Top

Published in:

Open Access 04-08-2023 | Addiction | Original Article

Gender and addiction and other mental disorders comorbidity: sociodemographic, clinical, and treatment differences

Authors: Silvia Díaz Fernández, Juan José Fernandez Miranda, Francisco Pascual Pastor, Francisco López Muñoz

Published in: Archives of Women's Mental Health | Issue 5/2023

Abstract

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high, but the details are uncertain in Spain. The objective of the present study was to know the prevalence of this comorbidity, as well as the pharmacological treatment, both in specific addiction treatment networks and in mental health networks, with a gender perspective. Observational, multicenter study, with a randomized sample, of patients under treatment for SUD or OMD in Spain (N = 1783). A specific questionnaire, collecting sociodemographic and clinical variables, diagnosed SUD and OMD, and prescribed psychotropic drugs, was completed by treating clinicians. Differences between females and males were searched. A high prevalence of OMD was found in those patients treated for their SUD (71%), and also of diagnoses of SUD (59%) in people treated for OMD. Significant relationships between addiction to certain substances and specific mental disorders were found (with no main differences between women and men). The treatments for OMD were very common in the addiction treatment networks, but that of SUDs in those patients treated in the mental health networks was less than expected. A high prescription of benzodiazepines was found. Women were less frequently diagnosed with cannabis, opioid, and especially cocaine use disorders, and they had fewer psychotic disorders and more affective, anxiety, sleep, and eating disorders, with the rest being the same, including personality disorders. Women had fewer treatments with agonists and more with antagonists, and more prescriptions of anxiolytics and antidepressants. This study provides preliminary information on the coexistence in routine clinical practice of addictive disorders and other mental disorders in Spain, and on the treatment provided, and shows differences in prevalence and clinical characteristics, and especially in treatment approaches between women and men. Thus, should be useful to adapt the treatment response with greater precision, and with a gender perspective.

Available only for authorised users

Abulseoud OA, Karpyak VM, Schneekloth T et al (2013) A retrospective study of gender differences in depressive symptoms and risk of relapse in patients with alcohol dependence. Am J Addict 22:437–442. https://doi.org/10.1111/j.1521-0391.2013.12021.xCrossRefPubMedPubMedCentral

Álvarez Y, Pérez-Mañá C, Torrens M, Farré M (2013) Antipsychotic drugs in cocaine dependence: a systematic review and meta-analysis. J Subst Abuse Treat 45:1–10. https://doi.org/10.1016/j.jsat.2012.12.013CrossRefPubMed

Arias F, Szerman N, Vega P et al (2013) Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente. Adicciones 25:118. https://doi.org/10.20882/adicciones.59CrossRefPubMed

Arias F, Szerman N, Vega P et al (2016) Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual. Adicciones 29:186. https://doi.org/10.20882/adicciones.782CrossRef

Arias-Horcajadas F, Fernandez-Miranda JJ, Florez-Menendez G, et al. (2020) tus + tm. Resumen de intervenciones, vademecum y árboles de decisiones lógicas. Guías clínicas basadas en la evidencia científica. Socidrogalcohol, Valencia.

Ashley OS, Marsden ME, Brady TM (2003) Effectiveness of substance abuse treatment programming for women: a review. Am J Drug Alcohol Abuse 29:19–53. https://doi.org/10.1081/ADA-120018838CrossRefPubMed

Azorin J-M, Simon N, Adida M, Belzeaux R (2016) Pharmacological treatment of schizophrenia with comorbid substance use disorder. Expert Opin Pharmacother 17:231–253. https://doi.org/10.1517/14656566.2016.1114101CrossRefPubMed

Conner KR, Pinquart M, Gamble SA (2009) Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abuse Treat 37:127–137. https://doi.org/10.1016/j.jsat.2008.11.007CrossRefPubMedPubMedCentral

Coughey K, Feighan K, Cheney R, Klein G (1998) Retention in an aftercare program for recovering women. Subst Use Misuse 33:917–933. https://doi.org/10.3109/10826089809056249CrossRefPubMed

Crockford D, Addington D (2017) Canadian schizophrenia guidelines: schizophrenia and other psychotic disorders with coexisting substance use disorders. Can J Psychiatry 62:624–634. https://doi.org/10.1177/0706743717720196CrossRefPubMedPubMedCentral

Cuenca-Royo AM, Torrens M, Sánchez-Niubó A et al (2013) Comorbilidad psiquiátrica en jóvenes-adultos consumidores de cannabis. Adicciones 25:45–54. https://doi.org/10.20882/adicciones.71CrossRefPubMed

Daigre C, Grau-López L, Rodríguez-Cintas L et al (2017) The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain. Qual Life Res 26:3201–3209. https://doi.org/10.1007/s11136-017-1668-4CrossRefPubMed

Darvishi N, Farhadi M, Haghtalab T, Poorolajal J (2015) Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One 10:e0126870. https://doi.org/10.1371/journal.pone.0126870CrossRefPubMedPubMedCentral

Donald M, Dower J, Kavanagh D (2005) Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders: a qualitative systematic review of randomised controlled trials. Soc Sci Med 60:1371–1383. https://doi.org/10.1016/j.socscimed.2004.06.052CrossRefPubMed

Drake RE, Mercer-McFadden C, Mueser KT et al (1998) Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophr Bull 24:589–608. https://doi.org/10.1093/oxfordjournals.schbul.a033351CrossRefPubMed

Erol A, Karpyak VM (2015) Sex and gender-related differences in alcohol use and its consequences: contemporary knowledge and future research considerations. Drug Alcohol Depend 156:1–13. https://doi.org/10.1016/j.drugalcdep.2015.08.023CrossRefPubMed

Fernández-Miranda JJ (2002) Trastornos de personalidad y adicción: relaciones etiológicas y conscuencias terapeúticas. An Psiquiatr 18:421–427

Fernández-Miranda JJ, García-Portilla González MP, Sáiz Martínez PA et al (2001) Influencia de los trastornos psiquiátricos en la efectividad de un programa de mantenimiento prolongado con metadona. Actas Esp Psiquiatr 29:228–232PubMed

Fernández-Miranda JJ, Orengo-Caus T, Díaz-Fernández S (2019) Comorbilidad psiquiátrica en adicciones. Trastorno por uso de opioides y otro trastorno mental comórbido. Guías clínicas basadas en la evidencia científica, Socidrogalcohol, Valencia

Florez-Menendez G, Balcells-Oliveró M, Uzal-Fernández C (2018) Comorbilidad psiquiátrica en adicciones. Trastorno por uso de alcohol y otro trastorno mental comórbido. Guías clínicas basadas en la evidencia científica, Socidrogalcohol, Valencia

Fonseca F, Robles-Martínez M, Tirado-Muñoz J et al (2021) A gender perspective of addictive disorders. Curr Addict Rep 8:89–99. https://doi.org/10.1007/s40429-021-00357-9CrossRefPubMedPubMedCentral

García-Carretero MA, Novalbos-Ruiz JP, Robles-Martínez M et al (2017) Psychopathological profile and prevalence of dual pathology on patients with alcoholic dependence undergoing outpatient treatment. Actas Esp Psiquiatr 45:1–11PubMed

Gjestad R, Franck J, Hagtvet KA, Haver B (2011) Level and change in alcohol consumption, depression and dysfunctional attitudes among females treated for alcohol addiction. Alcohol Alcohol 46:292–300. https://doi.org/10.1093/alcalc/agr018CrossRefPubMedPubMedCentral

Grau-López L, Roncero C, Daigre C et al (2014) Observational study on medications prescribed to dual-diagnosis outpatients. J Addict Med 8:84–89. https://doi.org/10.1097/ADM.0000000000000024CrossRefPubMed

Gual A (2007) Dual diagnosis in Spain. Drug Alcohol Rev 26:65–71. https://doi.org/10.1080/09595230601037000CrossRefPubMed

Guardia-Serecigni J, Flórez-Menéndez G (2018) Comorbilidad psiquiátrica en adicciones. Trastorno por uso de ansiolíticos e hipnóticos y otro trastorno mental comórbido. Guías clínicas basadas en la evidencia científica, Socidrogalcohol, Valencia

Hasin DS, Grant BF (2015) The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 50:1609–1640. https://doi.org/10.1007/s00127-015-1088-0CrossRefPubMedPubMedCentral

Hillemacher T, Frieling H (2019) Pharmacotherapeutic options for co-morbid depression and alcohol dependence. Expert Opin Pharmacother 20:547–569. https://doi.org/10.1080/14656566.2018.1561870CrossRefPubMed

Hunt GE, Large MM, Cleary M et al (2018) Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990–2017: Systematic review and meta-analysis. Drug Alcohol Depend 191:234–258. https://doi.org/10.1016/j.drugalcdep.2018.07.011CrossRefPubMed

Hunt GE, Siegfried N, Morley K et al (2019) Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane database Syst Rev 12:CD001088. https://doi.org/10.1002/14651858.CD001088.pub4CrossRefPubMed

Iqbal MN, Levin CJ, Levin FR (2019) Treatment for substance use disorder with co-occurring mental illness. Focus (Madison) 17:88–97. https://doi.org/10.1176/appi.focus.20180042CrossRef

Jordaan GP, Emsley R (2014) Alcohol-induced psychotic disorder: a review. Metab Brain Dis 29:231–243. https://doi.org/10.1007/s11011-013-9457-4CrossRefPubMed

Korte JE, Rosa CL, Wakim PG, Perl HI (2011) Addiction treatment trials: how gender, race/ethnicity, and age relate to ongoing participation and retention in clinical trials. Subst Abuse Rehabil 2:205–218. https://doi.org/10.2147/SAR.S23796CrossRefPubMedPubMedCentral

Luminet O, Cordovil de Sousa Uva M, Fantini C, de Timary P (2016) The association between depression and craving in alcohol dependency is moderated by gender and by alexithymia factors. Psychiatry Res 239:28–38. https://doi.org/10.1016/j.psychres.2016.02.062CrossRefPubMed

Mangrum LF, Spence RT, Lopez M (2006) Integrated versus parallel treatment of co-occurring psychiatric and substance use disorders. J Subst Abuse Treat 30:79–84. https://doi.org/10.1016/j.jsat.2005.10.004CrossRefPubMed

Maremmani AGI, Rovai L, Bacciardi S et al (2013) The long-term outcomes of heroin dependent-treatment-resistant patients with bipolar 1 comorbidity after admission to enhanced methadone maintenance. J Affect Disord 151:582–589. https://doi.org/10.1016/j.jad.2013.06.054CrossRefPubMed

McHugh RK, Devito EE, Dodd D et al (2013) Gender differences in a clinical trial for prescription opioid dependence. J Subst Abuse Treat 45:38–43. https://doi.org/10.1016/j.jsat.2012.12.007CrossRefPubMedPubMedCentral

Merrill JE, Reid AE, Carey MP, Carey KB (2014) Gender and depression moderate response to brief motivational intervention for alcohol misuse among college students. J Consult Clin Psychol 82:984–992. https://doi.org/10.1037/a0037039CrossRefPubMedPubMedCentral

Miquel L, Roncero C, García-García G et al (2013) Gender differences in dually diagnosed outpatients. Subst Abus 34:78–80. https://doi.org/10.1080/08897077.2012.709223CrossRefPubMed

Mueser KT, Noordsy DL, Drake RE, Fox L (2003) Integrated treatment for dual disorders: a guide to effective practice. The Guilford Press, New York, NY, US

Murthy P, Mahadevan J, Chand PK (2019) Treatment of substance use disorders with co-occurring severe mental health disorders. Curr Opin Psychiatry 32:293–299. https://doi.org/10.1097/YCO.0000000000000510CrossRefPubMed

Ochoa-Mangado E, Molins-Pascual S, Seijo-Ceballos P (2018) Comorbilidad psiquiátrica en adicciones. Trastorno por uso de cocaína y otro trastorno mental comórbido. Guías clínicas basadas en la evidencia científica, Socidrogalcohol, Valencia

Palma-Álvarez RF, Rodríguez-Cintas L, Abad AC et al (2019) Mood disorders and severity of addiction in alcohol-dependent patients could be mediated by sex differences. Front Psychiatry 10:343. https://doi.org/10.3389/fpsyt.2019.00343CrossRefPubMedPubMedCentral

Pascual-Pastor F, Fernández-Miranda JJ, Díaz-Fernández S, Sala-Añó C (2017) Comorbilidad psiquiátrica en adicciones. Concepto, epidemiología y diagnóstico. Marco general de tratamiento. Guías clínicas basadas en la evidencia científica. Socidrogalcohol, Valencia

Pereiro C, Pino C, Flórez G et al (2013) Psychiatric comorbidity in patients from the addictive disorders assistance units of Galicia: the COPSIAD study. PLoS One 8:e66451. https://doi.org/10.1371/journal.pone.0066451CrossRefPubMedPubMedCentral

Priester MA, Browne T, Iachini A et al (2016) Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: an integrative literature review. J Subst Abuse Treat 61:47–59. https://doi.org/10.1016/j.jsat.2015.09.006CrossRefPubMed

Robles-Martínez M, García-Carretero MÁ, Gibert J et al (2018) Differences between craving and health-related quality of life in patients with alcohol dependence with or without dual pathology in outpatient treatment: a descriptive study. Med Clin (Barc) 150:49–55. https://doi.org/10.1016/j.medcli.2017.06.005CrossRefPubMed

Rodríguez-Cintas L, Daigre C, Braquehais MD et al (2018) Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res 262:440–445. https://doi.org/10.1016/j.psychres.2017.09.021CrossRefPubMed

Roncero C, Fuste G, Barral C et al (2011) Therapeutic management and comorbidities in opiate-dependent patients undergoing a replacement therapy programme in Spain: the PROTEUS study. Heroin Addict Relat Clin Probl 13:5–16

Sáiz Martínez PA, Jimenez Treviño L, Díaz Mesa EM et al (2014) Patología dual en trastornos de ansiedad: recomendaciones en el tratamiento farmacológico. Adicciones 26:254. https://doi.org/10.20882/adicciones.7CrossRefPubMed

Salloum IM, Brown ES (2017) Management of comorbid bipolar disorder and substance use disorders. Am J Drug Alcohol Abuse 43:366–376. https://doi.org/10.1080/00952990.2017.1292279CrossRefPubMed

Sánchez-Peña JF, Alvarez-Cotoli P, Rodríguez-Solano JJ (2012) Psychiatric disorders associated with alcoholism: 2 year follow-up of treatment. Actas Esp Psiquiatr 40:129–135PubMed

Smith JP, Randall CL (2012) Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Res 34:414–431PubMedPubMedCentral

Spivak S, Strain EC, Spivak A et al (2020) Integrated dual diagnosis treatment among United States mental health treatment facilities: 2010 to 2018. Drug Alcohol Depend 213:108074. https://doi.org/10.1016/j.drugalcdep.2020.108074CrossRefPubMed

Thibaut F (2018) Gender differences in addiction: clinical implications. Psychiatr Times 35:17–18

Tiet QQ, Mausbach B (2007) Treatments for patients with dual diagnosis: a review. Alcohol Clin Exp Res:070212174136001. https://doi.org/10.1111/j.1530-0277.2007.00336.x

Tirado Muñoz J, Farré A, Mestre-Pintó J et al (2017) Patología dual en Depresión: recomendaciones en el tratamiento. Adicciones 30:66. https://doi.org/10.20882/adicciones.868CrossRef

Tirado-Muñoz J, Gilchrist G, Fischer G et al (2018) Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study. Arch Womens Ment Health 21:259–269. https://doi.org/10.1007/s00737-017-0800-3CrossRefPubMed

Torrens M, Gilchrist G, Domingo-Salvany A, Psycobarcelona Group (2011) Psychiatric comorbidity in illicit drug users: substance-induced versus independent disorders. Drug Alcohol Depend 113:147–156. https://doi.org/10.1016/j.drugalcdep.2010.07.013CrossRefPubMed

Torrens M, Mestre-Pintó J, Domingo-Salvany A (2015) Comorbidity of substance use and mental disorders in Europe. EMCDDA, Lisbon

Torrens M, Rossi PC, Martinez-Riera R et al (2012) Psychiatric co-morbidity and substance use disorders: treatment in parallel systems or in one integrated system? Subst Use Misuse 47:1005–1014. https://doi.org/10.3109/10826084.2012.663296CrossRefPubMed

Vitali M, Mistretta M, Alessandrini G et al (2018) Pharmacological treatment for dual diagnosis: a literature update and a proposal of intervention. Riv Psichiatr 53:160–169. https://doi.org/10.1708/2925.29419CrossRefPubMed

Werner F-M, Covenas R (2018) Long-term administration of antipsychotic drugs in schizophrenia and influence of substance and drug abuse on the disease outcome. Curr Drug Abuse Rev 10:19–24. https://doi.org/10.2174/1874473710666171020104524CrossRef

Zilberman ML, Tavares H, Hodgins DC, El-Guebaly N (2007) The impact of gender, depression, and personality on craving. J Addict Dis 26:79–84. https://doi.org/10.1300/J069v26n01_10CrossRefPubMed

Title: Gender and addiction and other mental disorders comorbidity: sociodemographic, clinical, and treatment differences
Authors: Silvia Díaz Fernández
Juan José Fernandez Miranda
Francisco Pascual Pastor
Francisco López Muñoz
Publication date: 04-08-2023
Publisher: Springer Vienna
Keywords: Addiction
Addiction
Opioids
Opioids
Published in: Archives of Women's Mental Health / Issue 5/2023
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI: https://doi.org/10.1007/s00737-023-01353-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gender and addiction and other mental disorders comorbidity: sociodemographic, clinical, and treatment differences

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2023

Comparing the factor structures and reliabilities of the EPDS and the PHQ-9 for screening antepartum and postpartum depression: a multigroup confirmatory factor analysis

Ethnic identity and barriers for using mental health services among Arab-Bedouin women coping with emotional distresses

Common mental disorders in Brazilian female shift workers: prevalence and associated factors

Parental bonding style and illness severity in a longitudinal study of individuals with first episode psychosis

Maternal prenatal attachment during the COVID-19 pandemic: exploring the roles of pregnancy-related anxiety, risk perception, and well-being

Mental health issues following sexual assault among the flood-affected women of Pakistan