The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization.
Abstract
General population data from the National Comorbidity Survey are presented on co-occurring DSM-III-R addictive and mental disorders. Co-occurrence is highly prevalent in the general population and usually due to the association of a primary mental disorder with a secondary addictive disorder. It is associated with a significantly increased probability of treatment, although the finding that fewer than half of cases with 12-month co-occurrence received any treatment in the year prior to interview suggests the need for greater outreach efforts.
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Studies have shown a higher utilization of treatment services for comorbid individuals.
“Since studies have shown a higher utilization of treatment services for comorbid individuals (Kessler et al., 1996), gaining further insight into the relationship between BI and help seeking in individuals with problematic drinking behaviour and comorbid anxiety and/or depressive disorders might enhance pro-active intervention strategies.”
From Differences in help seeking rates after brief intervention for alcohol use disorders in general practice patients with and without comorbid anxiety or depressive disorders (2008) · cites this paper as Kessler et al., 1996
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“When respondents had both addictive and other mental disorders in their lifetime, the median age at onset of the mental disorder was 11 years (Kessler et al., 1999) as compared with 21 years for the addictive disorders (Kessler et al., 1996a).”
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Alcohol use disorders comorbid with anxiety, depression and drug use disorders
Burns, L., & Teesson, M. (2002) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(02)00220-x · Cited by 339 · see citing works
“raised the proportion of the sample treated only minimally whilst the addition of a mental disorder to a substance use disorder raised it substantially (Kessler et al., 1996).”
BackgroundAlcohol in Europe: a public health perspective
Anderson, P., & Baumberg, B. (2006) · Lenus, The Irish Health Repository (Dr Steevens Hospital Library) · Cited by 334 · see citing works
Degenhardt, L. J., Hall, W., & Lynskey, M. T. (2001) · Addiction · doi:10.1046/j.1360-0443.2001.961116037.x · Cited by 330 · see citing works
“In general, the evidence to date suggests that people who are problematic users of one substance are more likely to have a range of other mental health problems and other substance use problems.(4,5) However, there appears to have been less direct comparison of the relationships of different drugs with other mental he…”
BackgroundAlvidrez, J. (1999) · Community Mental Health Journal · doi:10.1023/a:1018759201290 · Cited by 322 · see citing works
“Other studies have also found that people with comorbid substance use disorders are more likely to use mental health services than those without them ( Kessler, Nelson et al., 1996 ).”
BackgroundLongitudinal study of co-occurring psychiatric disorders and substance use.
BROOK, J. S., COHEN, P., & BROOK, D. W. (1998) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199803000-00018 · Cited by 308 · see citing works
Gender differences in alcohol and substance use relapse
Walitzer, K. S., & Dearing, R. L. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.11.003 · Cited by 310 · see citing works
Psychoactive drug abuse in older adults
Simoni, J. M., & Yang, H.-W. K. (2006) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2006.10.002 · Cited by 307 · see citing works
Rates of Psychiatric Comorbidity Among U.S. Residents with Lifetime Cannabis Dependence
Agosti, V., Nunes, E. V., & LEVIN, F. R. (2002) · The American Journal of Drug and Alcohol Abuse · doi:10.1081/ada-120015873 · Cited by 306 · see citing works
Youth With Mental Health Disorders: Issues and Emerging Responses
Cocozza, J. J., & Skowyra, K. R. (2000) · PsycEXTRA Dataset · doi:10.1037/e379712004-001 · Cited by 304 · see citing works
“Kessler et al. (1996) found that 50.9 percent of the general adult population with serious mental health disorders have a co-occurring substance abuse disorder, while Teplin, Abram, and McClelland (1991) found that 73 percent of adult jail detainees with serious mental health disorders had a…”
BackgroundInfluentialWhitbeck, L. B., McMorris, B. J., Hoyt, D. R., Stubben, J. D., & LaFromboise, T. D. (2002) · Journal of Health and Social Behavior · doi:10.2307/3090234 · Cited by 297 · see citing works
The essential handbook of treatment and prevention of alcohol problems
Heather, N., & Stockwell, T. R. (2004) · Cited by 296 · see citing works
Lewinsohn, P. M., Zinbarg, R. E., Seeley, J. R., Lewinsohn, M., & Sack, W. H. (1997) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(97)00017-0 · Cited by 294 · see citing works
Common genetic risk factors for conduct disorder and alcohol dependence.
Slutske, W. S., Heath, A. C., Dinwiddie, S. H., Madden, P. A. F., Bucholz, K. K., Dunne, M. P., Statham, D. J., & Martin, N. G. (1998) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.107.3.363 · Cited by 290 · see citing works
“Cross-sectional epidemiological surveys (e.g., Kessler et al., 1996) have shown that the onset of CD usually precedes the onset of AD, and longitudinal studies have confirmed this temporal association (Robins, Bates, & O'Neal, 1962; Vaillant & Milofsky, 1982; Zucker & Gomberg, 1986).”
BackgroundGenetic differences in alcohol sensitivity and the inheritance of alcoholism risk
Heath, A. C., Madden, P. A. F., Bucholz, K. K., Dinwiddie, S. H., Slutske, W. S., Bierut, L. J., Rohrbaugh, J., Statham, D. J., Dunne, M. P., Whitfield, J. B., et al. (1999) · Psychological Medicine · doi:10.1017/s0033291799008909 · Cited by 269 · see citing works
The economic costs of heroin addiction in the United States
Mark, T. L. (2001) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(00)00162-9 · Cited by 271 · see citing works
“Mental disorders precede substance abuse more than 80% of the time, generally by 5–10 years (Kessler et al., 1996).”
BackgroundPatients with Alcohol Problems
O’Connor, P. G., & Schottenfeld, R. S. (1998) · New England Journal of Medicine · doi:10.1056/nejm199802263380907 · Cited by 267 · see citing works
Friedlander, A. H., Marder, S. R., Pisegna, J. R., & Yagiela, J. A. (2003) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2003.0260 · Cited by 268 · see citing works
Neighbors, H. W., Musick, M. A., & Williams, D. R. (1998) · Health Education & Behavior · doi:10.1177/109019819802500606 · Cited by 266 · see citing works
Hunt, G. E., Malhi, G. S., Lai, H. M. X., & Cleary, M. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.141 · Cited by 289 · see citing works
Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth
Wasserman, G. A., McReynolds, L. S., Schwalbe, C. S. J., Keating, J. M., & Jones, S. A. (2010) · Criminal Justice and Behavior · doi:10.1177/0093854810382751 · Cited by 258 · see citing works
“national comorbidity study, adult SUD increases the likelihood of all other types of mental health problems (Kessler et al., 1996) especially externalizing disorders (Kessler et al.”
BackgroundAnxiety and alcohol use disorders: comorbidity and treatment considerations
Smith, J. (2012) · Alcohol research · doi:10.35946/arcr.v34.4.06 · Cited by 257 · see citing works
“First, anxiety disorders are more strongly associated with alcohol dependence than with alcohol abuse (e.g., Hasin et al. 2007; Kessler et al. 1996; Kushner et al. 2008).”
Baillargeon, J., Penn, J. V., Knight, K., Harzke, A. J., Baillargeon, G., & Becker, E. (2010) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-009-0252-9 · Cited by 200 · see citing works
Psychiatric Comorbidity Among Adolescents With Substance Use Disorders: Findings From the MECA Study
Kandel, D. B., Johnson, J. G., Bird, H., Weissman, M. M., Goodman, S. H., Lahey, B. B., Regier, D. A., & Schwab‐Stone, M. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199906000-00016 · Cited by 250 · see citing works
Sartory, G., Cwik, J. C., Knuppertz, H., Schürholt, B., Lebens, M., Seitz, R. J., & Schulze, R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0058150 · Cited by 252 · see citing works
“Nearly 50% of PTSD patients develop depression and almost as many suffer from alcohol/drug abuse and dependence [30].”
BackgroundBahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.01.007 · Cited by 241 · see citing works
Hawkins, E. H. (2009) · Annual Review of Psychology · doi:10.1146/annurev.psych.60.110707.163456 · Cited by 233 · see citing works
“(Kessler et al. 1996).”
BackgroundMethodInfluentialSmoking cessation during substance abuse treatment: What you need to know
Baca, C. T., & Yahne, C. E. (2008) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2008.06.003 · Cited by 228 · see citing works
“Treatment populations are likely to have higher rates of mental illness compared with individuals who are not in treatment (Kessler et al., 1996).”
BackgroundSancho, M., De Gracia, M., Rodríguez, R. C., Mallorquí-Bagué, N., Sánchez-González, J., Trujols, J., Sánchez, I., Jiménez-Murcia, S., & Menchón, J. M. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00095 · Cited by 224 · see citing works
Shared Genetic Risk of Major Depression, Alcohol Dependence, and Marijuana Dependence
Fu, Q. J., Heath, A. C., Bucholz, K. K., Nelson, E. C., Goldberg, J. H., Lyons, M. J., True, W. R., Jacob, T., Tsuang, M. T., & Eisen, S. A. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.12.1125 · Cited by 221 · see citing works
“We report the results of multivariate analyses of structured diagnostic interview data from twins from the VET Registry36 that directly test the hypothesis that shared genetic risk among ASPD, AD, and MJD is a major determinant of the shared genetic risk between MD and AD and between MD and MJD.”
BackgroundInfluentialTemperament and Adolescent Substance Use: A Transactional Analysis of Emerging Self-Control
Wills, T. A., & Dishion, T. J. (2004) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3301_7 · Cited by 219 · see citing works
“, combined substance abuse and depressive disorder), and research shows that comorbidity often starts between the ages of 12 and 14 years (Kessler et al., 1996).”
BackgroundComorbidity between patterns of substance use dependence and psychiatric syndromes
Kandel, D. B., Huang, F.-Y., & Davies, M. (2001) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(01)00126-0 · Cited by 219 · see citing works
“Antisocial personality disorder, which is strongly associated with substance dependence ( Kessler et al., 1996 ), was not ascertained in the NHSDA.”
BackgroundResultInfluentialGenetics of alcohol and tobacco use in humans
Tyndale, R. F. (2003) · Annals of Medicine · doi:10.1080/07853890310010014 · Cited by 219 · see citing works
Luo, X.-G., Kranzler, H., Zuo, L.-J., Wang, S., Blumberg, H., & Gelernter, J. (2005) · Human Molecular Genetics · doi:10.1093/hmg/ddi244 · Cited by 218 · see citing works
“2% of alcoholics suffer from a current affective disorder (16,17).”
BackgroundExplicit and implicit stigma against individuals with mental illness
Stier, A., & Hinshaw, S. P. (2007) · Australian Psychologist · doi:10.1080/00050060701280599 · Cited by 214 · see citing works
Caldwell, T. M., Rodgers, B., Jorm, A. F., Christensen, H., Jacomb, P. A., Korten, A. E., & Lynskey, M. T. (2002) · Addiction · doi:10.1046/j.1360-0443.2002.00092.x · Cited by 203 · see citing works
Levin, F., Evans, S., & Kleber, H. (1998) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(98)00049-0 · Cited by 198 · see citing works
Substance use and treatment of substance use disorders in a community sample of transgender adults
Keuroghlian, A. S., Reisner, S. L., Hughto, J. M. W., & Weiss, R. D. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.04.008 · Cited by 193 · see citing works
“…al., 2001; Rowe et al., 2015), past 7-day clinically significant depression (yes/no; Davis et al., 2008), current mental health treatment (yes/no; Kessler et al., 1996), inability to access gender-transition care in past 12 months (yes/no; Wilson et al., 2015), public accommodations…”
BackgroundCraig, A. R., Perry, K. N., Guest, R., Tran, Y., Dezarnaulds, A., Hales, A., Ephraums, C., & Middleton, J. W. (2015) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2015.02.027 · Cited by 192 · see citing works
Non-linear relationships in associations of depression and anxiety with alcohol use
Rodgers, B., Korten, A. E., Jorm, A. F., Jacomb, P. A., Christensen, H. M., & Henderson, A. S. (2000) · Psychological Medicine · doi:10.1017/s0033291799001865 · Cited by 188 · see citing works
“pulsive disorder, post-traumatic stress disorder and generalized anxiety disorder, as well as for high neuroticism scores (Helzer & Pryzbeck, 1988; Dick et al. 1994; Grant & Harford, 1995; Kessler et al. 1996; Magee et al. 1996; Heath et al. 1997; Swendsen et al. 1998).”
BackgroundResultInfluentialImpact of psychiatric comorbidity on treatment of adolescent drug abusers
Rowe, C. L., Liddle, H. A., Greenbaum, P. E., & Henderson, C. E. (2004) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(03)00166-1 · Cited by 184 · see citing works
“These studies indicated that 40–50% of non-treated individuals with a substance use disorder also meet criteria for a psychiatric disorder (Kessler et al., 1996; Regier et al., 1990).”
Carey, K. B., Carey, M. P., & Chandra, P. S. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0705 · Cited by 183 · see citing works
Wu, L.-T. T., Kouzis, A. C., & Leaf, P. J. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.8.1230 · Cited by 183 · see citing works
Self-citationRoy, L., Crocker, A. G., Nicholls, T. L., Latimer, E. A., & Reyes, A. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201200515 · Cited by 181 · see citing works
“The co-Table occurrence of antisocial personality disorder with a substance use disorder among persons with a mental illness is also well documented (48,49), as well as the cumulative effect that these conditions have on rates of criminal behavior and violence (42,50,51).”
Energy Drink Consumption and Increased Risk for Alcohol Dependence
Arria, A. M., Caldeira, K. M., Kasperski, S. J., Vincent, K. B., Griffiths, R. R., & O’Grady, K. E. (2011) · Alcoholism: Clinical and Experimental Research · doi:10.1111/j.1530-0277.2010.01352.x · Cited by 247 · see citing works
The sleep of remitted bipolar outpatients: a controlled naturalistic study using actigraphy
Millar, A., Espie, C. A., & Scott, J. L. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00055-7 · Cited by 179 · see citing works
Dawson, D. A., Grant, B. F., Stinson, F. S., & Chou, P. S. (2004) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2004.07.012 · Cited by 179 · see citing works
Schuckit, M. A., TIPP, J. E., Bucholz, K. K., Nürnberger, J. I., HESSELBROCK, V. M., Crowe, R., & Kramer, J. (1997) · Addiction · doi:10.1111/j.1360-0443.1997.tb02848.x · Cited by 178 · see citing works
A National Survey of Care for Persons With Co-occurring Mental and Substance Use Disorders
Watkins, K. E., Burnam, A., Kung, F.-Y., & Paddock, S. M. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.8.1062 · Cited by 177 · see citing works
Self‐Medication of Mental Health Problems: New Evidence from a National Survey
Harris, K. M., & Edlund, M. J. (2005) · Health Services Research · doi:10.1111/j.1475-6773.2005.00345.x · Cited by 176 · see citing works
“…Study, 51 percent of those who met criteria for a substance disorder at some time in their life also met criteria for a mental disorder at some point, and in the large majority of cases individuals reported that the mental disorder 117 preceded the substance disorder (Kessler et al. 1996).”
BackgroundSelf-citation
- Authors
- Kessler, R. C., Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G., & Leaf, P. J.
- Affiliations
- University of Michigan (US)
- Max Planck Institute of Psychiatry (DE)
- Harvard University (US)
- Johns Hopkins University (US)
- Venue
- American Journal of Orthopsychiatry
- Published
- 1996
- Volume
- 66
- Issue
- 1
- Pages
- 17-31
- ISSN
- 0002-9432 (ISSN-L)
- 1939-0025
- OpenAlex
- W2058704610
- Cited by
- 1,378
- References
- 46
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 19 · 2023: 18 · 2022: 22 · 2021: 27 · 2020: 36 · 2019: 36 · 2018: 38 · 2017: 41 · 2016: 50 · 2015: 49 · 2014: 77 · 2013: 73 · 2012: 67
- FWCI
- 26.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Orthopsychiatry (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Keywords
- co-occurring disorders, substance use disorders, mental illness, comorbidity prevalence, treatment utilization, mental health services, prevention, National Comorbidity Survey
- MeSH terms
- Adolescent, Adult, Mental Disorders, Humans, Middle Aged, Prevalence, Behavior, Addictive, Age of Onset, Age Distribution
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