Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2006

Open Access 01-12-2006 | Research article

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

Authors: Anne Signe Landheim, Kjell Bakken, Per Vaglum

Published in: BMC Psychiatry | Issue 1/2006

Login to get access

Abstract

Background

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.

Methods

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%).

Results

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.

Conclusion

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.
Literature
1.
Kessler RC: The epidemiology of dual diagnosis. Biol Psychiatry. 2004, 56: 730-737. 10.1016/j.biopsych.2004.06.034.CrossRefPubMed
2.
Verheul R, Kranzler HR, Poling J, Tennen H, Ball S, Rounsaville BJ: Co-occurrence of Axis I and Axis II disorders in substance abusers. Acta Psychiat Scand. 2000, 101: 110-118. 10.1034/j.1600-0447.2000.90050.x.CrossRefPubMed
3.
Landheim AS, Bakken K, Vaglum P: Gender differences in the prevalence of symptom disorders and personality disorders among poly-substance abusers and alcoholics. Eur Addict Res. 2003, 9: 8-17. 10.1159/000067732.CrossRefPubMed
4.
Ellingstad TP, Sobell LC, Sobell MB, Planthara P: Drug treatment outcome methodology (1993–1997). Strengths, weaknesses, and comparison to the alcohol field. Addictive Behav. 2002, 27: 319-330. 10.1016/S0306-4603(01)00261-1.CrossRef
5.
Ciraulo D, Piechniczek-Buczek J, Iscan EN: Outcome predictors in substance use disorders. Psychiatr Clin North Am. 2003, 26: 381-409. 10.1016/S0193-953X(02)00106-5.CrossRefPubMed
6.
Grella CE, Joshi V, Hser Y-I: Follow up of cocaine-dependent men and women with antisocial personality disorder. J Subst Abuse Treat. 2003, 25 (3): 155-164. 10.1016/S0740-5472(03)00127-2.CrossRefPubMed
7.
Rao SR, Broome KM, Simpson DD: Depression and hostility as predictors of long-term outcomes among opiate users. Addiction. 2004, 99 (5): 579-589. 10.1111/j.1360-0443.2004.00686.x.CrossRefPubMed
8.
Ritsher JB, McKellar JD, Finney JW, Otilingam P, Moos R: Psychiatric comorbidity, continuing care and mutual help as predictors of five-year remission from substance use disorder. J Stud Alcohol. 2002, 63: 709-715.CrossRefPubMed
9.
Verthein U, Degkwitz P, Haasen C, Krausz M: Significance of comorbidity for the long-term course of opiate dependence. Eur Addict Res. 2005, 11 (1): 15-21. 10.1159/000081412.CrossRefPubMed
10.
Krausz M, Verthein U, Degkwitz P: Psychiatric comorbidity in opiate addicts. Eur Addict Res. 1999, 5 (2): 55-62. 10.1159/000018966.CrossRefPubMed
11.
Ravndal E, Vaglum P: Psychopathology, treatment completion and 5 years outcome. A prospective study of drug abusers. J Subst Abuse Treat. 1998, 15 (2): 135-142. 10.1016/S0740-5472(97)00008-1.CrossRefPubMed
12.
Øjehagen A, Berglund M, Moberg AL: A 6 years follow-up of alcoholics after long-term outpatient treatment. Alcohol Clin Exp Res. 1994, 18 (3): 720-725. 10.1111/j.1530-0277.1994.tb00937.x.CrossRefPubMed
13.
Hulse GK, Tait RJ: Five-year outcomes of a brief alcohol intervention for adult in-patients with psychiatric disorders. Addiction. 2003, 98 (8): 1061-1068. 10.1046/j.1360-0443.2003.00404.x.CrossRefPubMed
14.
Ritsher JB, McKellar JD, Finney JW, Otilingam PG, Moos RH: Psychiatric comorbidity, continuing care and mutual help as predictors of five-year remission from substance use disorders. J Stud Alcohol. 2002, 63 (6): 709-715.CrossRefPubMed
15.
Hunter EE, Powell BJ, Penick EC, Nickel EJ, Liskow BI, Cantrell PJ, Landon JF: Comorbid psychiatric diagnosis and long-term drinking outcome. Compr Psychiatry. 2000, 41 (5): 334-338. 10.1053/comp.2000.8997.CrossRefPubMed
16.
Haver B, Gjestad R: Phobic anxiety and depression as predictor variables for treatment outcome. A LISREL analysis on treated female alcoholics. Nordic Journal of Psychiatry. 2005, 59 (1): 25-30. 10.1080/08039480510018797.CrossRefPubMed
17.
Gerdts SA, Iversen E: Implementation of the National Client Assessment Form in Norway. Final Report. 2000, Bergen: Bergen Clinics
18.
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Bruke J, Farmer A, Jablensky A, Pickens R, Regier DA, Sartorius N, Towle LH: The Composite International Diagnostic Interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1989, 45: 1069-1077.CrossRef
19.
Millon T: Manual for MCMI-II. 1982, Minneapolis: National Computer Systems, 2
20.
Derogatis LR, Lipman RS, Rickels K: The Hopkins Symptom Checklist (HSCL): A selfreport symptom inventory. Behav Sci. 1974, 19: 1-15.CrossRefPubMed
21.
Wittchen HU: Reliability and validity study of the WHO Composite International Doagnostic Interview (CIDI): A critical review. J Psychiatr Res. 1994, 28: 57-84. 10.1016/0022-3956(94)90036-1.CrossRefPubMed
22.
Flynn P: Issues in the assessment of personality disorder and substance abuse using the Millon Clinical Multiaxial inventory (MCMI-II). J Clinical Psychology. 1995, 51: 415-21.CrossRefPubMed
23.
Saunders JB, Aasland OG, Babor TF, De La Fuenta JR, Grant M: Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction. 1993, 88: 791-804. 10.1111/j.1360-0443.1993.tb02093.x.CrossRefPubMed
24.
Berman AH, Bergman H, Palmstierna T, Schlyter F: Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. Eur Addict Res. 2005, 11 (1): 22-31. 10.1159/000081413.CrossRefPubMed
25.
Reinert D, Allen JP: The Alcohol Use Disorders Identification Test (AUDIT): a review of recent research. Alcohol Clin Exp Res. 2002, 26 (2): 271-279. 10.1111/j.1530-0277.2002.tb02534.x.CrossRef
26.
Hosmer DW, Lemeshow S: Applied Logistic Regression. 1989, New York, : John Wiley & Sons Inc
27.
Finney JW, Moos RH: The long-term course of treated alcoholism: II. Predictors and correlates of 10-year functioning and mortality. J Stud Alcohol. 1992, 53 (2): 142-153.CrossRefPubMed
28.
Mann K, Schafer DR, Langle G, Ackermann K, Croissant B: The long-term course of alcoholism, 5, 10 and 16 years after treatment. Addiction. 2005, 100 (6): 797-805. 10.1111/j.1360-0443.2005.01065.x.CrossRefPubMed
29.
Guttinger F, Gschwend P, Schulte B, Rehm J, Uchtenhagen A: Evaluating long-term effects of heroin-assisted treatment: the results of a 6-year follow-up. Eur Addict Res. 2003, 9 (2): 73-79. 10.1159/000068811.CrossRefPubMed
30.
Schutte KK, Hearst J, Moos R: Gender differences in the relations between depressive symptoms and drinking behavior among problem drinkers: a three-wave study. J Consult Clin Psychol. 1997, 65 (3): 392-404. 10.1037/0022-006X.65.3.392.CrossRefPubMed
31.
Statistics Norway: Population Statistics. Deaths. 2005, . Official Statistics of Norway. Oslo, 2006
32.
Lemke S, Moos RH: Outcomes at 1 and 5 years for older patients with alcohol use disorders. J Subst Abuse Treat. 2003, 24: 43-50. 10.1016/S0740-5472(02)00321-5.CrossRefPubMed
33.
Noda T, Imamichi H, Kawata A, Hirano K, Ando T, Iwata Y, Yoneda H: Long-term outcome in 306 males with alcoholism. Psychiatry Clin Neurosci. 2001, 55 (6): 579-86. 10.1046/j.1440-1819.2001.00909.x.CrossRefPubMed
34.
Moos R, Moos B: Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders. Addiction. 98: 325-337. 10.1046/j.1360-0443.2003.00327.x.
35.
Timko C, Moos RH, Finney JW, Connell EG: Gender differences in help-utilization and the 8-year course of alcohol abuse. Addiction. 2002, 97 (7): 877-889. 10.1046/j.1360-0443.2002.00099.x.CrossRefPubMed
36.
Vaillant G, Clark W, Cyrus C, Milofsky E, Kopp J, Wulsin VW, Mogielnicki N: Prospective study of alcoholism treatment. Eight-year follow-up. Am J Med. 1983, 75:
37.
Schneider KM, Kviz FJ, Isola ML, Filstead WJ: Evaluating multiple outcomes and gender differences in alcoholism treatment. Addictive Behav. 1995, 20 (1): 1-21. 10.1016/0306-4603(94)00037-Y.CrossRef
38.
Flynn PM, Joe GW, Broome KM, Simpson DD, Brown BS: Recovery from opioid addiction in DATOS. J Subst Abuse Treat. 2003, 25: 177-186. 10.1016/S0740-5472(03)00125-9.CrossRefPubMed
39.
Hubbard RL, Craddock SG, Anderson J: Overview of 5-year followup outcomes in the drug abuse treatment outcome studies (DATOS). J Subst Abuse Treat. 2003, 25 (3): 125-134. 10.1016/S0740-5472(03)00130-2.CrossRefPubMed
40.
Gossop M, Marsden J, Stewart D, Kidd T: The National Treatment Outcome Research Study (NTORS): 4–5 year follow-up results. Addiction. 2003, 98 (3): 291-303. 10.1046/j.1360-0443.2003.00296.x.CrossRefPubMed
41.
Simpson DD, Joe GW, Bracy SA: Six-year follow-up of opioid addicts after admission to treatment. Arch Gen Psychiatry. 1982, 39 (11): 1318-1323.CrossRefPubMed
42.
Simpson DD: A national 5-year follow-up of treatment outcomes for cocaine dependence. Arch Gen Psychiatry. 2002, 59 (6): 538-544. 10.1001/archpsyc.59.6.538.CrossRefPubMed
43.
Gossop M, Browne N, Stewart D, Marsden J: Alcohol use outcomes and heavy drinking at 4–5 years among a treatment sample of drug misusers. J Subst Abuse Treat. 2003, 25 (3): 135-143. 10.1016/S0740-5472(03)00129-6.CrossRefPubMed
44.
Satre DD, Mertens JR, Arean PA, Weisner C: Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program. Addiction. 2004, 99 (10): 1286-1297. 10.1111/j.1360-0443.2004.00831.x.CrossRefPubMed
45.
Jarvis TJ: Implications of gender for alcohol treatment research: a quantitative and qualitative review. Br J Addict. 1992, 87: 1249-1261. 10.1111/j.1360-0443.1992.tb02734.x.CrossRefPubMed
46.
Hodgins DC, el-Guebaly N, Armstrong S, Dufour M: Implications of depression on outcome from alcohol dependence: a 3-year prospective follow-up. Alcohol Clin Exp Res. 1999, 23 (1):
47.
Kranzler HR, Del Boca FK, Rounsaville BJ: Comorbid psychiatric diagnosis predicts three-year outcomes in alcoholics: a posttreatment natural history study. J Stud Alcohol. 1996, 57 (6): 619-626.CrossRefPubMed
48.
Nunes E, Levin F: Treatment of depression in patients with alcohol or other drug dependence. JAMA. 2004, 291: 1887-1896. 10.1001/jama.291.15.1887.CrossRefPubMed
49.
Gonzales G, Feingold A, Oliveto A, Gonsai K, Kosten T: Comorbid major depressive disorder as a prognostic factor in cocaine abusing buprenorphine-maintained patients treated with desipramine and contingency management. Am J Drug Alcohol Abuse. 2003, 29: 497-514. 10.1081/ADA-120023455.CrossRef
50.
Vaglum P: Personality disorders and the course and outcome of substance abuse: A selective review of the 1984 to 2004 literature. Personality Disorders. Current Research and Treatments. Edited by: Reich J. 2005, New York: Routledge, 105-124.
51.
Secades-Villa R, Fernandez-Hermida JR: The validity of self-reports in a follow-up study with drug addicts. Addict Behav. 2003, 28 (6): 1175-82. 10.1016/S0306-4603(02)00219-8.CrossRefPubMed
Metadata
Title
Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties
Authors
Anne Signe Landheim
Kjell Bakken
Per Vaglum
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2006
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-6-44

Other articles of this Issue 1/2006

BMC Psychiatry 1/2006 Go to the issue

Research article

The effect of verbalization strategy on wisconsin card sorting test performance in schizophrenic patients receiving classical or atypical antipsychotics

Research article

Treatment of polydrug-using opiate dependents during withdrawal: towards a standardisation of treatment

Research article

Psychosis among "healthy" siblings of schizophrenia patients

Research article

Metabolic risk factor profile associated with use of second generation antipsychotics: a cross sectional study in a community mental health centre

Research article

Predicting inpatient violence using an extended version of the Brøset-Violence-Checklist: instrument development and clinical application

Research article

Attitudes to antipsychotic drugs and their side effects: a comparison between general practitioners and the general population