Psychiatric co-morbidity among male heroin addicts: differences between hospital and incarcerated subjects in Taiwan

Aims. To examine the differences in psychiatric co-morbidity between hospit al and incarcerated groups of heroin addicts in Taiwan. Design. Life-time p revalence of DSM-III-R-based coexisting psychiatric disorders, including pe rsonality disorders, were surveyed Settings. A psychiatric hospital and two prisons. Participants. Two hundred and sixty heroin users who were incarce rated ir? prisons, and 47 heroin users who voluntarily sought help ill a ps ychiatric hospital were interviewed by board-certified psychiatrists. Measu rements. Using two psychometric instruments, the Psychiatric Diagnostic Ass essment (PDA) and the Structured Interview for DSM-III-R Personality Disord ers (SIPD-R), psychiatric co-morbidity was assessed. Findings. Different li fe-time rates of coexisting psychiatric disorders among heroin addicts in d ifferent settings were found: 83% of hospital subjects and 66% of incarcera ted subjects were diagnosed as having at least one coexisting axis I or II disorder. The most prevalent coexisting DSM-III-R defined axis I disorders were additional substance use disorders (alcohol and methamphetamine), whil e the axis II disorder was antisocial personality disorder. The hospital gr oup had a significantly higher prevalence rate of mood disorder (p<0.001), paranoid personality disorder (p<0.05) and antisocial personality disorder (p<0.001) than the incarcerated group. Conclusions. We suggest that heroin addicts with coexisting psychiatric disorders receive relevant psychiatric treatment. Those with personality disorders, especially the antisocial type , should be considered for specialized therapeutic community programmes ins tead of incarceration.