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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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SUBSTANCE ABUSE AND BIPOLAR COMORBIDITY
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“It has long been observed in both clinical (Allan, 1995; Mirin, Weiss, Griffin, & Michael, 1991) and epidemiological (Armstrong & Costello, 2002; Grant & Harford, 1995; Kessler et al., 1996; Regier et al., 1990) samples that most people with substance use disorders also have a history of current or past mental disorde…”
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“Further, the mental disorder preceded the addictive order in almost 84% of those with mental health and substance use problems, developing most frequently during adolescence (Kessler et al., 1996).”
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Racial/Ethnic Disparities in Service Utilization for Individuals With Co-Occurring Mental Health and Substance Use Disorders in the General Population
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“Epidemiological studies have indicated a substantially higher incidence of psychostimulant drug abuse among depressed patients than in the general population ( Kessler et al. 1996 ).”
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“What proportion of the population will have an episode of depression? In the US National Comorbidity Study 17% had met criteria but the average age was only 34 so only half of the age of risk had passed (Kessler et al., 1996).”
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Changing the world: the design and implementation of comprehensive continuous integrated systems of care for individuals with co-occurring disorders
Minkoff, K., & Cline, C. A. (2004) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2004.07.003 · Cited by 90
“Dual diagnosis is an expectation, not an exception: Epidemiologic data defining the high prevalence of co-morbidity [13, 14], along with clinical outcome data associating ICOPSD with poor outcomes and high costs in multiple systems, imply that the whole system, at every level, must be”
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“If untreated, SP can lead to sequelae such as substance use and depression (Kendall, Safford, FlannerySchroeder and Webb, 2004; Kessler et al., 1996).”
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Background
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“A selfreport instrument based on the UM-CIDI ~Anthony et al., 1994; Kessler et al., 1996! interview was used to assess alcohol abuse and dependence.”
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Health risks and benefits of alcohol consumption.
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“6% prevalence in the population.(1,2) Features of bipolar disorders can include,”
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Associations between prescribed benzodiazepines, overdose death and buprenorphine discontinuation among people receiving buprenorphine
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“…present great challenge to treatment since they have more severe symptoms [7], greater disability [8] and poorer quality of life [9] than individuals with only alcohol use disorder, and may pose a greater economic burden to society due to their higher utilization of treatment services [8,10].”
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“…of such prevention efforts, it appears that primary anxiety disorders and primary conduct disorder are the most promising intervention targets (Kessler et al., 1996a, b, in press b) and that the window of opportunity for such interventions is in the decade between the early teenage years and…”
Self-citation
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“Conversely, among those with mental health problems, 15% also have had a substance use disorder ( Kessler et. al. 1996 ).”
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Probability and Predictors of Transition from Abuse to Dependence on Alcohol, Cannabis, and Cocaine: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
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“Major depressive disorder is one of the most commonly occurring mental disorders in the United States and is a known risk factor for substance use disorders (Kessler et al., 1996).”
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Gender differential in health care utilisation in India
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“The relationships between substance abuse and mental health has been demonstrated in numerous epidemiological studies (e.g. Kessler et al, 1996; Grant et al., 2004).”
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The Relationship of Axis II Personality Disorders to Other Known Predictors of Addiction Treatment Outcome
Pettinati, H. M., Pierce, J. D., Belden, P. P., & Meyers, K. (1999) · American Journal on Addictions · doi:10.1080/105504999305947 · Cited by 74
Dual Diagnosis: Alcoholism and Co‐Morbid Psychiatric Disorders
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“For trauma-exposed populations, heavy alcohol use is also associated with higher levels of reported suicidal ideation, depression, and anxiety, potentially through increased risky and impulsive behaviors (Kessler et al., 1996; Gonzalez et al., 2009; Mash et al., 2014).”
Background
The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC)
Carrà, G., Johnson, S., Bebbington, P., Angermeyer, M. C., Heider, D., Brugha, T. S., Azorin, J., & Toumi, M. (2012) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-012-0305-z · Cited by 74
“In the National Comorbidity Survey, half of those meeting criteria for a mental disorder also met those for lifetime substance use, with a rate of 45 % in people with non-affective psychosis [3].”
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“These disorders may also modulate the progression of substance addiction, such that the illness course is typically more severe and persistent (135).”
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The specific burden of comorbid anxiety disorders and of substance use disorders in bipolar I disorder
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“Overall, ADs appear to occur earlier (e.g., Costello et al., 2003; Kessler et al., 1996; Merikangas et al., 1998; Schuckit & Hesselbrock, 1994), though this order of onset might differ for different types of ADs (e.g., Falk, Yi, & Hilton, 2008; see below for a discussion of this possibility).”
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Bipolar comorbidity: from diagnostic dilemmas to therapeutic challenge
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“Moreover, it appears that rates of substance use (Kessler et al., 1996; Regier et al., 1990), panic disorder (Chen and Dilsaver, 1995b) and OCD (Chen and Dilsaver, 1995a) are higher in bipolar patients than in depression patients.”
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Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK
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“In the National Comorbidity Survey (NCS) [58], half of those who met criteria for a mental disorder also met those for a lifetime substance use one, with a rate for people with non-affective psychosis of 45%.”
Anxiety in a Socially High-Risk Sample of Pregnant Women in Canada
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Missed Opportunities in Addressing Drinking Behavior in Medical and Mental Health Services
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Childhood Depressive Symptoms and Early Onset of Alcohol Use
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Longitudinal predictors of addictions treatment utilization in treatment-naïve adults with alcohol use disorders
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“…utilization of addictions treatment services (Cohen et al., 2007; Grella et al., 2009; Harris and Bowe, 2008; Harris and Edlund, 2005; Kaskutas, 1997; Kessler et al., 1996; Mojtabai, 2005; Proudfoot, 2002; Raimo et al., 1999; Tighe and Saxe, 2006; Weisner et al., 2002; Wu et al., 2003; Wu, 2003).”
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Community reintegration of prisoners with mental illness: A social investment perspective
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“N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript morbidity between mental illness and addiction problems (Bartels et al., 1993; Drake, Rosenberg, & Mueser, 1996; Kessler et al., 1996).”
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Expanding the Scope of Dual Diagnosis and Co-Addictions: Behavioral Addictions
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“However, for women with a trauma or abuse history, mental disorders are more likely to precede this addiction (Kessler et al., 1996; Newmann & Sallman, 2004).”
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Continuing Care After Inpatient Psychiatric Treatment for Patients With Psychiatric and Substance Use Disorders
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Substance use among late adolescent urban youths: Mental health and gender influences
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“Mental health and substance use The association between mental health problems and substance use is well established (Harris, & Edlund, 2005; Kessler et al., 1996).”
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Blood-Borne Infections and Persons With Mental Illness: Substance Abuse and the Transmission of Hepatitis C Among Persons With Severe Mental Illness
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Remission from substance dependence: Differences between individuals in a general population longitudinal survey who do and do not seek help
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Improving the provision of services to young people from refugee backgrounds with comorbid mental health and substance use problems: addressing the barriers
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“The National Comorbidity Survey in the United States found that in a sample of 8100 people, 41–65% of people with an addictive disorder had at least one mental disorder and 51% of those with a mental disorder had at least one addictive disorder [11].”
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An experimental investigation of the impact of biological versus psychological explanations of the cause of “mental illness”
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The contribution of personality to the overlap between antisocial behavior and substance use/misuse
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Suicide in Alcohol-Dependent Individuals
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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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