The epidemiology of dual diagnosis
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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There are high rates of comorbidity between substance abuse and other Axis I conditions, between schizophrenia and bipolar disorder, and between ASD and mood and anxiety disorders.
“For example, there are high rates of comorbidity between substance abuse and other Axis I conditions [747-749], schizophrenia and bipolar disorder [750], and ASD and mood and anxiety disorders [751].”
From Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings (2012) · cites this paper as [747]
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- Authors
- Kessler, R. C.
- Affiliations
- Harvard University (US)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- 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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