Dual Diagnosis: Variations Across Differing Comorbid Diagnoses

Abstract

ABSTRACT Objectives: Increasing numbers of research investigations have documented the coexistence of substance use and other psychiatric disorders in a variety of patient populations. The next step in understanding such comorbidity is the exploration of whether the type of psychiatric disorder coexisting with a substance use disorder makes a difference in terms of the sequellae of the disorders for the patient. Methods: This study explored a variety of psychosocial/demographic and clinical variables for patients with a substance abuse disorder, differentiating five groups based on the type of coexisting psychiatric disorder: schizophrenia, depression, bipolar disorder, adjustment disorder, and personality disorder. Rates and sequellae of comorbidity for the five groups of patients were explored based on a pool of patients hospitalized at the Alaska Psychiatric Institute (API) between 1993 and 2001. The records of 181 patients with coexisting schizophrenia, 251 with depression, 120 with bipolar disorder, 197 with adjustment disorder, and 145 with personality disorder were utilized to explore psychosocial/demo-graphic and clinical differences and commonalities across groups. Results: Findings revealed significant differences between the five groups on almost all psychosocial/demographic and clinical variables. For example, patients with coexisting schizophrenia evidence more severe pathology and greater use of hospital resources; patients with coexisting personality disorder were more likely to be involved with the legal system; patients with bipolar disorder were most likely to evidence drug involvement at admission; and patients with adjustment disorders evidenced the fewest psychosocial challenges and a less severe course of treatment. Conclusion: Results confirmed the need to differentiate comorbid patients based on the type of coexisting other psychiatric disorder. Discussion of the implications of these findings for treatment service planning on an individual-patient and systemic-administrative level is presented.