Prevalence and impact of psychiatric comorbidity in opiate addicts

Abstract

The prevalence and temporal relationship of concurrent Axis I disorders in opioid-dependent patients receiving methadone maintenance treatment was assessed. It was hypothesized that subjects with psychiatric comorbidity would exhibit greater levels of hopelessness, suicidal ideation, personality disturbance, and psychiatric severity, and are more likely to have a clinical diagnosis of Antisocial Personality Disorder than those without comorbidity. Thirty-one subjects (17 men and 14 women) enrolled as out-patients at the Albert Einstein College of Medicine Melrose-On-Track Methadone Maintenance Clinic in the Bronx, New York, participated. The subjects were administered self-report forms and were interviewed with the SCID-SAC (Substance Abuse Comorbidity Version), a reliable and valid measure which evaluated Axis I psychiatric disorders and the diagnosis of Antisocial Personality Disorder (APD). The prevalence of comorbidity was evaluated, and subjects were dichotomized into two groups based on whether they received an additional diagnosis or not. The two groups were compared on the measures of hopelessness, suicidal ideation, clinical diagnosis of APD, Millon Clinical Multiaxial Inventory 3rd Edition (MCMI-III) personality disturbance, and SCL-90-R psychiatric symptoms.;Results indicated that 64.5% of the subjects received at least one lifetime comorbid psychiatric diagnosis in addition to opioid dependence. The most frequent comorbid diagnoses were depression, conduct disorder, and anxiety disorders. In the majority of patients with comorbidity, the substance abuse preceded the onset of the additional diagnoses. The patients with comorbid diagnoses had more symptoms of somatization, anxiety, and phobic anxiety, than those with substance abuse alone. In addition, patients with a current psychiatric disorder had significantly more symptoms of psychiatric severity, more personality disturbance, and were more hopeless than subjects without a current diagnosis. Furthermore, more males were diagnosed with antisocial personality disorder.;Given the additional psychiatric distress in opiate patients with lifetime comorbid or current psychiatric diagnoses, the results support the evaluation of current and lifetime psychiatric disorders, personality disorders, and psychiatric severity, in this population. Treatment strategies that focus on the entire spectrum of psychological symptoms and diagnoses in addition to substance abuse need to be developed and tested within this population.