COMORBID DYSTHYMIA AND SUBSTANCE DISORDER - TREATMENT HISTORY AND COST

Objective: The purpose of this study was to determine the treatment hi story and cost of previous treatment among patients with comorbid subs tance-related disorder and dysthymia, as compared to patients with sub stance-related disorder only. Method: Retrospective data were obtained regarding past treatment. Treatment cost was calculated on the basis of the 1996 cost of various treatment modalities. The setting was alco hol-drug programs located within departments of psychiatry in two cent ers. A total of 642 patients were assessed, of whom 39 had substance-r elated disorder and dysthymia and 308 had substance-related disorder o nly (the remaining patients had other comorbid conditions). Data colle ction instruments included an interview-based questionnaire regarding previous psychiatric and substance abuse treatment. Current cost of tr eatment in various settings was assessed on the basis of a survey of f acilities used by patients in this area. Results: Patients with substa nce-related disorder and dysthymia had received more substance-related disorder treatment in 18 of 20 measures. Patients with substance-rela ted disorder and dysthymia used 4.7 times more substance-related disor der treatment dollars than patients with substance-related disorder on ly, although their demographic characteristics were similar. Past self -help activities and pharmacotherapy were remarkably similar for both groups. Although substance-related disorder treatment differed conside rably between the two groups of patients, other types of psychiatric t reatment (i.e., non-substance-related treatment) did not differ betwee n the two groups. Conclusions: Patients with substance-related disorde r and dysthymia are referred to (or seek) substance-related disorder t reatment more often than patients with substance-related disorder only but are referred to (or seek) non-substance-related psychiatric treat ment no more often than patients with substance-related disorder only. The cost of previous substance-related disorder treatment was several times higher for the patients with substance-related disorder and dys thymia.