Heumann D. Alcoholic hepatitis clinical presentation. Medscape Drugs and Diseases. 2014. Available at: http://emedicine.medscape.com/article/170539-clinical Accessed on: 2015-07-27.
NIAAA. Alcohol's Effects on the Body. NIAAA. 2015. Available at: http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body Accessed on: 2015-04-29.
NIAAA. Beyond hangovers. NIAAA Publications. 2010b. Available at: http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.htm#chapter03 Accessed on: 2015-07-27.
Overview

Chronic substance use is associated with increased risk for many mental health conditions, listed below. One reason mental health problems contribute to developing substance use problems is that many individuals attempt to self-medicate their mental health symptoms through substance use. Conversely, chronic substance use can lead to mental health problems. In either event, it is important to discover mental health problems in people struggling with substance use problems through mental health screening.

Co-occurrence of substance use disorder(s) with mental disorder(s) is often called a "dual diagnosis." The incidence is high at around 7.9 million adults or around 45% of those seeking treatment for substance use disorder (CBHSQ, 2015).

For example, data from a classic study found the following prevalence for mental health disorders one year after the participants had been identified as alcohol dependent (the DSM diagnosis at the time) (Kessler et al., 1996; Regier et al., 1990).

  1. Mood Disorders: 29.2%
  2. Major Depressive Disorder: 27.9%
  3. Bipolar Disorder: 1.9%
  4. Anxiety Disorders: 36.9%
  5. Generalized Anxiety Disorder (GAD): 11.6%
  6. Panic Disorder: 3.9%
  7. Post Traumatic Stress disorder (PTSD): 7.7%
Depression

Depression is the most common mental health disorder co-occurring with substance use disorders (CBHSQ, 2015). The U.S. Preventive Services Task Force (USPSTF) has indicated that all adults should be screened for depression, even in the absence of a past history (USPSTF, 2016). It is particularly relevant in patients having substance use disorders, giving the frequency with which they are co-morbid. Screening tools suggested by the USPSTF include the Patient Health Questionnaire, the Hospital Anxiety and Depression Scales in adults, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale in postpartum and pregnant women. Noting the severity of each condition is also important.

Other Mental Health Disorders

Anxiety is also common in persons with substance use disorders. PTSD is particularly common. As many as 40% of patients who are drug dependent report symptoms of PTSD (Papastavrou et al, 2011).

Personality disorders, bipolar, Attention Deficit and Hyperactivity Disorder (ADHD), and psychosis are among the other mental health diagnoses with a relatively high incidence of substance use disorder.

View ReferencesHide References
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. HHS Publication. 2015; SMA 15-4927, NSDUH Series H-50: . Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm
E Papastavrou , A Farmakas, G Karayiannis, E Kotrotsiou. Co morbidity of Post-Traumatic-Stress Disorders and Substance Use Disorder. Health Science Journal. 2011; 5(2): 107-17. Available at: http://www.hsj.gr/medicine/co-morbidity-of-posttraumaticstress-disorders-and-substance-use-disorder.pdf Accessed on: 2013-10-10.
Ismene L. Petrakis, et al. . Comorbidity of alcoholism and psychiatric disorders. National Institute on Alcohol Abuse and Alcoholism . 2002. Available at: http://pubs.niaaa.nih.gov/publications/arh26-2/81-89.htm Accessed on: 2016-02-09.
U.S. Preventative Services Task Force. Final Recommendation Statement - Depression in Adults: Screening. U.S. Preventative Services Task Force Website. 2016. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1 Accessed on: 2016-02-02.
Overview

Chronic substance use is associated with increased risk for many medical conditions. Part of following up on positive screening for problematic substance involves assessing them for these conditions. Conversely, patients having these medical conditions should be carefully screened for substance use problems. The list of such conditions is extensive. The following are just some of the most common. The external resources on this page refer to more extensive lists.

Alcohol

Medical problems associated with chronic alcohol use include the following:

  • Hepatic encephalopathy
  • Cardiomyopathy
  • Arrhythmia
  • Alcoholic hepatitis and fatty liver/steatosis
  • Liver cirrhosis
  • Sleep Disorder
  • Pancreatitis
  • Cancer (heightened risk): Oral, Esophageal, Throat, Liver, Breast

(Heuman, 2014; NIAAA, 2010; NIAAA, 2015)

Drugs

Medical problems associated with misuse of prescription drugs and other drug abuse include the following:

  • Risk for addiction to IV drug use
  • Risk for overdose

Medical problems associated with intravenous drug use include the following:

  • Risk for contracting HIV, Hepatitis B or C, Tuberculosis, and Syphilis
  • Tissue infections and abscesses
  • Pulmonary complications
  • Occult infection
  • Increased risk of STDs – chlamydia, gonococcal disease, and human papilloma virus

(Degenhardt et al., 2011; Monto et al., 2008; NIDA 2005; Schoener et al., 2002)

Tobacco

Medical problems associated with tobacco use include the following:

  • Increased risk of many forms of cancer, especially lung, laryngeal, and oral cancer
  • Increased cardiovascular risk
  • Chronic obstructive pulmonary disease (COPD)/Emphysema
  • Periodontal disease / Premature tooth loss
  • Many other medical conditions are caused or made worse by tobacco use. The list is too long to include here. The reader is referred to the Surgeon General's Report for a more detailed list: Health Consequences of Smoking. See External Resources this page.

(CDC 2013; Eke et al. 2012; USDHHS 2014)

Medical problems associated with environmental tobacco smoke exposure include the following:

  • Otitis media
  • Increased cardiovascular risk and heart disease
  • Increased risk of certain forms of cancer
  • Frequent asthma attacks
  • Increased repiratory infections and symptoms
  • Increase risk of lung cancer

(CDC 2010)

View ReferencesHide References
Center for Disease Control and Prevention. Secondhand Smoke Fact Sheet. CDC Website. 2010. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm Accessed on: 2010-06-15.
Centers for Disease Control and Prevention. Tobacco Use: Targeting the Nation’s Leading Killer. CDC Website. 2011. Available at: http://stacks.cdc.gov/view/cdc/5527/
Degenhardt L , Bucello C , Mathers B. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction . 2011; 106: 32-51. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03140.x/abstract Accessed on: 2015-04-23.
Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. Journal of Dental Research. 2012; 91: 914-20. Available at: http://jdr.sagepub.com/content/91/10/914 Accessed on: 2014-12-16.
Heumann D. Alcoholic hepatitis clinical presentation. Medscape Drugs and Diseases. 2014. Available at: http://emedicine.medscape.com/article/170539-clinical Accessed on: 2015-07-27.
Monto A, Currie S, Wright TL. Liver disease in injection drug users with hepatitis C, with and without HIV coinfection. J Addict Dis. 2008; 27(2): 49-59. Available at: http://www.tandfonline.com/doi/abs/10.1300/J069v27n02_06?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.Ula6dplDvmc Accessed on: 2013-10-10.
National Institute on Drug Abuse. Linked Epidemics: Drug Abuse and HIV/AIDS. Topics in Brief. 2005. Available at: https://www.drugabuse.gov/publications/drugfacts/hivaids-drug-abuse-intertwined-epidemics Accessed on: 2011-04-16.
NIAAA. Alcohol's Effects on the Body. NIAAA. 2015. Available at: http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body Accessed on: 2015-04-29.
NIAAA. Beyond hangovers. NIAAA Publications. 2010b. Available at: http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.htm#chapter03 Accessed on: 2015-07-27.
Schoener EP, Hopper JA, Pierre JD. Injection drug use in North America. Infect Dis Clin North Am. 2002; 16(3): 535-551. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12371114 Accessed on: 2013-10-10.
U.S. Department of Health and Human Services.. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. . Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention . 2014. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm Accessed on: 2014-04-28.
U.S. Preventative Services Task Force. Final Recommendation Statement - Depression in Adults: Screening. U.S. Preventative Services Task Force Website. 2016. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1 Accessed on: 2016-02-02.

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