Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties

• Published in: BMC psychiatry Vol. 6; no. 1; p. 44
• Main Authors: Landheim, Anne Signe, Bakken, Kjell, Vaglum, Per
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.10.2006; BioMed Central; BMC
• Subjects: Adult; Depressive Disorder, Major - psychology; Diagnosis, Dual (Psychiatry); Female; Follow-Up Studies; Humans; Male; Middle Aged; Norway - epidemiology; Prognosis; Prospective Studies; Recurrence; Substance-Related Disorders - mortality; Substance-Related Disorders - psychology; Substance-Related Disorders - therapy; Treatment Outcome; Norway
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/1471-244X-6-44

Most 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. A 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%). At 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. For 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.