Cited by 589Substance Abuse Treatment and OutcomesMental Health Treatment and AccessBipolar Disorder and Treatment

The epidemiology of dual diagnosis

Kessler, Ronald C.·2004·Biological Psychiatry

Abstract

The English language literature on the epidemiology of dual diagnosis is reviewed. The literature shows mental disorders to be significantly related to alcohol and drug use disorders. The strongest associations involve externalizing mental disorders and alcohol-drug dependence. Mental disorders are associated with alcohol-drug use, problems among users, dependence among problem users, and persistence among people with lifetime dependence. These dual diagnoses are associated with severity and persistence of both mental and alcohol-drug disorders. A wider range of mental disorders is associated with nicotine dependence. Most people with dual diagnosis report their first mental disorder occurred at an earlier age than their first substance disorder. Prospective studies confirm this temporal order, although significant predictive associations are reciprocal. Analyses comparing active and remitted mental disorders suggest that some primary mental disorders are markers and others are causal risk factors for secondary substance disorders. The article closes with a discussion of ways epidemiologic research can be used to help target and evaluate interventions aimed at preventing secondary substance use disorders by treating early-onset primary mental disorders.

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Crossref · 10.1016/j.biopsych.2004.06.034

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Authors
Kessler, R. C.
Affiliations
Harvard University (US)
Corresponding author
Kessler, Ronald C.
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2004-11
Volume
56
Issue
10
Pages
730-737
ISSN
0006-3223 (ISSN-L)
OpenAlex
W2028877810
Cited by
588
References
113
Citations by year
2026: 7 · 2025: 22 · 2024: 20 · 2023: 17 · 2022: 28 · 2021: 28 · 2020: 34 · 2019: 34 · 2018: 26 · 2017: 27 · 2016: 38 · 2015: 46 · 2014: 32 · 2013: 35 · 2012: 28
FWCI
2.13
Type
journal article
Language
en
Open access
closed
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Robert Wood Johnson Foundation (044708)
  • National Institute of Mental Health (U01-MH60220)
  • John W. Alden Trust
  • National Institute on Drug Abuse
  • Substance Abuse and Mental Health Services Administration
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
dual diagnosis, alcoholism, drug addiction, nicotine dependence, early-onset mental disorders
MeSH terms
Mental Disorders, Cross-Sectional Studies, Humans, Prospective Studies, Tobacco Use Disorder, Comorbidity, Age of Onset, Diagnosis, Dual (Psychiatry), Disease Progression, Substance-Related Disorders

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