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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Chi, F. W., Satre, D. D., & Weisner, C. M. (2006) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2006.00100.x · Cited by 52
Dual Diagnosis and Suicide Risk in a Spanish Outpatient Sample
Szerman, N., López‐Castromán, J., Árias, F., Morant, C., Vich, F. D. A. B., Mesías, B., Basurte-Villamor, I., Vega, P., & Baca‐García, E. (2012) · Substance Use & Misuse · doi:10.3109/10826084.2011.636135 · Cited by 49
“Population surveys have reported rates around 50% for lifetime comorbidity (Kessler et al., 1996; Regier, Farmer, & Rae, 1990), and higher numbers have been found in treatment samples (Kessler, 2004; Weaver et al.”
Background
Gender Differences in Anxiety and Depression before and after Alcohol Detoxification: Anxiety and Depression as Gender-Related Predictors of Relapse
Oliva, F., Nibbio, G., Vizzuso, P., Sodano, A. J., Ostacoli, L., Carletto, S., & Picci, R. L. (2018) · European Addiction Research · doi:10.1159/000490046 · Cited by 54
Substance Abuse Treatment: Critical Issues and Challenges in the Treatment of Latina Women
Amaro, H. D. L. A., Nieves, R., Wolde-Yohannes, S., & Labault-Cabeza, N. M. (1999) · Hispanic Journal of Behavioral Sciences · doi:10.1177/0739986399213005 · Cited by 52
“Similar to other studies (Kessler et al., 1996), we found a high rate of mental health problem in this sample of Latina women.”
BackgroundResult
Neurobiological mechanisms in addictive and psychiatric disorders
Bruijnzeel, A. W., Repetto, M. J., & Gold, M. S. (2004) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2004.06.005 · Cited by 51
“Approximately 80% of the alcoholics complain about depressive symptoms, and 30% meet the criteria for a depressive episode [88–92].”
Background
Pharmacotherapy of Comorbid Mood, Anxiety, and Substance Use Disorders
Brady, K. T., & Verduin, M. L. (2005) · Substance Use & Misuse · doi:10.1080/10826080500294924 · Cited by 56
“In both the ECA and the National Comorbidity Survey, bipolar disorder was the Axis I condition most commonly associated with a comorbid substance use disorder (Reiger et al., 1990; Kessler et al., 1996).”
Background
Use of Professional and Informal Support by Black Men With Mental Disorders
Woodward, A. T., Taylor, R. J., & Chatters, L. M. (2010) · Research on Social Work Practice · doi:10.1177/1049731510388668 · Cited by 52
“These findings are consistent with previous research on professional service use (Harris & Edlund, 2005; Kessler et al., 1996; Wang et al., 2005) and indicate that greater illness severity increases the overall intensity of help seeking and the variety of sources from which help is received.”
Result
Factors associated with adolescent utilization of alcohol treatment services
Wu, P., Hoven, C. W., Tiêt, Q. Q., Kovalenko, P., & Wicks, J. (2002) · The American Journal of Drug and Alcohol Abuse · doi:10.1081/ada-120002978 · Cited by 52
COMORBIDITY OF PSYCHIATRIC AND SUBSTANCE USE DISORDERS IN LATE ADOLESCENCE: A CLUSTER ANALYTIC APPROACH
Beitchman, J. H., Beitchman, J. H., Adlaf, E. M., Douglas, L., Atkinson, L. R., Young, A., Johnson, C. J., Escobar, M. D., & Wilson, B. (2001) · The American Journal of Drug and Alcohol Abuse · doi:10.1081/ada-100104510 · Cited by 52
“Among adult males, the most consistent comorbid pattern occurs between SUD and ASPD (41, 42).”
BackgroundInfluential
Enrollment in Supported Employment Services for Clients With a Co-occurring Disorder
Frounfelker, R. L., WILKNISS, S. M., Bond, G. R., Devitt, T. S., & Drake, R. E. (2011) · Psychiatric Services · doi:10.1176/ps.62.5.pss6205_0545 · Cited by 51
“With the lifetime rate of alcohol or drug use disorders in the general population around 17%, overall lifetime prevalence among people with serious mental illness is about 50% (1).”
BackgroundResult
Perpetration of partner violence: Effects of cocaine and alcohol dependence and posttraumatic stress disorder
Parrott, D. J., Drobes, D. J., Saladin, M. E., Coffey, S. F., & Dansky, B. S. (2003) · Addictive Behaviors · doi:10.1016/j.addbeh.2003.08.036 · Cited by 51
Comorbid Psychiatric Diagnoses and Their Association with Cocaine‐Induced Psychosis in Cocaine‐Dependent Subjects
Tang, Y., Kranzler, H. R., Gelernter, J. E., Farrer, L. A., & Cubells, J. F. (2007) · American Journal on Addictions · doi:10.1080/10550490701525723 · Cited by 51
Treatment of Substance Use Disorders Among Women of Reproductive Age by Depression and Anxiety Disorder Status, 2008–2014
Zhou, J., Ko, J. Y., Haight, S. C., & Tong, V. T. (2019) · Journal of Women s Health · doi:10.1089/jwh.2018.7597 · Cited by 52
“16 For women speciﬁcally, less than half with depression or anxiety symptoms receive any treatment 2,3,5,17,18 and less than 10% with substance use disorders receive any treatment.”
TRIADD: The Risk for Alcohol Abuse, Depression, and Diabetes Multimorbidity in the American Indian and Alaska Native Populations
Tann, S. S. (2007) · American Indian and Alaska Native Mental Health Research · doi:10.5820/aian.1401.2007.5 · Cited by 52
“…Medical Campus (www.ucdenver.edu/caianh) Eighty percent of alcoholics report depressive symptoms, while 30-40% of individuals with diagnosed alcohol dependence are likely to experience a major depressive episode in their lifetimes (Hitzemann, 2000; Kessler et al., 1996; Regier et al., 1990).”
Background
Consequences of adolescent drug use on psychiatric disorders in early adulthood
Brook, J. S., Richter, L., & Rubenstone, E. (2000) · Annals of Medicine · doi:10.3109/07853890008995947 · Cited by 51
Gender Differences in the Relationships Between Multiple Measures of Alcohol Consumption and Physical and Mental Health
Green, C. A., Perrin, N., & Polen, M. R. (2004) · Alcoholism Clinical and Experimental Research · doi:10.1097/01.alc.0000125342.28367.a1 · Cited by 51
Effect of Assertive Community Treatment for Patients with Substance Use Disorder: A Systematic Review
Penzenstadler, L. E., Soares, C., Anci, E., Molodynski, A., & Khazaal, Y. (2019) · European Addiction Research · doi:10.1159/000496742 · Cited by 50
Brain Myelination in Prevalent Neuropsychiatric Developmental Disorders: Primary and Comorbid Addiction
Flaherty, L. T. (2013) · Routledge eBooks · doi:10.4324/9780203780589-9 · Cited by 49
“, 2004)—disorders that are plagued by high rates of comorbid addiction, which often contributes to poor outcomes (Kessler et al., 1996; Merikangas et al., 1998; Swartz et al., 2000; Kresina et al., 2004; Swann et al., 2004).”
BackgroundInfluential
Childhood and adolescent risk factors for comorbid depression and substance use disorders in adulthood
Green, K. M., Zebrak, K. A., Fothergill, K. E., Robertson, J. A., & Ensminger, M. E. (2012) · Addictive Behaviors · doi:10.1016/j.addbeh.2012.06.008 · Cited by 55
“…separately, thus not taking into consideration the substantial overlap between depression and substance use disorders in clinical and community samples (Compton et al., 2007; Grant, 1995; Grant et al., 2004; Kessler et al., 1996; Regier et al., 1990; Roberts et al., 2007; Swendsen et al., 1998).”
BackgroundInfluential
Crack cocaine trajectories among users in a midwestern American city
Falck, R. S., Wang, J., & Carlson, R. G. (2007) · Addiction · doi:10.1111/j.1360-0443.2007.01915.x · Cited by 49
Followup of cocaine-dependent men and women with antisocial personality disorder
Grella, C. E., Joshi, V., & Hser, Y. (2003) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(03)00127-2 · Cited by 50
“…of adult antisocial personality (ASP) disorder and substance use disorders among individuals in drug treatment (Alterman & Cacciola, 1991; Flynn, Craddock, Luckey, Hubbard, & Dunteman, 1996; Kleinman et al., 1990; Rounsaville et al., 1991) and in the general population (Kessler et al., 1996).”
Background
Strengthening the role of two key institutions in the prevention of adolescent substance abuse
Hallfors, D. D., & Dorn, R. A. V. (2002) · Journal of Adolescent Health · doi:10.1016/s1054-139x(01)00322-6 · Cited by 50
“Retrospective epidemiologic research from the National Comorbidity Study found that mental health conditions preceded addictive disorders in 86% of cases and that both disorders usually occur first in adolescence [18].”
Background
Rekindling an old flame: A haploid model for the evolution and impact of flammability in resprouting plants
Kerr, B., Schwilk, D. W., Bergman, A., & Feldman, M. W. (1999) · Evolutionary ecology research · Cited by 50
Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress
Martin, C. E., Vujanovic, A. A., Paulus, D. J., Bartlett, B., Gallagher, M. W., & Tran, J. K. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.01.002 · Cited by 49
Psychiatric comorbidity in cocaine users treated in therapeutic community: Substance-induced versus independent disorders
Vergara-Moragues, E., González-Saiz, F., M. Lozano, O., Betanzos Espinosa, P., Fernández Calderón, F., Bilbao-Acebos, I., Pérez García, M., & Verdejo García, A. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.07.043 · Cited by 68
“…studies conducted in the United States and Europe have demonstrated that psychiatric disorders are highly prevalent among patients diagnosed with substance-use disorders (SUD), i.e. subjects with abuse or substance dependence (Compton et al., 2005; Kessler et al., 1996; Pavarin, 2006).”
Background
Characterizing the longitudinal patterns of substance use among individuals diagnosed with serious mental illness after psychiatric hospitalization
Bahorik, A. L., Newhill, C. E., & Eack, S. M. (2013) · Addiction · doi:10.1111/add.12153 · Cited by 49
On the interaction between drugs of abuse and adolescent social behavior
Trezza, V., Baarendse, P. J. J., & Vanderschuren, L. J. M. J. (2014) · Psychopharmacology · doi:10.1007/s00213-014-3471-z · Cited by 53
“…studies have shown that antisocial personality disorder (ASPD) is highly comorbid with drug and alcohol addiction (Alterman and Cacciola 1991; Cloninger et al. 1978; Helzer and Pryzbeck 1998; Hesselbrock and Hesselbrock 2006; Kessler et al. 1996; Kofoed and MacMillan 1986; Regier et al. 1990).”
Perceived Alcohol Stigma: Factor Structure and Construct Validation
Glass, J. E., Kristjansson, S. D., & Bucholz, K. K. (2012) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2012.01887.x · Cited by 49
“…infer labeling status, we also included perceived need for treatment to recognize that treatment participation is much less common for AUDs than for substanceunrelated psychiatric disorders (Kessler et al. 1996), and labeling status exists on a continuum that includes self-labeling (Thoits 1985).”
Background
CURRENTLY ACTIVE AND REMITTED ALCOHOL DEPENDENCE IN A NATIONWIDE ADULT GENERAL POPULATION—RESULTS FROM THE FINNISH HEALTH 2000 STUDY
Pirkola, S. P., Poikolainen, K., & Lönnqvist, J. K. (2006) · Alcohol and Alcoholism · doi:10.1093/alcalc/agh240 · Cited by 49
“Its degrading impact on both psychiatric morbidity and treatment management is considered highly important (Kessler et al., 1996; Grant et al., 2004).”
Background
Women Living With a History of Physical and/or Sexual Abuse, Substance Use, and Mental Health Problems
Nehls, N., & Sallmann, J. (2005) · Qualitative Health Research · doi:10.1177/1049732304272917 · Cited by 50
The association between age of onset of opioid use and comorbidity among opioid dependent patients receiving methadone maintenance therapy
Naji, L., Dennis, B. B., Bawor, M., Varenbut, M., Daiter, J., Plater, C., Paré, G., Marsh, D. C., Worster, A., Desai, D., et al. (2017) · Addiction Science & Clinical Practice · doi:10.1186/s13722-017-0074-0 · Cited by 53

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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