IMPLICATIONS OF MENTAL AND SUBSTANCE USE DISORDERS - A COMPARISON OF SINGLE AND DUAL DIAGNOSIS PATIENTS

To understand better the implications of co-occurring mental and subst ance use disorders, we examined DSM-III-R diagnoses and life problems among a representative sample of 314 patients admitted to either a psy chiatric hospital or a residential substance abuse treatment program f rom the same inner-city catchment area. Based upon the Structured Clin ical Interview for DSM-III-R, the patients were divided into four grou ps. The first two groups had dual diagnoses, either: a) a primary axis I mental disorder (MD) and a comorbid psychoactive substance use diso rder (PSUD); or b) a PSUD-related mental disorder and a PSUD, but no p rimary axis I MD. The third and fourth groups had a single diagnosis, either: c) a primary axis I MD, but no lifetime PSUD; or d) a PSUD, bu t no lifetime primary axis I MD. As expected, the two dual disorder gr oups had more cumulative problems than did either of the single disord er groups. Dually disordered patients with PSUD-related MD most resemb led single-diagnosis PSUD patients in terms of substance use profile a nd life problems. Dually disordered patients with primary MD more rese mbled single-diagnosis MD patients, but had more severe life problems. Presence of a PSUD was associated with male gender, antisocial person ality disorder, and more severe legal problems. Presence of a primary mental disorder was associated with more extensive prior hospitalizati ons and greater psychiatric severity.