Substance Misuse and Mental Illness

Concurrent substance misuse and mental illness —"dual diagnosis" or "comorbidity"—is an important consideration. In the Epidemiologic Catchment Area study, 29% of individuals with a lifetime history of any mental disorder (other than substance use) had a history of substance use (22% alcohol disorder and 15% a drug disorder) (22).

Comorbidity can be classified on the basis of the primary diagnosis (23,24). There are those with a primary diagnosis of a major mental illness who have a secondary diagnosis of substance misuse that further affects their mental health. Such individuals may use drugs to relieve the adverse symptoms of their mental illness. Conversely, substance misuse may be the primary diagnosis leading to psychiatric complications and mental illness—for example, depression with suicidal ideation may occur among substance abusers. On occasions, mental illness and substance misuse may coexist, such as when an underlying traumatic experience results in both substance misuse and posttraumatic stress disorder.

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