Abstract
BackgroundMost help-seeking substance abusers have comorbid psychiatric disorders. The importance of such disorders for the long-term course of substance abuse is, however, still unclear. The aim of this paper is to describe six-year outcomes regarding death and relapse among alcoholics and poly-substance abusers and to analyse the predictive value of lifetime psychiatric disorders on relapse.MethodsA consecutive sample of substance-dependent patients who received treatment in two counties in Norway (n = 287) was followed up after approximately six years. Information on socio-demographics, Axis I (CIDI) and II disorders (MCMI-II) and mental distress (HSCL-25) was gathered at baseline. At follow-up, detailed information regarding socio-demographics, use of substances (AUDIT and DUDIT) and mental distress (HSCL-25) was recorded (response rate: 63%).ResultsAt six-year follow-up, 11% had died, most often male alcoholics (18%). Among the surviving patients, 70% had drug or alcohol related problems the year prior to follow-up. These patients were, classified as "relapsers". There were no significant differences in the relapse rate between women and men and among poly-substance abusers and alcoholics. The relapsers had an earlier onset of a substance use disorder, and more frequently major depression and agoraphobia. Multivariate analysis indicated that both psychiatric disorders (major depression) and substance use factors (early onset of a substance use disorder) were independent predictors of relapse.ConclusionFor reducing the risk of long-term relapse, assessment and treatment of major depression (and agoraphobia) are important. In addition, we are in need of a comprehensive treatment and rehabilitation program that also focuses on the addictive behaviour.
Highlights
Most help-seeking substance abusers have comorbid psychiatric disorders
There is a need for outcome studies in clinically representative samples that differentiate between genders as well as between alcoholics and poly-substance abusers, and that include both measures of substance abuse and Axis I and Axis II disorders
The since-deceased patients were older (44.2 vs. 38.7 years, p = 0.01), more frequently alcoholics (73% vs. 54%, p = 0.04) and more likely to have a later onset of a substance use disorder
Summary
Most help-seeking substance abusers have comorbid psychiatric disorders The importance of such disorders for the long-term course of substance abuse is, still unclear. Most help-seeking substance abusers have comorbid symptom disorders and/or personality disorders [1,2,3] By controlling for socio-demographic and substance use factors, such studies may clarify whether lifetime Axis I and II disorders have a unique and independent impact on the long-term course of substance abuse. If they have such an impact, it may have important implications for treatment planning [16]
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