PSYCHIATRIC AND SUBSTANCE USE COMORBIDITY AMONG TREATMENT-SEEKING OPIOID ABUSERS

Background: Major studies of psychiatric comorbidity in opioid abusers reported rates of comorbidity that far exceeded general population es timates. These studies were published more than a decade ago and repor ted on few women and few substance use diagnoses. Methods: Psychiatric and substance use comorbidity was assessed in 716 opioid abusers seek ing methadone maintenance. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition diagnostic assessment was conducted 1 month after admission. Rates of psychiatric and substance use disord er were compared by gender, and associations were assessed between psy chiatric comorbidity and dimensional indexes of substance use severity , psychosocial impairment, and personality traits. Results: Psychiatri c comorbidity was documented in 47% of the sample (47% women and 48% m en). Antisocial personality disorder (25.1%) and major depression (15. 8%) were the most common diagnoses. Patients had at least 2 substance use diagnoses, most often opioid and cocaine dependence. Demographics, substance use history, and personality variables discriminated betwee n patients with vs without comorbidity. Psychiatric comorbidity also w as associated with a more severe substance use disorder. Conclusions: Psychiatric comorbidity, especially personality and mood disorder, was common in men and women. The positive associations between psychiatri c comorbidity and severity of substance use and other psychosocial pro blems were most consistent among those with antisocial personality.