Background: In China, there is limited information on smoking and its socio-demographic correlates in general, and in psychiatric patients in particular. The aim of this study was to determine the prevalence of lifetime, current mild, and heavy smoking, the socio-demographic correlates of current smoking, and its relationship with psychiatric disorders in the Beijing municipality, China. Methods: A total of 5926 subjects who met the study's entry criteria were randomly selected from the urban and rural areas of Beijing and interviewed using standardized assessment tools, including the collection of basic socio-demographic and clinical data. All subjects fully cooperated in the interviews and readily disclosed all of the information. Results: The prevalence of lifetime smoking was 35.9%: the rates for current mild and heavy smoking were 21.8% and 10.8%, respectively. An age of 24 years or above, male sex, married. divorced, separated or widowed marital status, relatively low level of education (less than college level), being employed, a relatively high monthly income (more than RMB500), rural abode, and having a psychiatric disorder were risk factors of current smoking. Both current mild and heavy smoking were significantly associated with alcohol dependence, and current heavy smoking was also associated with a history of a major depressive episode. Conclusions: The prevalence of smoking in the rural and urban areas of Beijing is unacceptably high. In addition to certain socio-demographic factors, smoking was associated with common psychiatric disorders. Nationwide surveys are warranted to further explore the prevalence of smoking in China. Effective strategies to reduce the high rate of smoking are also needed.

McClave AK; Eily LRM; Davis SP; Dube SR. Smoking characteristics of adults with selected lifetime mental illnesses: Results from the 2007 National Health Interview Survey. American Journal of Public Health 100(12): 2464-2472, 2010. (47 refs.)

Objectives: We estimated smoking prevalence frequency intensity and cessation attempts among US adults with selected diagnosed lifetime mental illnesses. Methods: We used data from the 2007 National Health Interview Survey on 23393 noninstitutionalized US adults to obtain age adjusted estimates of smoking prevalence frequency intensity and cessation attempts for adults screened as having serious psychological distress and persons self reporting bipolar disorder schizophrenia attention deficit disorder or hyperactivity dementia or phobias or fears. Results: The age adjusted smoking prevalence of adults with mental illness or serious psychological distress ranged from 34 3% (phobias or fears) to 59 1% (schizophrenia) compared with 18 3% of adults with no such illness. Smoking prevalence increased with the number of comorbid mental illnesses. Cessation attempts among persons with diagnosed mental illness or serious psychological distress were comparable to attempts among adults without mental illnesses or distress however lower quit ratios were observed among adults with these diagnoses indicating lower success in quitting. Conclusions: The prevalence of current smoking was higher among persons with mental illnesses than among adults without mental illnesses. Our findings stress the need for prevention and cessation efforts targeting adults with mental illnesses.

McDonell MG; Hsiao RC; Russo J; Pasic J; Ries RK. Clinical prevalence and correlates of substance use in adolescent psychiatric emergency patients. Pediatric Emergency Care 27(5): 384- 389, 2011. (38 refs.)

Objectives: This study used clinical and administrative data to describe the clinical prevalence and correlates of substance use disorders (SUDs) in 622 adolescents aged 12 to 17 years who were evaluated with 1 or more psychiatric diagnoses after presenting to an urban psychiatric emergency service. Methods: Clinical and administrative data including demographics, diagnosis, psychiatric severity, suicidality, treatment history, treatment disposition, social support, and overall functioning were retrospectively obtained from patient records. These data were used to describe the prevalence and correlates of SUDs in this sample of adolescents with psychiatric disorders. Results: Twenty-eight percent of youth had an SUD. Marijuana and alcohol use disorders were the most common. The diagnosis of SUD was not associated with specific psychiatric diagnostic categories (mood, anxiety, and psychotic), psychiatric symptom severity, or suicidality, in the overall sample. There was limited evidence for a mediating/moderating effect of sex on the correlation between psychiatric measures and SUD diagnosis. Older age, SUD treatment history, and role dysfunction (ie, poor school functioning) were independently associated with any SUD diagnosis or a drug use disorder when accounting for sex. Older age and history of SUD treatment were independently correlated with alcohol use disorders. Twenty-three percent of youth with SUDs were referred for SUD treatment. Conclusions: Substance use disorders were prevalent in this population, and the rate of SUD treatment disposition was lower than anticipated. Substance use disorders were associated with lower functioning but not independently correlated with psychiatric diagnostic categories or symptom severity. This study supports the need for improved screening, intervention, and referral options for SUDs in this setting.

Mewton L; Teesson M; Slade T; Grove R. The epidemiology of DSM-IV alcohol use disorders amongst young adults in the Australian population. Alcohol and Alcoholism 46(2): 185-191, 2011. (41 refs.)

Aim: The aim of the study was to examine the descriptive epidemiology of 12-month alcohol use disorders (AUDs) amongst young adults in the Australian general population. Methods: The 2007 National Survey of Mental Health and Well Being, a nationally representative household survey of 8841 Australian adults (16-85 years), assessed participants for symptoms of the most prevalent DSM-IV mental disorders. Young adults were over-sampled to provide detailed information on this age group. Results: 11.1% of young adults in the Australian population were diagnosed with an AUD. Compared with the rest of the young adult sample, young adults with AUDs were at greater risk of reporting another drug use disorder, an anxiety disorder, high levels of consumption, a medium or high score on the Kessler Psychological Distress Scale, and a moderate to severe score on the WHO Disability Assessment Schedule 2.0. Mental health services were rarely used by young adults with AUDs. Difficulties in differentiating young adults diagnosed with abuse and those diagnosed with dependence with the criteria we used supported accumulating evidence questioning the validity of the abuse-dependence distinction. Conclusions: AUDs in young adulthood are prevalent and associated with comorbid psychopathology, risky levels of alcohol consumption and disability. Despite the clinical significance of AUDs in this age group, few young adults with these disorders use mental health services. In this age group, the proposed changes for DSM-V regarding the classification of AUD would seem helpful.

Mortlock KS; Deane FP; Crowe TP. Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings. Journal of Substance Abuse Treatment 40(4): 397- 404, 2011. (60 refs.)

There has been much international impetus to address the importance of identifying and treating clients experiencing both a substance use disorder and a mental disorder in treatment settings. Gaps in the literature still exist after a decade of research into this area. There is little research on the prevalence of co-occurring mental disorders (CODs) in the residential alcohol and other drug (AOD) treatment modality. In this study, the mental disorder status of 278 participants resident in AOD treatment settings across Australia was estimated using the Addiction Severity Index Self Report (J.S. Cacciola, A. Pecoraro, & A.I. Alterman, 2008) and the Mental Health Screening Form Ill (J.F.X. Carroll & J.J. McGinley, 2001). The estimated rate of diagnosable Axis I mental disorder comorbidity varied from 64% to 71% depending upon which cutoff score was used with the MHSF-III. Missing data emerged as a major limitation of the self-report version of the Addiction Severity Index psychiatric composite score in this population.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Treatment for Substance Use and Depression among Adults, by Race/Ethnicity. (July 2, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (2 refs.)

This issue of "The NSDUH Report" focuses on the need for and receipt of treatment for a substance use problem and major depression among adults aged 18 or older by race/ethnicity. All findings are annual averages based on combined 2004 to 2007 NSDUH data. Summary: Combined 2004 to 2007 data indicate that 9.7% of adults aged 18 or older needed treatment for a substance use problem in the past year, and 10.5% of those needing substance use treatment received it in the past year in a specialty facility. Approximately 1 in 12 adults (7.5%) had a major depressive episode (MDE) in the past year, and 66.1% of them received treatment for depression in the past year. Among those in need of substance use treatment, blacks had higher rates of receipt of treatment in a specialty facility than persons of two or more races, Hispanics, whites, and Asians (17.8 vs. 11.9, 11.3, 9.2, and 5.5%, respectively). Among adults with past year MDE, whites were more likely to have received treatment than blacks, Hispanics, and Asians (69.6 vs. 57.4, 53.4, and 48.0%, respectively), and persons of two or more races were more likely to have received treatment than Hispanics and Asians (65.2 vs. 53.4 and 48.0%, respectively

Public Domain

Ozcan ME; Egri M; Cumurcu BE. Less prevalent alcohol use disorders among Turkish psychiatric outpatients. Neurology, Psychiatry and Brain Research 16(1): 23-28, 2009. (47 refs.)

Aim: This study aimed to assess the frequency of problem drinking among outpatients who were seen at a general psychiatry outpatient clinic of a university hospital located in the province of Malatya, eastern Turkey. Methods: Five-hundred and seven patients between 17-72 years old were interviewed in a 6 months period. The mean age was 35.8 +/- 12.4 years, and 72.2% of the sample was female. Patients who were diagnosed with one of the following disorders were included: anxiety disorders (n=287), major depressive disorder (n=110), and somatoform disorders (n=110). Comorbidities with other DSM-IV Axis-1 disorders were excluded. Patients with other psychiatric disorders, such as schizophrenia and psychoses, bipolar disorders, primary alcohol and substance use disorders, and sexual function disorders were seen at separate, specialized outpatient clinics. Results: Overall, 19.8% of respondents reported alcohol use in the past year with significant differences in prevalence rates by gender; 41.7% among males and 11.5% among females (chi(2) =57.55, p<0.0001). The frequency of alcohol use (p=0.86), or family history of alcohol intake (p=0.22), or problem drinking (p=0.07) was not significantly different among patient groups. None of patients with somatoform disorders had problem drinking. Conclusion: Both alcohol use, and problem drinking frequencies were lower than the results of the studies from other countries. These results might be impaired, since the majority of patients was female. Problem drinking and subjects with a positive CAGE score were more common among males aged 40-54 years.

Perala J; Kuoppasalmi K; Pirkola S; Harkanen T; Saarni S; Tuulio-Henriksson A et al. Alcohol-induced psychotic disorder and delirium in the general population. British Journal of Psychiatry 197(3): 200-206, 2010. (37 refs.)

Background: Epidemiologic data on alcohol-induced psychotic disorder and delirium (alcohol-induced psychotic syndrome, AIPS) are scarce. Aims: To investigate the epidemiology of AIPS, the risk factors for developing AIPS among people with alcohol dependence, and mortality associated with alcohol dependence with or without AIPS, in a sample drawn from the general population of Finland. Method: A general population sample of 8028 persons were interviewed with the Composite International Diagnostic Interview and screened for psychotic disorders using multiple sources. Best-estimate diagnoses of psychotic disorders were made using the Structured Clinical Interview for DSM-IV Axis I Disorders and case notes. Data on hospital treatments and deaths were collected from national registers. Results: The lifetime prevalence was 0.5% for AIPS and was highest (1.8%) among men of working age. Younger age at onset of alcohol dependence, low socioeconomic status, father's mental health or alcohol problems and multiple hospital treatments were associated with increased risk of AIPS. Participants with a history of AIPS had considerable medical comorbidity, and 37% of them died during the 8-year follow-up. Conclusions: Alcohol-induced psychotic disorder is a severe mental disorder with poor outcome.

Pihl RO; Sutton R. Drugs and aggression readily mix; so what now? Substance Use & Misuse 44(9/10, Special Issue): 1188-1203, 2009. (95 refs.)

Intoxicated aggression is both a dangerous and a costly problem for society, with alcohol being involved in over 50% of violent crimes, and the cost alcohol-consumption-related crime being estimated at $205 billion in the United States alone. First, the authors reviewed the substantial evidence for the connection between alcohol consumption and aggression, and then they examined the risk factors for this problem. These included societal/cultural factors, such as availability and alcohol expectancies, and individual factors, such as demographic characteristics, personality, comorbid disorders, individual differences in response to alcohol, and cognitive functioning. Finally, interventions were suggested focusing on policy, alcohol sellers, treatments for alcohol abuse and dependency, anger management, pharmacology, and low executive functioning. Further efforts are still needed to target interventions to specific risk factors.

Richardson TH. Cannabis use and mental health: A review of recent epidemiological research. (review). International Journal of Pharmacology 6(6): 796-807, 2010. (117 refs.)

Cannabis is the most commonly used drug in the world. This review examines recent epidemiological research on the relationships between cannabis use and mental health problems. Relationships with depression, anxiety disorders, mania and psychosis are examined, with relevant issues such as the effect of confounding variables, temporal directions and causality being discussed. Factors which influence the relationship such as dose-response effects, age of first cannabis use and risk of mental health problems are also examined. Causality is often difficult to establish, as cannabis is often used by those with mental illness for self-medication. However, there is substantial evidence to suggest that cannabis may induce or exacerbate a number of mental health problems.

Rosenthal RN; Nunes EV; Le Fauve CE. Implications of epidemiological data for identifying persons with substance use and other mental disorders. American Journal on Addictions 21(2): 97-103, 2012. (76 refs.)

The authors conducted systematic searches in standard databases using key search terms related to epidemiology, prevalence, and co-occurring substance use and other mental disorders (COD), as well as specific combinations of drug and mental disorders. The authors targeted high-quality, large sample epidemiological surveys so as to utilize studies of high methodological rigor in the construction of recommendations for clinical identification. Further refined searches to identify these studies revealed common themes and related research gaps. Findings suggest that clinicians should have increased expectation that a patient with a substance use disorder (SUD) has a co-occurring mental disorder if the SUD is relatively severe, if the patient began using substances (including tobacco) at an early age, is female, is dependent on nicotine, or has a drug use disorder. Patients identified as having at least one SUD and one co-occurring mental disorder should be assessed to identify other likely CODs, because disorders are not normally distributed and tend to cluster in relatively few individuals.

Saunders JB; Rey JM, eds. Young People and Alcohol Impact, Policy, Prevention, Treatment. Chichester, UK: Wiley-Blackwell, 2011. (Chapter refs.)

This edited work is intended as a basic reference in the area of adolescent alcohol use. It is divided into five sections. Part I reviews alcohol use patterns among adolescents, in terms of levels of consumption. The relationship of early onset drinking is also discussed. This section also highlights short- and long-term consequences of adolescent alcohol use, including risky sexual behaviour, increased risk of pregnancy, violence and sexual assault, and accidents. Part II sets forth basic information on the biological aspects resulting from drinking among adolescents. This includes the effects on the adolescent brain and impact of prenatal alcohol exposure, and also touches upon genetic influences. Part III deals with prevention and early intervention, including efforts to reduce high-risk drinking and alcohol-related damage among youth, including community-based prevention strategies, such as community mobilization, environmental strategies media advocacy, social marketing campaigns and policy change. It also focuses upon brief interventions with special populations, including schools, colleges and the military. Part IV, with three chapters considers assessment and diagnosis. A framework for comprehensive assessment is described, with the mnemonic "HEADS," referring to Home, Education, Activities, Drugs, Sexuality and Suicide. The importance of the clinical relationship is discussed. Part V, with six chapters focuses upon treatment. It includes material on the family-based interventions, psychosocial and pharmacological approaches. This section also discusses th epidemiology and clinical management of common co-occurring psychiatric disorders common - conduct disorder, attention deficit/hyperactivity disorder and mood disorders.

Subramaniam M; Abdin E; Vaingankar J; Phua AMY; Tee J; Chong SA. Prevalence and correlates of alcohol use disorders in the Singapore Mental Health Survey. Addiction 107(8): 1443-1452, 2012. (37 refs.)

Aims: To establish the prevalence, correlates, comorbidity and treatment gap of alcohol use disorders in the Singapore resident population. Design: The Singapore Mental Health Study is a cross-sectional epidemiological survey. Setting A nationally representative survey of the resident (citizens and permanent residents) population in Singapore. Participants: A total of 6616 Singaporean adults aged 18 years and older. Measurements: The diagnoses were established using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) diagnostic modules for life-time and 12-month prevalence of selected mental illnesses including alcohol use disorders. Findings: The life-time prevalence of alcohol abuse and alcohol dependence was 3.1% and 0.5%, while the 12-month prevalence of alcohol abuse and alcohol dependence was 0.5% and 0.3%, respectively. The life-time and 12-month prevalence of alcohol use disorders was 3.6% and 0.8%, respectively. Those with alcohol use disorder had significantly higher odds of having major depressive disorder [odds ratio (OR) 3.1] and nicotine dependence (OR 4.5). Compared to the rest of the population, those with an alcohol use disorder had significantly higher odds of having gastric ulcers (OR 3.0), respiratory conditions (OR 2.1) and chronic pain (OR 2.1). Only one in five of those with alcohol use disorder had ever sought treatment. Conclusions: The prevalence of alcohol use disorders is relatively low in the Singapore adult population. Comorbidity with mental and physical disorders is significant, emphasizing the need to screen people with alcohol use disorders for these comorbidities.

Sussman S; Lisha N; Griffiths M. Prevalence of the addictions: A problem of the majority or the minority? (review). Evaluation & the Health Professions 34(1): 3-56, 2011. (193 refs.)

An increasing number of research studies over the last three decades suggest that a wide range of substance and process addictions may serve similar functions. The current article considers 11 such potential addictions (tobacco, alcohol, illicit drugs, eating, gambling, Internet, love, sex, exercise, work, and shopping), their prevalence, and co-occurrence, based on a systematic review of the literature. Data from 83 studies each study n = at least 500 subjects) were presented and supplemented with small-scale data. Depending on which assumptions are made, overall 12-month prevalence of an addiction among U. S. adults varies from 15% to 61%. The authors assert that it is most plausible that 47% of the U. S. adult population suffers from maladaptive signs of an addictive disorder over a 12-month period and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors.

Vaughn MG; Define RS; DeLisi M; Perron BE; Beaver KM; Fu QA et al. Sociodemographic, behavioral, and substance use correlates of reckless driving in the United States: Findings from a national sample. Journal of Psychiatric Research 45(3): 347-353, 2011. (29 refs.)

This study examined the sociodemographic, behavioral, psychiatric, and substance use correlates of three forms of reckless driving using a nationally representative sample of U.S. adults. Participants were 43,093 adults from the National Epidemiologyogic Survey on Alcohol and Related Conditions (NESARC). Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version (AUDADIS-IV). This measure provides extensive sociodemographic data as well as diagnoses for mood, anxiety, personality, and substance use disorders. Reckless driving was significantly associated with male gender, lower levels of income, being born in the U.S., and numerous forms of antisocial behaviors. Fully adjusted models revealed significant effects with respect to substance use disorders across categories of reckless drivers with those having their licenses revoked or suspended being particularly more likely to be diagnosed with antisocial (AOR = 3.35, 95% CI = 2.54, 4.42) and paranoid personality disorder (AOR = 1.56, 95% CI = 1.07, 2.29). All three reckless driving groups were more likely to have a family history of antisocial behavior than non-reckless drivers. Study findings provide information from which targeted behavioral interventions can be applied.

Vaughn MG; Fu Q; DeLisi M; Beaver KM; Perron BE; Terrell K et al. Correlates of cruelty to animals in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Psychiatric Research 43(15): 1213-1218, 2009. (28 refs.)

Objective: To examine the sociodemographic, behavioral, and psychiatric correlates of cruelty to animals in the US. Materials and methods: Data were derived from a nationally representative sample of adults residing in the US Structured psychiatric interviews (N=43,093) were completed by trained lay interviewers between 2001 and 2002. Personality, substance use, mood, and anxiety disorders and cruelty to animals were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (DSM-IV) version. Results: The lifetime prevalence of animal cruelty in US adults was 1.8%. Men, African-Americans, Native-Americans/Asians, native-born Americans, persons with lower levels of income and education and adults living the western region of the US reported comparatively high levels of cruelty to animals, whereas Hispanics reported comparatively low levels of such behavior. Cruelty to animals was significantly associated with all assessed antisocial behaviors. Adjusted analyses revealed strong associations between lifetime alcohol use disorders, conduct disorder, antisocial, obsessive-compulsive, and histrionic personality disorders, pathological gambling, family history of antisocial behavior, and cruelty to animals. Conclusions: Cruelty to animals is associated with elevated rates observed in young, poor, men with family histories of antisocial behavior and personal histories of conduct disorder in childhood. and antisocial, obsessive-compulsive and histrionic personality disorders, and pathological gambling in adulthood. Given these associations, and the widespread ownership of pets and animals, effective screening of children, adolescents and adults for animal cruelty and appropriate mental health interventions should be deployed.

Vos PJ; Cloete KJ; le Roux A; Kidd M; Jordaan GP. A retrospective review of trends and clinical characteristics of methamphetamine-related acute psychiatric admissions in a South African context. African Journal of Psychiatry 13(5): 390-394, 2010. (24 refs.)

Objective: Epidemiological studies indicate that methamphetamine (MA) abuse poses a major challenge to health in the Western Cape. The objectives of this study were to retrospectively assess the trends, clinical characteristics and treatment demand of MA-related admissions to a psychiatric ward in this region. Method: The clinical records of patients admitted to an acute psychiatric admission ward at Tygerberg Hospital from 1 January 2002 to 30 June 2002 and 1 January 2006 to 30 June 2006, were retrospectively reviewed. Admission numbers including those of adolescent and adult substance users were compared for both study periods. Study samples comparing demographic profile, admission status, length of stay, psychopathology, treatment requirements and referral pattern to other disciplines between MA users and non-users were collected for the 2006 period. Results: There was a significant (p <0.01) increase in adolescent substance user admissions between the study periods. A significant (p <0.01) increase in adolescent and adult MA user admissions was also noted. MA users were significantly (p = 0.04) younger than non-MA users, whilst the former presented mainly with psychotic features associated with aggression, requiring involuntary admission of an average of 8 weeks. MA users required significantly (p = 0.007) more benzodiazepines compared to non-MA users. Conclusion: Although MA use is relatively recent to the Western Cape, its adverse psychiatric effects and consequences have become a major challenge. These effects in both adolescent and adult patient populations and the associated impact on psychiatric services demand urgent intervention strategies as well as prospective study.

Wang LJ; Chiang SC; Su LW; Lin SK; Chen CK. Factors associated with drug-related psychiatric disorders and suicide attempts among illicit drug users in Taiwan. Substance Use & Misuse 47(10): 1185-1188, 2012. (16 refs.)

Illicit drug users, entering a detention center and two psychiatric hospitals in Northern Taiwan, were interviewed for lifetime drug-use-related psychiatric disorders and suicide attempts. Among 197 participants, 17.3%, 16.8%, and 14.2% had a drug-induced psychotic disorder (DIP), a drug-induced mood disorder (DIM), and a history of suicide attempts, respectively. Continuous use of methamphetamine and joblessness were associated with DIP and DIM, accordingly. Polysubstance use was collectively correlated with DIP and DIM. Female gender and history of having any mood disorder were predictors of suicide. These results provide useful clues for detecting drug-related psychiatric disorders and suicide among illicit drug users. The study's limitations are noted.

Weich L; Pienaar W. Occurrence of comorbid substance use disorders among acute psychiatric inpatients at Stikland Hospital in the Western Cape, South Africa. African Journal of Psychiatry 12(3): 213-217, 2009. (30 refs.)

Objective: Little is known about the epidemiology of substance use disorders (SUD) among psychiatric inpatients in the Western Cape, South Africa. Therefore, this study was conducted to examine the prevalence of SUD among acute adult psychiatric inpatients at Stikland Hospital, one of three state acute psychiatric hospitals in the Western Cape. Method: A prospective descriptive prevalence survey was undertaken over a three-month period. During this period, data was collected on psychiatric patients (N=298) who were hospitalized in the acute psychiatric wards at Stikland. This included patient demography psychiatric and substance use history Urine was also collected and analyzed for substances commonly abused in the Western Cape. Results: A co-morbid SUD (abuse or dependence) was diagnosed in 51% of patients. In addition, a diagnosis of a substance-induced psychiatric disorder was made in 8% of these patients, 1% of who was diagnosed with a substance-induced mood disorder, while 7% was diagnosed with a substance-induced psychotic disorder. Patients diagnosed with a co-morbid SUD were younger than those without a SUD and more likely to have been involuntary admissions. These patients also displayed more violence prior to admission that contributed to their admission and were more likely to have used cannabis or methamphetamine as their preferred drug of abuse. Only a small group of patients had documented evidence of any prior interventions for their SUD. Conclusion: SUD are prevalent among psychiatric inpatients and contribute to their morbidity. This has implications for staff training and service development.

Wu LT; Gersing K; Burchett B; Woody GE; Blazer DG. Substance use disorders and comorbid Axis I and II psychiatric disorders among young psychiatric patients: Findings from a large electronic health records database. Journal of Psychiatric Research 45(11): 1453-1462, 2011. (59 refs.)

This study examined the prevalence of substance use disorders (SUDS) among psychiatric patients aged 2-17 years in an electronic health records database (N = 11,457) and determined patterns of comorbid diagnoses among patients with a SUD to inform emerging comparative effectiveness research (CER) efforts. DSM-IV diagnoses of all inpatients and outpatients at a large university-based hospital and its associated psychiatric clinics were systematically captured between 2000 and 2010: SUD, anxiety (AD), mood (MD), conduct (CD), attention deficit/hyperactivity (ADHD), personality (PD), adjustment, eating, impulse-control, psychotic, learning, mental retardation, and relational disorders. The prevalence of SUD in the 2-12-year age group (n = 6210) was 1.6% and increased to 25% in the 13-17-year age group (n = 5247). Cannabis diagnosis was the most prevalent SUD, accounting for more than 80% of all SUD cases. Among patients with a SUD (n = 1423), children aged 2-12 years (95%) and females (75-100%) showed high rates of comorbidities; blacks were more likely than whites to be diagnosed with CD, impulse-control, and psychotic diagnoses, while whites had elevated odds of having AD, ADHD, MD, PD, relational, and eating diagnoses. Patients with a SUD used more inpatient treatment than patients without a SUD (43% vs. 21%); children, females, and blacks had elevated odds of inpatient psychiatric treatment. Collectively, results add clinical evidence on treatment needs and diagnostic patterns for understudied diagnoses.