Cited by 1,378Substance Abuse Treatment and OutcomesMental Health Treatment and AccessGambling Behavior and Treatments

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The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization.

Kessler, Ronald C., Nelson, Christopher B., McGonagle, Katherine A., Edlund, Mark J., Frank, Richard G., Leaf, Philip J.·1996·American Journal of Orthopsychiatry

DOI 10.1037/h0080151

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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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Markou, A. (1998) · Neuropsychopharmacology · doi:10.1016/s0893-133x(97)00113-9 · Cited by 767
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Self-citation
Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
Lopez‐Quintero, C., Cobos, J. P. D. L., Hasin, D. S., Okuda, M., Wang, S., Grant, B. F., & Blanco, C. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.11.004 · Cited by 733
“Psychiatric comorbidity predicted transition to dependence, as previously reported (Breslau et al., 2004; Glantz et al., 2008; Kessler, 2004; Kessler et al., 1996; Zimmermann et al., 2003).”
Method
Axis I Psychiatric Comorbidity and Its Relationship to Historical Illness Variables in 288 Patients With Bipolar Disorder
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“In terms of mental health, the relationship between substance misuse and mental health, challenges large numbers of persons has been established (Kessler et al., 1996).”
Background
Gender differences in substance use disorders
Brady, K. T., & Randall, C. L. (1999) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(05)70074-5 · Cited by 910
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“Our finding of a greater severity of psychopathology among women it is likely to reflect the greater prevalence rates of primary mood and anxiety disorders experienced by women in general (Dunne et al., 1993; Kessler et al., 1996).”
Background
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National Research Council (2014) · National Academies Press eBooks · doi:10.17226/18613 · Cited by 648
“By comparison, an earlier study estimates that 5 percent of the general population has a serious mental illness, although the rates are not directly comparable across different time periods and studies, given variations in survey questions and measures (Kessler et al., 1996).”
BackgroundResult
Mental disorders as risk factors for substance use, abuse and dependence: results from the 10‐year follow‐up of the National Comorbidity Survey
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Self-citation
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Kessler, R. C. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.06.034 · Cited by 588
Self-citation
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Swan, G. E., & Lessov‐Schlaggar, C. N. (2007) · Neuropsychology Review · doi:10.1007/s11065-007-9035-9 · Cited by 605
“…use have a high cooccurrence (approximately 80% of alcohol-dependent individuals [Hurt et al. 1994; Pomerleau et al. 1997; Romberger and Grant 2004; Kessler et al. 1996] and 70–90% of those seeking treatment for alcohol abuse are smokers, Room 2004), the potential importance of their combined…”
Background
Comorbid Psychiatric Disorders in Youth in Juvenile Detention
Abram, K. M., Teplin, L. A., McClelland, G. M., & Dulcan, M. K. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.11.1097 · Cited by 564
“Rates of comorbidity among detained adolescents may be even higher than rates among detained adults.(15,21,22) Despite its importance, there have been few empirical studies of ADM comorbidity among juvenile detainees and no large-scale investigations, to our knowledge.”
Result
Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: an integrative literature review
Priester, M. A., Browne, T., Iachini, A., Clone, S., DeHart, D., & Seay, K. D. (2016) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.09.006 · Cited by 561
“Extant studies utilizing national population survey data have examined patterns of treatment utilization among persons with COD (Kessler et al., 1994, 1996; Hatzenbuehler et al., 2008; Mojtabai, Chen, Kaufmann, & Crum, 2014).”
Background
Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness
Barry, C. L., McGinty, E. E., Pescosolido, B. A., & Goldman, H. H. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201400140 · Cited by 547
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Shaffer, H. J., & Korn, D. A. (2002) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.23.100901.140532 · Cited by 538
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“Research has supported a temporal relationship, with anxiety disorders typically preceding the onset of substance use disorders (Abraham & Fava, 1999; Christie, Burke, Regier, Rae, Boyd, & Locke, 1988; Deas-Nesmith, Brady, & Campbell, 1998; Greenbaum, Prange, Friedman, & Silver, 1991; Kessler et al., 1996).”
Background
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Jané‐Llopis, E., & MATYTSINA, I. (2006) · Drug and Alcohol Review · doi:10.1080/09595230600944461 · Cited by 496
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“Of clinical importance, individuals with SUDs that co-occur with other mental disorders often have more severe symptoms, require specialized treatment, and have poorer treatment outcomes (Kessler et al., 1996; Ouimette et al., 1998b; Watkins et al., 2001).”
BackgroundInfluential
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Edlund, M. J., Steffick, D., Hudson, T. J., Harris, K. M., & Sullivan, M. (2007) · Pain · doi:10.1016/j.pain.2007.02.014 · Cited by 480
“Reasons to suspect an increased risk of opioid abuse in those with mental disorders include high levels of mental and substance abuse disorder comorbidity (Kessler et al., 1996; Grant et al., 2004), and self-medication of mental health symptoms (Harris and Edlund, 2005).”
BackgroundSelf-citation
Mental health, resilience and inequalities
Friedli, L. (2009) · Cited by 477
Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions
Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Ruan, W. J., Goldstein, R. B., Smith, S. M. R., Saha, T. D., & Huang, B. (2005) · Psychological Medicine · doi:10.1017/s0033291705006069 · Cited by 465
“Results presented above show that GAD is strongly associated with alcohol, drug and nicotine dependence, but not abuse, a finding consistent with the few surveys that have assessed these disorders (Wittchen et al. 1994; Kessler et al. 1996; Carter et al. 2001; Hunt et al. 2002; Alonso et al. 2004).”
Result
10-Year Research Update Review: The Epidemiology of Child and Adolescent Psychiatric Disorders: II. Developmental Epidemiology
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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).”
The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study.
Galván, F. H., Bing, E. G., Fleishman, J. A., London, A. S., Caetano, R., Burnam, M. A., Longshore, D. L., Morton, S. C., Orlando, M., & Shapiro, M. F. (2002) · Journal of Studies on Alcohol · doi:10.15288/jsa.2002.63.179 · Cited by 438
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Result
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A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health
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Comparison of induced and independent major depressive disorders in 2,945 alcoholics
Schuckit, M. A., TIPP, J. E., Bergman, M., Reich, W., HESSELBROCK, V. M., & Smith, T. L. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.7.948 · Cited by 387
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Current and Future Trends in Internet-Supported Mental Health Interventions
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“…health interventions appear to hold great potential—they offer direct, convenient access to resources that a person might otherwise not have, especially because nearly two thirds of all people with diagnosable mental disorders do not seek treatment (Kessler et al., 1996; Regier et al., 1993).”
Background
The effect of depression on return to drinking: a prospective study.
Greenfield, S., Weiss, R., Muenz, L., Vagge, L., Kelly, J., Bello, L. R., & Michael, J. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.3.259 · Cited by 383
“A LTHOUGH DEPRESSION and alcohol dependence commonly coexist in community and treatment-seeking populations,(1-5) there is no clear consensus on appropriate assessment and treatment of patients who present with symptoms of both disorders.(2,6-9) To make appropriate treatment decisions, clinicians must know the likely…”
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Weisner, C. M., Mertens, J. R., Parthasarathy, S., Moore, C. D., & Lu, Y. (2001) · JAMA · doi:10.1001/jama.286.14.1715 · Cited by 368
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The Life Course Perspective on Drug Use
Hser, Y., Longshore, D. L., & Anglin, M. D. (2007) · Evaluation Review · doi:10.1177/0193841x07307316 · Cited by 360
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BackgroundInfluential
The duration and correlates of addiction and treatment careers.
Dennis, M. L., Scott, C. K., Funk, R. R., & Foss, M. A. (2005) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2004.10.013 · Cited by 366
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Alcohol use disorders comorbid with anxiety, depression and drug use disorders
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“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).”
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Alcohol in Europe: a public health perspective
Anderson, P., & Baumberg, B. (2006) · Lenus, The Irish Health Repository (Dr Steevens Hospital Library) · Cited by 327
Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis
Degenhardt, L. J., Hall, W., & Lynskey, M. T. (2001) · Addiction · doi:10.1046/j.1360-0443.2001.961116037.x · Cited by 330
“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…”
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Ethnic Variations in Mental Health Attitudes and Service Use Among Low-Income African American, Latina, and European American Young Women
Alvidrez, J. (1999) · Community Mental Health Journal · doi:10.1023/a:1018759201290 · Cited by 338
“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 ).”
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Longitudinal 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
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Walitzer, K. S., & Dearing, R. L. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.11.003 · Cited by 310
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
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
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
“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…”
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Untitled work
Whitbeck (2002) · doi:10.2307/3090234
The essential handbook of treatment and prevention of alcohol problems
Heather, N., & Stockwell, T. R. (2004) · Cited by 296
Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents
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
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
“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).”
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Genetic 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
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
“Mental disorders precede substance abuse more than 80% of the time, generally by 5–10 years (Kessler et al., 1996).”
Background
Patients with Alcohol Problems
O’Connor, P. G., & Schottenfeld, R. S. (1998) · New England Journal of Medicine · doi:10.1056/nejm199802263380907 · Cited by 267
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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
The African American Minister as a Source of Help for Serious Personal Crises: Bridge or Barrier to Mental Health Care?
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Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis
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Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth
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“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.”
Background
Anxiety and alcohol use disorders: comorbidity and treatment considerations
Smith, J. (2012) · Alcohol research · doi:10.35946/arcr.v34.4.06 · Cited by 257
“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).”
Risk of Reincarceration Among Prisoners with Co-occurring Severe Mental Illness and Substance Use Disorders
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Psychiatric Comorbidity Among Adolescents With Substance Use Disorders: Findings From the MECA Study
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“Nearly 50% of PTSD patients develop depression and almost as many suffer from alcohol/drug abuse and dependence [30].”
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Prevalence of substance use disorder comorbidity among individuals with eating disorders: a systematic review and meta-analysis
Bahji, 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
A Tale of Two Systems: Co-Occurring Mental Health and Substance Abuse Disorders Treatment for Adolescents
Hawkins, E. H. (2009) · Annual Review of Psychology · doi:10.1146/annurev.psych.60.110707.163456 · Cited by 233
“(Kessler et al. 1996).”
BackgroundMethodInfluential
Smoking 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
“Treatment populations are likely to have higher rates of mental illness compared with individuals who are not in treatment (Kessler et al., 1996).”
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Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review
Sancho, 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
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BackgroundInfluential
Temperament 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 234
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“Antisocial personality disorder, which is strongly associated with substance dependence ( Kessler et al., 1996 ), was not ascertained in the NHSDA.”
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Genetics of alcohol and tobacco use in humans
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CHRM2 gene predisposes to alcohol dependence, drug dependence and affective disorders: results from an extended case–control structured association study
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“2% of alcoholics suffer from a current affective disorder (16,17).”
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Explicit and implicit stigma against individuals with mental illness
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Patterns of association between alcohol consumption and symptoms of depression and anxiety in young adults
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Substance use and treatment of substance use disorders in a community sample of transgender adults
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“…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…”
Background
Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury.
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“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).”
BackgroundResultInfluential
Impact 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
“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).”
Psychometric Evaluation of the Alcohol Use Disorders Identification Test and Short Drug Abuse Screening Test With Psychiatric Patients in India
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Influence of Comorbid Alcohol and Psychiatric Disorders on Utilization of Mental Health Services in the National Comorbidity Survey
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Self-citation
Criminal Behavior and Victimization Among Homeless Individuals With Severe Mental Illness: A Systematic Review
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“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
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The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls
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A National Survey of Care for Persons With Co-occurring Mental and Substance Use Disorders
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Self‐Medication of Mental Health Problems: New Evidence from a National Survey
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“…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)
ORCID: Kessler, Ronald C.
Nelson, Christopher B.
Edlund, Mark J.
Frank, Richard G.
Venue: American Journal of Orthopsychiatry
Publisher: American Psychological Association (APA)
Published: 1996
Volume: 66
Issue: 1
Pages: 17-31
ISSN: 0002-9432 (ISSN-L)
1939-0025
DOI: 10.1037/h0080151
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
Health Sciences › Medicine › Psychiatry and Mental health › 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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The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization.

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