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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How Much Do Mental Health and Substance Use/Addiction Affect Use of General Medical Services? Extent of Use, Reason for Use, and Associated Costs
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Technology-Based Interventions for Substance Use and Comorbid Disorders: An Examination of the Emerging Literature
Sugarman, D. E., Campbell, A. N. C., Iles, B. R., & Greenfield, S. F. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000148 · Cited by 41
Relationship Characteristics and Depression among Fathers with Newborns
Huang, C., & Warner, L. A. (2005) · Social Service Review · doi:10.1086/426719 · Cited by 39
“Studies also document high rates of co-occurrence of depression and substance abuse or dependence among various target populations: national household surveys (Kessler et al. 1996; Kessler, Crum, et al. 1997), community samples of drug users (Wang et al.”
Background
Anxiety and social stress related to adolescent gambling behaviour
Ste-Marie, C., Gupta, R., & Derevensky, J. L. (2002) · International Gambling Studies · doi:10.1080/14459790208732303 · Cited by 41
Alcohol involvement and dysphoria: A longitudinal examination of gender differences from late adolescence to adulthood.
Locke, T. F., & Newcomb, M. D. (2001) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.15.3.227 · Cited by 38
Rates and Patterns of Comorbidity of Adolescent Behavioral Syndromes as Reported by Parents and Teachers in a Taiwanese Nonreferred Sample
Yang, H., Chen, W. J., & Soong, W. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200109000-00013 · Cited by 39
Exploring the Consumer's and Provider's Perspective on Service Quality in Community Mental Health Care
Mason, K., Olmos-Gallo, A., Bacon, D. R., McQuilken, M., Henley, A., & Fisher, S. (2004) · Community Mental Health Journal · doi:10.1023/b:comh.0000015216.17812.ed · Cited by 39
“Nearly two-thirds of all people with diagnosable mental disorders do not seek treatment (Kessler et al., 1996; Regier et al., 1993).”
Background
Reliability of self-reported Antisocial Personality Disorder Symptoms among substance abusers
Cottler, L. B., Compton, W. M., Ridenour, T. A., Abdallah, A. B., & Gallagher, T. (1998) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(98)00013-1 · Cited by 39
Tobacco and Psychiatric Dual Disorders
Graham, N. A., Frost-Pineda, K., & Gold, M. S. (2007) · Journal of Addictive Diseases · doi:10.1300/j069v26s01_02 · Cited by 38
The Economics of Treatment for Depression
Stecher, C. D., Cloonan, S., & Domino, M. E. (2023) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-061022-040533 · Cited by 43
Adolescent Substance Abuse and Mental Health: Problem Co-Occurrence and Access to Services
Winstanley, E. L., Steinwachs, D. M., Stitzer, M. L., & Fishman, M. J. (2012) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2012.709453 · Cited by 38
“MH problems are likely to experience multiple MH problems and research has demonstrated similar findings for adults (Kessler et al., 1996).”
Result
Prescription drug misuse: a growing national problem.
Hertz, J. A., & Knight, J. R. (2006) · PubMed · doi:10.1016/j.admecli.2006.06.009 · Cited by 38
A Longitudinal Study of Risk Factors for Incident Drug Use in Adults: Findings from a Representative Sample of the US Population
Harrington, M., Robinson, J. A., Bolton, J. M., Sareen, J., & Bolton, J. M. (2011) · The Canadian Journal of Psychiatry · doi:10.1177/070674371105601107 · Cited by 39
Women, Trauma Histories, and Co‐occurring Disorders: Assessing the Scope of the Problem
Newmann, J. P., & Sallmann, J. (2004) · Social Service Review · doi:10.1086/421922 · Cited by 38
“…of studies link abuse experiences (particularly histories of sexual abuse) to the subsequent onset of both mental health and substance use problems (Kessler et al. 1995; Kessler, Davis, and Kendler 1997; Breslau et al. 1999; Hiday et al. 2001; Horwitz et al. 2001; Kessler, Molnar, et al. 2001;…”
Background
Personal Social Networks and Dual Disorders: A Literature Review and Implications for Practice and Future Research
Tracy, E., & Biegel, D. (2006) · Journal of Dual Diagnosis · doi:10.1300/j374v02n02_04 · Cited by 38
Concurrent Mental Health and Substance Use Problems among Street-Involved Youth
Kirst, M. J., Frederick, T., & Erickson, P. G. (2011) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-011-9328-3 · Cited by 38
“This rate jumps to 82% for those reporting a diagnosis of conduct disorder or adult antisocial behaviour disorder ( Kessler et al. 1996 ).”
Background
Predictors of Treatment Contact Among Individuals with Cannabis Dependence
Agosti, V., & LEVIN, F. R. (2004) · The American Journal of Drug and Alcohol Abuse · doi:10.1081/ada-120029869 · Cited by 38
“Nevertheless, only a minority of persons with cannabis dependence ever seek treatment (7).”
Background
Implementing integrated mental health and substance abuse services
Drake, R. E., & Bond, G. R. (2010) · Journal of Dual Diagnosis · doi:10.1080/15504263.2010.540772 · Cited by 37
“Despite enormous rates of overlap between mental illnesses and substance use disorders (greater than 50% comorbidity for some conditions; Kessler et al., 1996; Regier et al., 1990), both fields have been slow to modify their approaches to serve clients with cooccurring disorders (Kessler, 2004).”
Background
A systematic review of virtual reality therapies for substance use disorders: Impact on secondary treatment outcomes
Taubin, D., Berger, A. F., Greenwald, D., Greenwald, H. J., Burke, C. W., Gongora, D. S., & Wilens, T. E. (2022) · American Journal on Addictions · doi:10.1111/ajad.13342 · Cited by 46
Treating depression and substance use: A randomized controlled trial
Hunter, S. B., Watkins, K. E., Hepner, K. A., Paddock, S. M., Ewing, B. A., Osilla, K. C., & Perry, S. (2012) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2011.12.004 · Cited by 37
“While some depressive symptoms are organic brain syndromes which resolve with abstinence, epidemiologic studies examining the temporal relationship between the disorders indicate that, in most cases, the depressive disorder preceded the substance use disorder, suggesting they are independent co-occurring disorders (Gi…”
Background
Parent Psychopathology and Youth Internalizing Symptoms in an Urban Community: A Latent Growth Model Analysis
Burstein, M., Ginsburg, G. S., Petras, H., & Ialongo, N. S. (2009) · Child Psychiatry & Human Development · doi:10.1007/s10578-009-0152-y · Cited by 38
Socio-demographic patterns of posttraumatic stress disorder in Medellin, Colombia and the context of lifetime trauma exposure
Gaviria, S. L., Alarcón, R. D., Espinola, M., Restrepo, D., Lotero, J., Fernández, D. Y. B., Sierra, G. M., Chaskel, R., Espinel, Z., & Shultz, J. M. (2016) · Disaster Health · doi:10.1080/21665044.2016.1263086 · Cited by 37
Bipolar affective disorder and its impact on various aspects of marital relationship
Grover, S., Nehra, R., & Thakur, A. (2017) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_15_16 · Cited by 45
“[12] Many patients experience psychosocial and occupational difficulties,[13,14] financial problems,[15] marital failure,[16,17] substance abuse,[18,19] neuropsychological deficits,[20] sexual dysfunction,[21] suicide,[22] poor quality of life,[23] legal issues,[24] poor parenting skills,[25] and disability.”
Background
Twelve-month prevalence of psychiatric disorders and treatment-seeking among Asian Americans/Pacific Islanders in the United States: Results from the National Epidemiological Survey on Alcohol and Related Conditions
Xu, Y., Okuda, M., Hser, Y., Hasin, D. S., Liu, S.-M., Grant, B. F., & Blanco, C. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.12.009 · Cited by 37
Perceptions of mental health and substance abuse program administrators and staff on service delivery to persons with co-occurring substance abuse and mental disorders
Grella, C. E., Gil‐Rivas, V., & Cooper, L. (2004) · The Journal of Behavioral Health Services & Research · doi:10.1007/bf02287337 · Cited by 37
Co-Occurring Stress and Substance Abuse in College First Offenders
O’Hare, T., & Sherrer, M. V. (2000) · Journal of Human Behavior in the Social Environment · doi:10.1300/j137v03n01_02 · Cited by 37
“…and programmatic hurdles for addressing co-occurring mental health and substance abuse problems are common, and due, in part, to diagnostic (either-or) approaches to funding and service delivery for mental health and substance abuse problems (Kessler et al., 1996; Brems and Johnson, 1997).”
BackgroundInfluential
Adolescent addictive internet use and drug abuse in Wuhan, China
Gong, J., Chen, X., Zeng, J., Li, F., Zhou, D., & Wang, Z. (2008) · Addiction Research & Theory · doi:10.1080/16066350802435152 · Cited by 37
“Co-morbidity with depression, anxiety, eating disorders, and disruptive behavior disorders are also documented (Kessler et al. 1996; Weingerg et al. 1998).”
Background
Health services use in women with a history of bulimia nervosa or binge eating disorder
Striegel‐Moore, R. H., Dohm, F., KRAEMER, H. C., Schreiber, G. B., Crawford, P. B., & Daniels, S. R. (2004) · International Journal of Eating Disorders · doi:10.1002/eat.20090 · Cited by 37
Quetiapine for Alcohol Use and Craving in Bipolar Disorder
Longoria, J., Brown, E. S., Perantie, D. C., Bobadilla, L., & Nejtek, V. A. (2004) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000106230.36344.b1 · Cited by 37
Alcohol use and depression among African-American and Caucasian adolescents.
Maag, J. W., & Irvin, D. M. (2005) · PubMed · Cited by 37
A Randomized, Double-Blind, Placebo-Controlled Trial of Citicoline for Cocaine Dependence in Bipolar I Disorder
Brown, E. S., Todd, J. P., Hu, L. T., Schmitz, J. M., Carmody, T. J., Nakamura, A., Sunderajan, P., Rush, A. J., Adinoff, B., Bret, M. E., et al. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.14070857 · Cited by 36
Addiction as a Systems Failure: Focus on Adolescence and Smoking
Baler, R., & Volkow, N. D. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.12.008 · Cited by 38
Personality disorders and cigarette smoking among adults in the United States
Zvolensky, M. J., Jenkins, E. F., Johnson, K. A., & Goodwin, R. D. (2010) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.11.009 · Cited by 40
“Similar types of findings have been reported in other representative surveys (e.g. Kessler et al., 1996; Henderson et al., 2000).”
Result
Social Connectedness, Self-Efficacy, and Mental Health Outcomes Among Homeless Youth
Begun, S., Bender, K., Brown, S. M., Barman‐Adhikari, A., & Ferguson, K. M. (2016) · Youth & Society · doi:10.1177/0044118x16650459 · Cited by 36
“Perhaps most distressing, depressive and substance use disorders frequently co-occur in general (Kessler et al., 1996), specifically among homeless youth; such co-occurrences are significantly and positively associated with youth’s gravest experiences of adverse health outcomes as well as street victimization (Whitbec…”
Background

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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