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The epidemiology of dual diagnosis

Kessler, Ronald C.·2004·Biological Psychiatry

DOI 10.1016/j.biopsych.2004.06.034

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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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Validação dos instrumentos "Avaliação global das Necessidades Individuais - inicial e rastreio rápido
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Sexual disorders in the men treated in a psychiatric ward
Błachut, M. K., Badura-Brzoza, K., Ścisło, P., Bugdol, M. N., Świerzy, K., Piegza, M., & Gorczyca, P. W. (2021) · Psychiatria Polska · doi:10.12740/pp/onlinefirst/136102 · Cited by 1
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BackgroundInfluential
Collaborative Reduction of Criminal Justice Involvement for Persons with Mental Illness
Joy, M. T., & Osher, F. C. (2022) · Springer eBooks · doi:10.1007/978-3-031-10239-4_34 · Cited by 2
Effect of serotonin receptor gene variants on substance use disorders
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“Patients with drug and mixed drug use often have severe psychiatric problems (e.g., Kessler, 2004; National Board of Health and Welfare, 2019a; Stinson et al., 2005), which probably may influence the relationship on rupture-repair and outcome.”
Risk of substance-related problems in hypochondriasis
Isomura, K., Österman, S., Hedman-Lagerlöf, E., Kuja‐Halkola, R., Brikell, I., Chang, Z., D'Onofrio, B. M., Larsson, H., Lichtenstein, P., Mataix‐Cols, D., et al. (2026) · Psychological Medicine · doi:10.1017/s0033291725103048 · Cited by 1
“Similar assumptions on substance misuse as possible coping strategies were also made in studies on other psychiatric disorders (Goldfield et al., 2024; Grant et al., 2016; Kessler, 2004; Lai et al., 2015; Smith & Book, 2008; Virtanen et al., 2020; Virtanen et al., 2022).”
Anxiety and depression among opiate users who misuse substances during treatment
Stapleton, R. D., & Comiskey, C. M. (2011) · Irish Journal of Psychological Medicine · doi:10.1017/s0790966700011848 · Cited by 1
A stress process model of arrest among homeless women: Exploring risk and protective factors
Gentzler, K. C. (2014) · Lincoln (University of Nebraska) · Cited by 1
Drug combinations contributing to death according to mental health status
Merrill, R., & Sloan, A. (2014) · Mental Health and Substance Use · doi:10.1080/17523281.2013.841748 · Cited by 2
A preliminary review of an outpatient dual diagnosis recovery group programme
Chilton, J., Parrish, M., & Crone, D. (2011) · Groupwork · doi:10.1921/095182411x636554 · Cited by 1
“Substance use, often beginning at a young age, also compounds some of the relevant prognostic factors (Bellack et al, 2006; Daley et al, 1992; Kessler, 2004).”
Background
L’impact de la concomitance de troubles liés à la consommation de substance et de troubles de santé mentale sur les comportements à risque en fonction de l’âge
Coleman‐Cowger, V. H., Baumer, P. C., Dennis, M. L., & Scott, C. K. (2016) · Drogues santé et société · doi:10.7202/1035549ar · Cited by 1
Trastorno mental y tipo de sustancia consumida: estudio piloto sobre la utilización de la Entrevista de Cribado de Patología Dual (ECDD)
Tristante, M. S.-M., Miñarro-López, J., Montoya‐Castilla, I., & Pérez‐Marín, M. (2017) · Revista Internacional de Investigación en Adicciones · doi:10.28931/riiad.2017.2.03 · Cited by 1
Differences in Co-occurring Disorder Timing, Onset, and Sequence by Gender
van Draanen, J., & Upchurch, D. M. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00799-w · Cited by 1
“Those who had psychiatric disorder and SUD onset within the same year ( n = 398) were assigned to the psychiatric disorder category because psychiatric disorder is more likely to onset before SUD, overall (Kessler, 2004).”
Method
Substance use disorders and psychiatric co-morbidity in the public healthcare services of Veneto Region. State of art and epidemiological data
Nava, F. A., Bassetti, G., Bianco, M., Filippi, M., Kusstatscher, S., Imperadore, G., Mazzo, M., Nuti, M., Saccon, D., Sanavio, F., et al. (2022) · MISSION · doi:10.3280/mis57-2022oa12976 · Cited by 1
“Kessler R.C., Nelson C.B., McGonagle K.A., Edlund M.J., Frank R.G., Leaf P.J. (1996). The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am. J. Orthopsychiatry, 66(1): 17-31. Kessler R.C. (2004). The epidemiology of dual diagnosis. Biol. Psychiatry, 56…”
BackgroundInfluential
Training in Substance Use Disorders, Part 2: Updated Curriculum Guidelines
Crockford, D. N., Bahji, A., Schütz, C. G., Brasch, J. S., Buckley, L., Danilewitz, M., Dubreucq, S., Mak, M. S. B., & George, T. P. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241232456 · Cited by 1
The association between the consumption of psychoactive substances and psychiatric disorders in polyconsumers at the Puebla Juvenile Integration Center
Bañuelos, K. L., Vicuña-García, J. A., de León, I. D. L.-P., & Osorio‐Espinoza, A. (2024) · Revista Médica de Risaralda · doi:10.22517/25395203.25312 · Cited by 1
“Today, it is known that at least 70% of people with SUD (9) also have a psychiatric disorder, with epidemiological studies showing that the co-existence of both disorders can reach to up to 50% of the general population and up to 80% of the clinical population (10).”
Background
Narcissism and alcohol use: The mediating role of drinking motives among college students
Solka, J., & Finan, L. J. (2024) · Journal of American College Health · doi:10.1080/07448481.2024.2368000 · Cited by 2
“This is particularly important given young adulthood is often the age of onset for substance use disorders, 60 young people are actively exploring their identities and social roles, 24 and this period includes shifts in legal drinking status.”
Neurobiology of Addiction
Koob, G. F., Kandel, D. B., Baler, R., & Volkow, N. D. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_29 · Cited by 1
Enfermedad psiquiátrica en Atención Primaria
Aubá, E., Astiz, E. M., Fernández, A. S., & Cortés, M. J. (2011) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/s0304-5412(11)70171-8 · Cited by 1
El efecto aditivo en el diagnóstico dual: una revisión del funcionamiento cognitivo de pacientes con depresión mayor y alcoholismo
Flores-Medina, Y., Rodríguez‐Agudelo, Y., Bernal-Hernández, J., & Cruz-Fuentes, C. S. (2015) · Psiquiatría Biológica · doi:10.1016/j.psiq.2015.11.004 · Cited by 1
From Nihilism to Hope: Reframing the Concept of Addiction
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COMORBIDITY OF ALCOHOL AND MENTAL HEALTH: ADDRESSING ACCESS TO DUAL DIAGNOSIS TREATMENT CENTERS AND THE PERCEIVED EFFECTIVENESS
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BackgroundResult
Alcohol and substance misuse
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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)
DOI: 10.1016/j.biopsych.2004.06.034
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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

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