The DOI matches its Crossref record; 110 of the 113 references it cites were found in a registry or an index.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
Citations
Cites
Kessler, R. C. (1994) · Archives of General Psychiatry · doi:10.1001/archpsyc.1994.03950010008002 · Cited by 12,370
Self-citationPrevalence and development of psychiatric disorders in childhood and adolescence
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.8.837 · Cited by 4,035
Regier, D. A. (1990) · JAMA · doi:10.1001/jama.1990.03450190043026 · Cited by 3,962
The Self-Medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications
Khantzian, E. J. (1997) · Harvard Review of Psychiatry · doi:10.3109/10673229709030550 · Cited by 3,242
Smoking and Mental Illness: A Population-Based Prevalence Study
Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000) · JAMA · doi:10.1001/jama.284.20.2606 · Cited by 2,508
Kessler, R. C. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830160031005 · Cited by 2,085
Self-citationThe Structure of Common Mental Disorders
Krueger, R. F. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.10.921 · Cited by 1,881
Kessler, R. C., Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G., & Leaf, P. J. (1996) · American Journal of Orthopsychiatry · doi:10.1037/h0080151 · Cited by 1,378
Self-citationDieting and binging: A causal analysis.
Polivy, J., & Herman, C. P. (1985) · American Psychologist · doi:10.1037//0003-066x.40.2.193 · Cited by 1,279
Freeman, H. E., & Robins, L. N. (1967) · American Sociological Review · doi:10.2307/2091752 · Cited by 1,221
Flagged first, then by citations
3 of the 113 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Aharonovich, 2001, Anger and depressive states among treatment-seeking drug abusers, Am J Addict, 10, 327
- Kranzler, 2003, Dual diagnosis, Am J Addict, 12, S26
- 2000, Cross-national comparisons of the prevalences and correlates of mental disorders, Bull World Health Organ, 78, 413
Cited by
Sorted by citations
Items 301–400 of 589
Dual Diagnosis of Substance Abuse and Severe Mental Illness: The Scope of the Problem
Buckley, P. F. (2007) · Journal of Dual Diagnosis · doi:10.1300/j374v03n02_07 · Cited by 13
Left-handedness is statistically linked to lifetime experimentation with illicit drugs
Preti, A., Usai, I., Pintus, E., Sardu, C., Petretto, D., & Masala, C. (2012) · Laterality · doi:10.1080/1357650x.2011.575786 · Cited by 11
“Since mental disorders are linked to increased use of both licit and illicit drugs (Kessler, 2004), and some mental and somatic disorders are related to a higher incidence of non-right-handedness (Bryden et al., 2005; Denny, 2009; Dragovic & Hammond, 2005), our sample is likely to include a lower…”
BackgroundBrief alcohol intervention in a psychiatric outpatient setting: a randomized controlled study
Nehlin, C., Grönbladh, L., Fredriksson, A., & Jansson, L. (2012) · Addiction Science & Clinical Practice · doi:10.1186/1940-0640-7-23 · Cited by 13
“Although a strong association between alcohol use and psychiatric disorders is well-established [12], only a small number of studies have examined BI in psychiatric care settings [13-15].”
BackgroundKoob, G. F., Kandel, D. B., Baler, R., & Volkow, N. D. (2015) · Wiley eBooks · doi:10.1002/9781118753378.ch22 · Cited by 14
Validation of the full and brief Externalizing Spectrum Inventory in Dutch forensic inpatients
Soe-Agnie, S. E., Patrick, C. J., Nijman, H. L. I., & de Jong, C. A. J. (2015) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789949.2015.1090621 · Cited by 12
“…antisocial behavioral disorders and substance use disorders (SUDs), has been shown to reflect systematic covariance (Cerda, Sagdeo, & Galea, 2008; Kessler, 2004; Krueger, 1999; Merikangas & Kalaydjian, 2007) and research has shown these disorders –including APD, violence proneness, and different…”
BackgroundSajid, A., Whiteman, A., Bell, R. L., Greene, M., Engleman, E. A., & Chambers, R. A. (2016) · American Journal on Addictions · doi:10.1111/ajad.12441 · Cited by 12
Monteschi, M., Vedana, K. G. G., & Miasso, A. I. (2010) · Texto & Contexto - Enfermagem · doi:10.1590/s0104-07072010000400014 · Cited by 12
Jung, J., Goldstein, R. B., & Grant, B. F. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.08.003 · Cited by 12
“Such comorbidity is associated with greater clinical severity and complexity, as well as poor treatment outcomes [1,5,6].”
Sundström, C., Petersen, E. M., Sinadinovic, K., Gustafsson, P., & Berman, A. H. (2019) · Addiction Science & Clinical Practice · doi:10.1186/s13722-019-0140-x · Cited by 12
The role of the working alliance in psychological treatment of substance use disorder outpatients
Gidhagen, Y., Holmqvist, R., Philips, B., & Falkenström, F. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1807639 · Cited by 12
“SUD patients form a heterogeneous group, often with various psychiatric and personalityrelated problems, e.g., co-occurring psychiatric disorders (e.g., Grant et al., 2004a; Grant et al., 2004b; Kessler, 2004).”
BackgroundGoossens, F. X., Lammers, J., Onrust, S. A., Conrod, P., de Castro, B. O., & Monshouwer, K. (2015) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-015-0781-6 · Cited by 12
Dual diagnosis and psychosocial interventions—Introduction and commentary
Thylstrup, B., & Johansen, K. S. (2008) · Nordic Journal of Psychiatry · doi:10.1080/08039480802571069 · Cited by 12
Chambers, R. A. (2013) · Journal of Dual Diagnosis · doi:10.1080/15504263.2013.807072 · Cited by 12
“Even as most behavioral health patients live with dual diagnosis (Grant, 1996; Grant et al., 2004; Kessler, 2004; Kessler et al., 1994; Lasser et al., 2000), and despite mounting evidence suggesting the biological interrelatedness of these diseases (Chambers, 2013; Chambers et al.”
BackgroundKuussaari, K., & Hirschovits-Gerz, T. (2015) · Scandinavian Journal of Public Health · doi:10.1177/1403494815616303 · Cited by 12
“Patients with co-occurring SUD and MHD have high levels of morbidity and mortality, an increased risk of suicide, a high consumption of treatment services, high relapse rates and inadequate treatment outcomes, which present serious challenges for the treatment system [6,16].”
BackgroundStepankova, L., Kralikova, E., Zvolska, K., Kmetova, A., Blaha, M., Bortlicek, Z., Sticha, M., Anders, M., Schroeder, D. R., & Croghan, I. T. (2013) · Preventing Chronic Disease · doi:10.5888/pcd10.130051 · Cited by 11
“Smokers are more likely than nonsmokers to be depressed (7), and conversely, depressed patients are more likely than nondepressed patients to be smokers (8).”
Equine-assisted services for individuals with substance use disorders: a scoping review
Diaz, L., Gormley, M. A., Coleman, A., Sepanski, A., Corley, H., Perez, A., & Litwin, A. H. (2022) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-022-00506-x · Cited by 11
Avaliação multidimensional do usuário de drogas e a Escala de Gravidade de Dependência
Kessler, F. H. P., Faller, S., Formigoni, M. L. O. D. S., Cruz, M. S., Brasiliano, S., Stolf, A. R., & Pechansky, F. (2010) · Revista de Psiquiatria do Rio Grande do Sul · doi:10.1590/s0101-81082010000200005 · Cited by 11
Ranta, J., & Raitasalo, K. (2015) · Nordic Studies on Alcohol and Drugs · doi:10.1515/nsad-2015-0056 · Cited by 16
“The observations on high comorbidity rates of substance abuse and mental disorders have later been confirmed by several other studies (Grant & Harford, 1995; Kessler, 2004; Merikan- gas et al., 1998).”
ResultMarijuana Use and Psychiatric Disorders in Perinatally HIV-Exposed Youth: Does HIV Matter?
Elkington, K. S., Cruz, J. E., Warne, P. A., Santamaria, E. K., Dolezal, C. L., & Mellins, C. A. (2015) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsv117 · Cited by 11
Substance Abuse in Women: Does Gender Matter?
Back, S. E., Contini, R., & Brady, K. T. (2007) · The Psychiatric times · Cited by 11
Mood symptoms and impairment due to substance use: A network perspective on comorbidity
Moriarity, D. P., Bart, C. P., Stumper, A., Jones, P. J., & Alloy, L. B. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.086 · Cited by 16
Le, S. M., Trouiller, P., Thi, H. D., Hai, O. K. T., Minh, K. P., Vallo, R., Rapoud, D., Quillet, C., Nguyen, T. L., Nguyen, Q. D., et al. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108334 · Cited by 11
Salom, C., Kelly, A. B., Alati, R., Williams, G. M., Patton, G. C., & Williams, J. W. (2015) · Drug and Alcohol Review · doi:10.1111/dar.12303 · Cited by 11
“It has been suggested that, as for other problems that cluster in youth such as delinquency and sexual behaviours [13], there may be common factors that underlie the co-occurrence of alcohol and mental health problems [14].”
BackgroundFrem, Y., Torrens, M., Domingo‐Salvany, A., & Gilchrist, G. (2017) · Advances in Dual Diagnosis · doi:10.1108/add-01-2017-0002 · Cited by 14
Comorbidity of Lifetime Alcohol Use Disorder and Major Depressive Disorder in San Juan, Puerto Rico
Caetano, R., Vaeth, P. A. C., & CANINO, G. J. (2019) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2019.80.546 · Cited by 11
“Results from the logistic regression in Table 2, similar to results in the literature (Grant et al., 2004; Kessler, 2004; Lai et al., 2015; Merikangas & Kalaydjian, 2007), showed AUD severity as clearly related in a positive manner to comorbid MDD.”
ResultMarín-Navarrete, R., Templos-Núñez, L., Eliosa-Hernández, A., Villalobos-Gallegos, L., Fernández-Mondragón, J., Pérez-López, A., Galván-Sosa, D., Verdeja, R. E., Alonso, E., Feaster, D. J., et al. (2014) · Substance Use & Misuse · doi:10.3109/10826084.2014.931972 · Cited by 10
“According to the literature, the levels of comorbidity presented by people assisting to specialized addiction treatment units showed a range of co-occurring disorders from 50% to 75% (Kessler, 2004; SAMHSA, 2005).”
BackgroundAlcohol Use Screening and Case Finding: Screening Tools, Clinical Clues, and Making the Diagnosis
Freedy, J. R., & Ryan, K. (2011) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2010.11.007 · Cited by 10
A systematic review of comprehensive interventions for substance abuse: Focus on victimization
Sabri, B., Greene, C., & Lucas, G. M. (2019) · Aggression and Violent Behavior · doi:10.1016/j.avb.2019.08.006 · Cited by 10
“Violence victimization has been associated with cooccurrence of mental health and HIV among people who use substances (de Waal et al., 2018; Kessler, 2004; Marshall et al., 2008; Nayak, Lown, Bond, & Greenfield, 2012; Sabri, 2012; Taylor, 2011), greater impairment in functioning and poorer response to substance abuse…”
BackgroundScreening and Treating Mental Disorders in Addiction Treatment Settings: A Stepped Care Model
Parikh, S. V. (2007) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-007-9095-3 · Cited by 10
“Substance abuse treatment As the formerly separate solitudes of mental and addictions disorders meet, the presence of traditional psychiatric disorders in patients being treated for substance abuse (SA) disorders is increasingly apparent (Castel et al. 2006; Kessler 2004).”
BackgroundKamimura, A., Ashby, J., Tabler, J., Nourian, M. M., Trinh, H. N., Chen, J. I., & Reel, J. J. (2016) · Journal of Ethnicity in Substance Abuse · doi:10.1080/15332640.2015.1102114 · Cited by 10
“Substance use is often related to depression and anxiety (Davis et al., 2006; 2005; Kessler, 2004; Lechner et al., 2014).”
BackgroundMcClintick, M. N., & Grant, K. A. (2016) · Psychopharmacology · doi:10.1007/s00213-016-4427-2 · Cited by 9
“There are well-known associations between difficult temperament, antisocial personality, unstable temperament, and alcohol abuse (DeJong et al. 1993; Kessler 2004; Skodol et al. 1999).”
Backgroundde Vries, B., Pijnenborg, G. H. M., van der Stouwe, E. C. D., Visser, E., de Jong, S., Pharmaco therapy and outcome survey (PHAMOUS)-investigators, Bartels‐Velthuis, A. A., Bruggeman, R., Castelein, S., Jörg, F., et al. (2019) · PLoS ONE · doi:10.1371/journal.pone.0219056 · Cited by 10
Dual diagnosis affects prognosis in patients with drug dependence in integrative care setting
Samartzis, L. (2014) · ICUS and Nursing Web Journal · Cited by 10
U-shaped curve of psychosis according to cannabis use: New evidence from a snowball sample
Brañas, A., Barrigón, M. L., Torres, N. G., Garcelán, S. P., Testal, J. F. R., Lahera, G., & Ruíz-Veguilla, M. (2016) · Journal of Psychopharmacology · doi:10.1177/0269881116660712 · Cited by 10
“Use of alcohol and other drugs has also been linked to a higher prevalence of psychiatric disorders (Kessler, 2004) and differences in the onset of psychosis (Power et al., 2013).”
BackgroundTiburcio, M., Nagy, G. A., Mohedano, G. R., Vélez, N. M., Carreño, S., Cisneros, D. P., & Rey, G. N. (2019) · Nurse Education in Practice · doi:10.1016/j.nepr.2019.03.005 · Cited by 12
Abu‐Zaid, A., Bhagavathula, A. S., Rahmani, J., Alyoubi, R. A., Alomar, O., Baradwan, S., Alkhamis, W. H., Khalifa, M., Alshahrani, M. S., Khadawardi, K. A., et al. (2022) · The European Journal of Contraception & Reproductive Health Care · doi:10.1080/13625187.2022.2040983 · Cited by 10
“PCOS-exposed offspring distinctively harbour increased risks of acquiring developmental delay and neurobehavioral disorders, such as ASD, ADHD, Tourette’s syndrome, and chronic tic disorders [10,13,39].”
BackgroundTrastorno dual en población general de Itagüí, Colombia
Pérez, G. A. C., & Hincapié, G. M. S. (2015) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2015.08.005 · Cited by 10
Balhara, Y. P. S., Sarkar, S., Bera, S. C., Gupta, R. G., Chawla, N., & Lal, R. (2016) · international journal high risk behaviors & addiction · doi:10.5812/ijhrba.32501 · Cited by 9
“Substance use disorders (SUD) often tend to co-occur with other psychiatric disorders (1-3).”
BackgroundMammen, K., Mills, L., Deacon, R. M., Bruno, R., Dunlop, A. J., Holmes, J., Luksza, J., Shakeshaft, A. P., Farrell, M., & Lintzeris, N. (2021) · Drug and Alcohol Review · doi:10.1111/dar.13346 · Cited by 9
A, B. D. G. (2015) · Journal of Alcoholism and Drug Dependence · doi:10.4172/2329-6488.1000207 · Cited by 9
“However, the figure was much less than those found in other studies from India (50-75%) and the US (50-60%) [6-8].”
ResultStohler, R., & Wulf Rössler, A. (2005) · Key issues in mental health (Online)/Key issues in mental health (Print) · doi:10.1159/isbn.978-3-318-01002-2 · Cited by 9
Sanches, R. F., & Marques, J. M. D. A. (2010) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462010000200014 · Cited by 10
Typology of persons with severe mental disorders
Fleury, M., Grenier, G., Bamvita, J., & Tremblay, J. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-137 · Cited by 9
“Co-morbidity of disorders tended to be more chronic than unique mental disorders, and treatment was less effective [37].”
BackgroundMood and Attention Variability in Women with Alcohol Dependence: A Preliminary Investigation
Bowen, R., Block, G. W., & Baetz, M. (2008) · American Journal on Addictions · doi:10.1080/10550490701756013 · Cited by 9
Martínez‐Gras, I., Navarrete, F. F., Arriazu, J. P., Pascual, J. P., de Gauna, M. D. I. R., Fraguas, D., & Rubio, G. (2016) · Adicciones · doi:10.20882/adicciones.785 · Cited by 9
Darcin, A., Nurmedov, S., Noyan, C., Yilmaz, O., & Dilbaz, N. (2015) · Dusunen Adam The Journal of Psychiatry and Neurological Sciences · doi:10.5350/dajpn2015280302
Chambers, J. E., Perkins, S. M., Mosesso, K. M., Ahdoot, A., Arnaudo, C. L., & Chambers, R. A. (2025) · American Journal on Addictions · doi:10.1111/ajad.13673 · Cited by 11
“1,2 There is a major unmet need to provide more accessible and effective treatments for patients with comorbid mental illness and addictions.”
The Impact of Personality Disorders and Severity of Dependence in Psychosocial Problems
Vélez-Moreno, A., Tejada, A. J. R., Rivera, F., Fernández‐Calderón, F., Linares, E. T., López, J. R., González‐Sáiz, F., & Lozano, O. M. (2016) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-016-9696-9 · Cited by 8
“Variables such as motivation for change and duration of treatment time (Ball et al. 2006; Meier et al. 2005), therapeutic alliance (Gerstley et al. 1989), types of comorbidity (Kessler 2004) and neurocognitive impairment (Worley et al. 2014) have shown this modulating role.”
BackgroundDrug-related mortality in psychiatric patients
Lynskey, M. T., Kimber, J., & Strang, J. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00372-7 · Cited by 8
Pathologie duelle, actualités et perspectives
Benyamina, A. (2018) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2018.08.016 · Cited by 8
Criminal offending and associated factors in dual diagnosis patients
Eggink, E., de Waal, M. M., & Goudriaan, A. E. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.01.057 · Cited by 13
Michalis, G., Bellos, S., Politis, S., Magklara, K., Petrikis, P., & Skapinakis, P. (2019) · Depression Research and Treatment · doi:10.1155/2019/5871857 · Cited by 7
Levine, J. A., Gius, B. K., Boghdadi, G., Connors, G. J., Maisto, S. A., & Schlauch, R. C. (2020) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.14462 · Cited by 9
“…poorer physical and mental health, have higher rates of relapse and attrition in treatment, and worse long-term outcomes resulting in repeated treatment attempts and more frequent visits to hospitals and emergency rooms (e.g. Kessler, 2004, Kushner et al., 2005, Mark, 2003, Pettinati et al., 2013).”
BackgroundInfluentialWood, C. M., & Vindel, A. C. (2009) · Psychosocial Intervention · doi:10.5093/in2009v18n3a3 · Cited by 7
“…el hábito de fumar es más común entre las personas con trastornos mentales, incluidos los trastornos de ansiedad (Breslau, 1995; Breslau, Novak y Kessler, 2004; Feldner, Vujanovic, Gibson y Zvolensky, 2008; Morissette, Tull, Gulliver, Kamholz y Zimering, 2007; Ziedonis et al., 2008), los…”
Professionals’ perceptions about healthcare resources for co-occuring disorders in Spain
Roncero, C., Vega, P., Martı́nez-Raga, J., Barral, C., Basurte-Villamor, I., Rodríguez-Cintas, L., Mesías, B., Grau‐López, L., Casas, M., & Szerman, N. (2014) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-8-35 · Cited by 7
“Background Dual pathology, dual disorders or co-occurring disorders are defined as the presence of an addictive and another mental disorder, with rates well-documented above 50% [1-14].”
BackgroundImpulsivity, dual diagnosis, and the structure of motivated behavior in addiction
Chambers, R. A. (2008) · Behavioral and Brain Sciences · doi:10.1017/s0140525x08004792 · Cited by 8
Chambers, R. A., Sajdyk, T. J., Conroy, S. K., Lafuze, J. E., Fitz, S. D., & Shekhar, A. (2007) · Behavioral Neuroscience · doi:10.1037/0735-7044.121.6.1316 · Cited by 8
“…reinforcement learning and drug taking (Baxter & Murray, 2002; Carelli, Williams, & Hollander, 2003; Everitt, Cardinal, Parkinson, & Robbins, 2003; Kilts, 2001), and its basolateral regions have direct connectivity with frontal cortical–striatal circuits implicated in addiction (Baxter & Murray,…”
BackgroundHoxmark, E., & Wynn, R. (2010) · Journal of Addictions Nursing · doi:10.3109/10884602.2010.520170 · Cited by 8
“The prevalence rates vary across studies, according to the location of the studies and the research methodologies used, and the way substance abuse and psychiatric illness are defined (Kessler, 2004; Landheim, Bakken, & Vaglum, 2003; Verheul et al., 2000; Wynn, 2007).”
BackgroundRecent illicit drug use among psychiatric patients in Brazil: a national representative study
Nahas, M. A., Melo, A. P. S., Cournos, F., McKinnon, K. M., Wainberg, M. L., & Guimarães, M. D. C. (2017) · Revista de Saúde Pública · doi:10.11606/s1518-8787.2017051006543 · Cited by 8
Torres-Galván, S., Flores-López, M., Romero‐Sanchiz, P., Requena-Ocaña, N., Porras-Perales, Ó., Nogueira‐Arjona, R., Mayoral, F., Araos, P. F., Serrano, A., Muga, R., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-93075-1 · Cited by 8
Thomasius, R., Sack, P., & Petersen, K. U. (2010) · Mental Health and Substance Use · doi:10.1080/17523281.2010.504643 · Cited by 7
“In a majority of adults with SUD, PCD preceded the onset of SUD, often beginning in childhood (Kessler, 2004 ).”
BackgroundLongitudinal Dynamics of Substance Use and Psychiatric Symptoms in Count Data with Zero Inflation
Ferrer, E. E., Conger, R. D., & Robins, R. W. (2016) · Multivariate Behavioral Research · doi:10.1080/00273171.2016.1144501 · Cited by 7
“…these studies have also yielded mixed results (Brook, Brook, Zhang, Cohen, & Whiteman, 2002; Hallfors, Waller, Bauer, Ford, & Halpern, 2005; Kessler, 2004; Magidson, Liu, Lejuez, & Blanco, 2012; Needham, 2007; Trim, Meehan, King, & Chassin, 2007; van Laar, van Dorsselaer, Monshouwer, &…”
The Treatment of Complex Dual Disorders: Clinicians’ and Service Users’ Perspectives
Phillip Therien Anais, S. (2014) · Journal of Addiction Research & Therapy · doi:10.4172/2155-6105.s10-006 · Cited by 7
“Second, while mental disorders and alcohol or drug disorders are significantly interrelated, DDs are associated with increased severity and persistence of both disorders [5].”
BackgroundHjemsæter, A. J., Bramness, J. G., Drake, R. E., Skeie, I., Monsbakken, B., Thoresen, M., & Landheim, A. S. (2019) · Cogent Psychology · doi:10.1080/23311908.2019.1634325 · Cited by 7
“The relationships, including the causal direction, between different types and levels of SUDs and various mental health problems continue to be debated (Kessler, 2004; Swendsen et al., 2010).”
BackgroundKlemetsen, M. G., & Lindstrøm, T. C. (2017) · Human-animal interaction bulletin · doi:10.1079/hai.2017.0008 · Cited by 7
Fathers' mental Ill-health and child maltreatment: A systematic review of the literature
Holdroyd, I., Bywaters, P., Duschinsky, R., Drayak, T., Taylor, J. L., & Coughlan, B. (2023) · Children and Youth Services Review · doi:10.1016/j.childyouth.2023.107317 · Cited by 7
“Mood swings, irritability and mood disorders stemming from substances and alcohol use (Kessler, 2004), may suggest a pathway by which substance use disorder can lead to increased psychopathology symptoms, and in turn CM. Parents with mental mixed anxiety and depressive disorder or PTSD reported…”
BackgroundGoldstein, R. B., Asarnow, J. R., Jaycox, L. H., SHOPTAW, S. J., & Murray, P. J. (2007) · Journal of Addictive Diseases · doi:10.1300/j069v26n03_05 · Cited by 7
Early mental health morbidity and later smoking at age 17 years
Zubrick, S. R., Lawrence, D. M., Mitrou, F., Christensen, D., & Taylor, C. L. (2011) · Psychological Medicine · doi:10.1017/s0033291711002182 · Cited by 7
“Kessler (2004) noted that retrospective data consistently found mental disorders to start earlier than substance disorders.”
BackgroundInfluentialFleury, M., Grenier, G., Bamvita, J., & Caron, J. (2014) · Psychiatric Quarterly · doi:10.1007/s11126-014-9335-1 · Cited by 7
“While in the majority of these cases, mental and substance use disorders have occurred separately, epidemiological studies confirm that these types of disorders do often co-occur [2].”
BackgroundMericle, A. A., Alvidrez, J., & Havassy, B. E. (2007) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2007.10399876 · Cited by 7
Bizzarri, J. V., Casetti, V., Panzani, P., Unterhauser, J., Mulas, S., Fanolla, A., Zitelli, C., Briani, A., Giupponi, G., Maremmani, I., et al. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.05.011 · Cited by 7
“First of all, comorbidity is associated with severity and persistence of both mental disorders and SUDs [21].”
BackgroundOutcome of psychological treatment of patients with substance use disorders in routine care
Gidhagen, Y., Philips, B., & Holmqvist, R. (2016) · Journal of Substance Use · doi:10.1080/14659891.2016.1200149 · Cited by 7
A neurocognitive model of the comorbidity of substance use and personality disorders
Koudys, J. W., & Ruocco, A. C. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815298-0.00006-x · Cited by 10
Drug use among people in prison: A global review of epidemiology, harms and interventions
Favril, L., Strang, J., & Fazel, S. (2025) · Addiction · doi:10.1111/add.70245 · Cited by 9
“In any case, having a co-occurring mental disorder can worsen the prognosis and increase the severity of drug use disorders, which is associated with poorer treat-ment outcomes [87].”
Meta-analysis of the effects of adjuvant drugs in co-occurring bipolar and substance use disorder
Raduà, J., Fortea, L., Goikolea, J. M., Zorrilla, E. P., Bernardo, M., Arrojo, M., Cunill, R., Castells, X., Becoña, E., López‐Durán, A., et al. (2023) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2023.01.005 · Cited by 6
Dorard, G., Bungener, C., Phan, O., Edel, Y., Corcos, M., & Berthoz, S. (2016) · L Encéphale · doi:10.1016/j.encep.2016.05.013 · Cited by 1
Błachut, M. K., Ścisło, P., Jarząb, M., Zając, M., Piegza, M. J., Badura-Brzoza, K., & Gorczyca, P. W. (2019) · Psychiatria Polska · doi:10.12740/pp/onlinefirst/103352 · Cited by 6
Genome-wide association study of psychiatric and substance use comorbidity in Mexican individuals
Martínez‐Magaña, J. J., Mendoza, A. D. G., Velázquez, J. A. V., Bustos-Gamiño, M. N., Juárez‐Rojop, I. E., Tovilla‐Zárate, C. A., Sarmiento, E., Uribe, E. S., Rodríguez-Mayoral, O., Fleiz-Bautista, C., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-85881-4 · Cited by 8
Chaim, C. H., Santana, G. L., Albertin, P. D. V., Silveira, C. M., Siu, E., Viana, M., Pang, W.-Y., & Andrade, L. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248403 · Cited by 4
“suggesting that having any PD is a predictor of transitioning from substance use to dependence [17] and that the comorbid mental disorder typically starts at an earlier age than the AUD [18].”
BackgroundHepner, K. A., Roth, C. P., Farris, C. A., Sloss, E. M., Martsolf, G. R., Pincus, H. A., Watkins, K. E., Batka, C., Mandel, D., Hosek, S. D., et al. (2015) · Rand health quarterly · doi:10.7249/rhq-05-02-16 · Cited by 6
Young female psychiatric patients' reasons for excessive alcohol use: a qualitative interview study
Nehlin, C., Fredriksson, A., & Öster, C. (2013) · Mental Health and Substance Use · doi:10.1080/17523281.2012.755559 · Cited by 6
Defining dual diagnosis: a qualitative study of the views of health care workers
Staiger, P. K., Long, C. M., McCabe, M. P., & Ricciardelli, L. A. (2008) · Mental Health and Substance Use · doi:10.1080/17523280802274985 · Cited by 6
“Kessler, 2004 ), the term ‘dual diagnosis’ is generally understood to refer to the co-occurrence of mental health and alcohol and other drug (AOD) disorders or problems (e.”
BackgroundCarter, M., Fisher, C. M., & Isaac, M. (2013) · SAGE Open · doi:10.1177/2158244013512133 · Cited by 9
“This approach is challenging to generalize to the nebulous and fluid variables, interactions, timeframes, sociocultural subtleties, and individualization inherent in comorbidity (Kelly, Daley, & Douaihy, 2012; Kessler, 2004a; Thylstrup & Johansen, 2009; Tracy & Johnson, 2007).”
BackgroundMethodInfluentialBruckner, T. A., Yoon, J., & Gonzales, M. (2016) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-016-0722-9 · Cited by 7
Exploratory Analysis of Polygenic Risk Scores for Psychiatric Disorders: Applied to Dual Diagnosis
Martínez‐Magaña, J. J., González‐Castro, T. B., Mendoza, A. D. G., Tovilla‐Zárate, C. A., Juárez‐Rojop, I. E., Uribe, E. S., Rodríguez-Mayoral, O., Lanzagorta, N., Escamilla, M., Kauffer, L. R. M., et al. (2019) · Revista de investigaci�n Cl�nica · doi:10.24875/ric.19003013 · Cited by 7
Marino, L. A., Gukasyan, N., Hu, M., Campbell, A. N. C., Pavlicová, M., & Nunes, E. V. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1910711 · Cited by 6
“About half of those with drug or alcohol use disorders meet lifetime criteria for another mental health condition such as anxiety and depressive disorders (Kessler, 2004).”
BackgroundManagement of Substance Abuse in Pregnancy: Maternal and Neonatal Aspects
Brandt, L., Leifheit, A. K., Finnegan, L. P., & Fischer, G. (2014) · Springer eBooks · doi:10.1007/978-3-642-54562-7_12 · Cited by 6
Cortina, C. C., Feijoó-Fonnegra, L. M., Manzur-Pineda, K., Palacio-Muñoz, M., Fonnegra, J. R., González, L. E. M., Mejía, M. C. B., & Restrepo, D. (2021) · Revista Colombiana de Psiquiatría (English ed ) · doi:10.1016/j.rcpeng.2021.05.001 · Cited by 6
The origin of addictions by means of unnatural decision
Ahmed, S. H. (2008) · Behavioral and Brain Sciences · doi:10.1017/s0140525x08004731 · Cited by 8
Ray, L. A., Hart, E., Chelminski, I., Young, D., & Zimmerman, M. (2011) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2010.540284 · Cited by 6
“Furthermore, alcohol use disorders are often comorbid with other Axes I and II diagnoses and such comorbidity is associated with even poorer outcomes on a variety of functional domains (6).”
BackgroundHindmarch, G., Meredith, L. S., McCullough, C., Griffin, B. A., & Watkins, K. E. (2024) · Chronic Stress · doi:10.1177/24705470241279335 · Cited by 5
“…to patients with a mental disorder or SUD alone, patients with co-occurring disorders have more severe and persistent mental health and SUD, 16,26 are more likely to have experienced homelessness and incarceration, 16,27,28 are more dif fi cult to treat for mental health and SUD, 16,26,29 and…”
BackgroundIntervention skills – a neglected field of research in medical education and beyond
Richters, C., Schmidmaier, R., Popov, V., Schredelseker, J., Fischer, F., & Fischer, M. R. (2024) · PubMed Central · doi:10.3205/zma001703 · Cited by 5
“This is also known as dual diagnosis [16], when a complex condition requires an integrated treatment approach that addresses both a primary disorder and a co-morbidity concurrently.”
BackgroundAlmeida, M. C., Cogo‐Moreira, H., Galvão, P. P. D. O., Mari, J. D. J., & Sanchez, Z. M. (2023) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-01000-y · Cited by 5
“…the predictors of early alcohol use among children (Gudjonsson et al., 2012; Sibley et al., 2014), anxiety usually precedes substance use disorders (Kessler, 2004), psychotic episodes are indicated as potential consequences of marijuana use in adolescence (Arsenault et al., 2004), and depression…”
Substance use among young people in the West Arsi Zone, Ethiopia: A cross-sectional study
Shifa, J. E., Adams, J., & Demant, D. (2025) · PLoS ONE · doi:10.1371/journal.pone.0319432 · Cited by 5
“However, substance use can in some cases further disrupt neurobiological pathways, exacerbating existing mental health problems or triggering the emergence of new ones [93].”
Canela, C., Schleifer, R., Jeger, J., Ebner, G., Seifritz, E., & Liebrenz, M. (2015) · Forensische Psychiatrie Psychologie Kriminologie · doi:10.1007/s11757-014-0302-3 · Cited by 5
An audit of non-urgent general adult referrals to Stikland State Psychiatric Facility
Ras, J. M., Koen, L., Botha, U. A., & Niehaus, D. J. H. (2011) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v17i4.312 · Cited by 5
Frieri, T., Montemagni, C., Crivelli, B., Scalese, M., Villari, V., & Rocca, P. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.03.018 · Cited by 6
“The high prevalence of substance use disorders (SUD) in patients with severe mental illness has been well documented in clinical and epidemiologic studies both in Europe [1–3] and in the United States [4–6] with lifetime prevalence that ranges from 29% to 71% and with different comorbid rates in various psychiatric di…”
BackgroundTreatment of Comorbid Substance Use Disorders and ADHD in Youth
Carrellas, N. W., Wilens, T. E., & Anselmo, R. (2016) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-016-0072-y · Cited by 6
Por trás da tela: uso e consequências dos jogos online para multijogadores
Cassel, P. A., Terribile, T. G., & Machado, J. C. (2019) · Research Society and Development · doi:10.33448/rsd-v8i10.1421 · Cited by 4
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
