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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“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…”
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“The sex, marital status, level of education and occupation were found to be significant risk factors for psychoactive substance use in patients with other psychiatric disorders [Table 4].”
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“[12], but is higher than is found in substance abusers in population studies [2,9,11].”
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Method
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“…from mental illness show an association with substance use disorders (Beaumont, Charbonneau, & Delisle, 2005; Clark, Samnaliev, & McGovern, 2007; Kessler et al., 1996; Landheim, Bakken, & Vaglum, 2006; Ministère de la Santé et des Services Sociaux, 2005; Nadeau, 2001; RachBeisel, Scott, &…”
Background
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“Additionally, individuals with mania are more than eight times more likely to suffer from drug dependence within the past 12 months and nearly nine times more likely to have lifetime drug dependence compared to the general population (Kessler et al., 1996).”
Background
“New” public management of mentally disordered offenders:
Wolff, N. (2002) · International Journal of Law and Psychiatry · doi:10.1016/s0160-2527(01)00098-x · Cited by 19
“…of the mentally disordered (Abramson, 1972; Fisher, Packer, Simon, & Smith, 2000; Lamb & Weinberger, 1998; Torrey et al., 1992), substance abuse (Kessler et al., 1996; Menezes et al., 1996), social exclusion and isolation (Link, Cullen, Mirotznik, & Struening, 1992), and overburdened family…”
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Defining Location in the Mental Health System: A Case Study of a Consumer-Run Agency
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“The agency assumed that hierarchical relationships between staff and clients are not necessarily destructive, a view that is at odds with a self-help philosophy but consistent with evidence that formal service use is beneficial ( Kessler et al., 1996 ) and that social movements can maintain central values despite form…”
Background
Evaluation of psychiatric symptoms in cocaine users in the Brazilian public health system: Need for data and structure
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“A large body of population-based epidemiologic studies has documented the prevalence and high comorbidity of psychiatric disorders (Grant et al., 2004b; Kessler et al., 1996; Merikangas et al., 2003), and that the co-occurrence of psychiatric disorders is associated with reduced functioning and quality of life, poorer…”
Background
A Whole-Brain Investigation of White Matter Microstructure in Adolescents with Conduct Disorder
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“Discussion Researchers have consistently found that individuals with bipolar disorder are at increased risk for alcohol and substance related disorders (Kessler et al., 1996;Levin & Hennessy, 2004; Strakowski et al., 2005, 2000 Strakowski et al., 1998).”
BackgroundResult
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“In the NCS, 51% of those with a lifetime occurrence of a mental disorder reported a lifetime occurrence of at least one addictive disorder as well ( Kessler et al. 1996 ).”
Background
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Thompson, M. N., Nitzarim, R. S., Her, P., Sampe, M., & Diestelmann, J. (2015) · Journal of Career Assessment · doi:10.1177/1069072715621517 · Cited by 19
“Given documented differences in developmental levels across adolescent age (e.g., Kessler et al., 1996), it seems likely that experiences and perceptions related to financial strain and stress and work beliefs and expectations may differ across adolescent age.”
Background
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“Many community studies have revealed significant co-morbidity between depression and alcoholism (Clark et al., 1997; Kessler et al., 1996; Maier and Merikangas, 1996; Penick et al., 1994; Pomerleau et al., 1997; Regier et al., 1990; Rodgers et al., 2000; Roy et al., 1991; Spak et al., 2000).”
Background
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BackgroundMethodInfluential
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“[2] Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ.”
BackgroundInfluential
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Mackie, C. J., Conrod, P., & Brady, K. T. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3375-0_21 · Cited by 18
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Background
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“In the context of bipolar disorder, individuals with mania are 8.4 times more likely to experience lifetime drug dependence as compared to the general population (Helzer and Pryzbeck, 1988; Kessler et al., 1996a).”
BackgroundInfluential
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Background
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Background
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“Mental and SUDs occur commonly and are often comorbid (e.g., Hasin & Grant, 2015; Kessler et al., 1996, Kessler, Birnbaum, et al., 2005).”
BackgroundSelf-citation
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“Stigma associated with mental illness does not only form a barrier to accessing treatment but also accounts for the unresponsive nature of care provided at mental health institutions as well as governments’ unwillingness to invest in mental health services (Kessler et al., 1996).”
Background
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“For instance, having a major depressive episode triples the odds that a person will also have an abuse or dependence problem within a year, and having bipolar disorder increases the odds by more than 600% ( Kessler et al., 1996; see also Johnson, Posner, & Rolf, 1995.) Moreover, when people have histories of psycho l…”
Background
The association between cannabis use and depression: a review of the evidence
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“Because psychiatric symptoms often predate problematic substance use [33, 34], the individuals’ substance of choice may be selected to manage their specific psychiatric symptoms and help them achieve emotional stability [35, 36].”
Background
Exposure to Family Violence and Temperament Factors as Predictors of Adult Psychopathology and Substance Use Outcomes
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Relapse Contexts for Substance Abusing Adolescents with Comorbid Psychopathology
Anderson, K. G., Frissell, K. C., & Brown, S. A. (2007) · Journal of Child & Adolescent Substance Abuse · doi:10.1300/j029v17n01_04 · Cited by 15
“Population estimates for adults with comorbid substance use disorders and other Axis I psychopathology (e.g., depression and anxiety disorders) have ranged from 29% (Kessler et al., 1996) to 37% (Burns & Teesson, 2002; Regier et al., 1990), with substantially higher rates in clinical settings.”
Background
Substance Use and Facial Injury
Murphy, D. A. (2010) · Oral and Maxillofacial Surgery Clinics of North America · doi:10.1016/j.coms.2010.01.005 · Cited by 15
Individual and Network Correlates of Antisocial Personality Disorder Among Rural Nonmedical Prescription Opioid Users
Vickers‐Smith, R., Young, A. M., Mullins, U. L., & Havens, J. R. (2016) · The Journal of Rural Health · doi:10.1111/jrh.12184 · Cited by 15
“4%) had a co-occurring history of at least 1 addictive disorder (alcohol abuse and/or dependence, drug abuse and/or dependence).(11) Studies suggest that individuals meeting diagnostic criteria for ASPD were more likely to engage in daily illicit drug use(12) and more likely to report high-risk drug behaviors, such as…”
Background
The Validity of the Montgomery-Asberg Depression Rating Scale in an Inpatient Sample with Alcohol Dependence
Hobden, B., Schwandt, M. L., Carey, M. L., Lee, M. R., Farokhnia, M., Bouhlal, S., Oldmeadow, C. J., & Leggio, L. (2017) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13400 · Cited by 15
“…increased depressive and AD symptoms severity increases the likelihood of seeking treatment for addiction (Burns et al., 2005; Sullivan et al., 2005), resulting in higher rates of depression within populations admitted to addiction treatment facilities (Kodl et al., 2007; Tolliver and Anton, 2015).”
Background
Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care–Based Alcohol Screening Data
Palzes, V. A., Kline‐Simon, A. H., Satre, D. D., Sterling, S., Weisner, C. M., & Chi, F. W. (2020) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2020.81.436 · Cited by 15
“The co-occurrence of AUD among individuals with mental illness is well established (Kessler et al., 1996), and this subgroup should continue to be a focus of research on recovery.”
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Comorbidity of addictive problems: Assessment and treatment implications
Essau, C. A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818626-8.00011-6 · Cited by 15
Empirically Supported Family and Peer Interventions for Dual Disorders
Moore, B. C. (2005) · Research on Social Work Practice · doi:10.1177/1049731505275059 · Cited by 15
“Lifetime co-occurrence data from the National Cormorbidity Survey show that 41.0% to 65.5% of respondents who experienced an addictive disorder also have had at least one mental disorder, and 50.9% of respondents with one or more mental disorders also have a history of at least one addictive disorder ( Kessler et al.,…”
BackgroundMethodInfluential
Mutual-Help Groups for Dually Diagnosed Individuals: Rationale, Description, and Review of the Evidence
Kelly, J. F., & Yeterian, J. D. (2008) · Journal of Groups in Addiction & Recovery · doi:10.1080/15560350802424852 · Cited by 15
“Also evident from epidemiological research is that substance use disorders (SUD) tend to co-occur frequently with other psychiatric disorders (Jané-Llopis & Matytsina, 2006; Kessler et al., 1996; 1997; Mowbray et al., 1995; RachBeisel, Scott, & Dixon, 1999).”
Background
Does Availability of Illicit Drugs Mediate the Association between Mental Illness and Substance Use?
Liang, W., Lenton, S. R., ALLSOP, S. J., & Chikritzhs, T. N. (2011) · Substance Use & Misuse · doi:10.3109/10826084.2011.574769 · Cited by 15
“Mood and anxiety disorders have been associated with an increased prevalence of drug use disorders (Brady & Sinha, 2005; Kessler et al., 1996; King et al., 1996; Reed, Anthony, & Breslau, 2007).”
Background
Methodological issues in workplace substance abuse prevention research
Hersch, R. K., Cook, R. F., Deitz, D., & Trudeau, J. V. (2000) · The Journal of Behavioral Health Services & Research · doi:10.1007/bf02287309 · Cited by 15
The co-occurrence of substance use in other mental disorders: editor's introduction
Blanchard, J. (2000) · Clinical Psychology Review · doi:10.1016/s0272-7358(99)00024-0 · Cited by 15
Effectiveness of a jail‐based treatment program for individuals with co‐occurring disorders
Rothbard, A. B., Wald, H. P., Zubritsky, C. D., Jaquette, N., & Chhatre, S. (2009) · Behavioral Sciences & the Law · doi:10.1002/bsl.882 · Cited by 19
Comorbid prevalence of alcohol dependence, substance abuse, and external cause of injury in patients with bipolar disorder in a nationwide representative sample in Taiwan
Hsieh, M. H., Tang, C., Hung, S., Lee, I. H., Lin, Y.-J., & Yang, Y. K. (2012) · Bipolar Disorders · doi:10.1111/j.1399-5618.2012.01039.x · Cited by 14
Correlates of Mental Health Service Use Among Young Adults With Mental Illness: Results From the National Survey on Drug Use and Health
Miller, S., Ringeisen, H. L., Muñoz, B., Hedden, S. L., Colpe, L. J., Rohloff, H., & Embry, V. (2016) · Psychiatric Services · doi:10.1176/appi.ps.201400486 · Cited by 16
“Mental illness and substance use disorders frequently cooccur: more than 65% of participants with lifetime substance use disorders have at least one lifetime mental disorder (50).”
Background
Suicide after contact with substance misuse services: a national registry study
Myhre, M. Ø., Kildahl, A. T., & Walby, F. A. (2020) · BJPsych Open · doi:10.1192/bjo.2020.23 · Cited by 14
Searching for Sobriety: How Persons with Severe Mental Illness Experience Abstaining from Substance Use
Pettersen, H. (2014) · Journal of Addiction Research & Therapy · doi:10.4172/2155-6105.1000193 · Cited by 14
“Both epidemiological [1,2] and clinical [3,4] studies have reported that individuals diagnosed with severe mental illness (SMI) are more prone to substance use than are people without SMI.”
Trajectories of Marijuana use Beginning in Adolescence Predict Tobacco Dependence in Adulthood
Brook, J. S., Lee, J. Y., & Brook, D. W. (2014) · Substance Abuse · doi:10.1080/08897077.2014.964901 · Cited by 14
Latent class analysis of alcohol treatment utilization patterns and 3-year alcohol related outcomes.
Mowbray, O., Glass, J. E., & Grinnell-Davis, C. L. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.01.012 · Cited by 16
Levetiracetam for the Treatment of Co-Occurring Alcohol Dependence and Anxiety: Case Series and Review
Mariani, J. J., & LEVIN, F. R. (2008) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990802308213 · Cited by 14
Substance abuse and dependence among patients attending an emergency hospital in eastern Nile delta, Egypt
Amr, M. (2014) · African Journal of Psychiatry · doi:10.4172/psychiatry.1000110 · Cited by 14
Blunted Frontostriatal Blood Oxygen Level–Dependent Signals Predict Stimulant and Marijuana Use
Blair, M. A., Stewart, J. L., May, A. C., Reske, M., Tapert, S. F., & Paulus, M. P. (2018) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2018.03.005 · Cited by 14
“In addition, although SUD has been associated with greater incidence of psychiatric illness (73,74), lack of clinical symptom measures collected at follow-up hinders our ability to determine whether mental health symptoms affected interim substance use.”
Background
Psychiatric comorbidities among opioid-dependent patients attending department of psychiatry, regional institute of medical sciences hospital, Manipur
Mohanty, R., Singh, S. G., & Singh, N. (2018) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_102_17 · Cited by 14
“Indian Journal of Social Psychiatry | Volume 34 | Issue 2 | April-June 2018 133 Studies of psychiatric comorbidities in opioid abusers suggest that up to 80% patients meet the criteria for at least one nonsubstance use disorder during their lifetime while current disorders have reported in 30%–70% of the patients.[8]…”
Background
Obesity and Weight-Related Medical Problems of Incarcerated Persons With and Without Mental Disorders
Wolff, N., Shi, J. C., Fabrikant, N., & Schumann, B. E. (2012) · Journal of Correctional Health Care · doi:10.1177/1078345812445270 · Cited by 14
Management of "dual diagnosis" patients : consensus, controversies and considerations.
Basu, D., & Gupta, N. (2000) · PubMed Central · Cited by 14
Child & Adolescent Psychiatry: Use of Community-Based Services by Rural Adolescents With Mental Health and Substance Use Disorders
Anderson, R. L. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.10.1339 · Cited by 14
Psychiatric Care of Patients With Depression and Comorbid Substance Use Disorders
Montoya, I. D., Svikis, D. S., Marcus, S. C., Suarez, A., Tanielian, T., & Pincus, H. A. (2000) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v61n0917 · Cited by 14
Substance Use Scales of the Minnesota Multiphasic Personality Inventory
Miller, C. S., Shields, A. L., Campfield, D. C., Wallace, K. A., & Weiss, R. D. (2007) · Educational and Psychological Measurement · doi:10.1177/0013164406299130 · Cited by 14
A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders
Peterson, B. S., West, A. E., Weisz, J. R., Mack, W. J., Kipke, M. D., Findling, R. L., Mittman, B. S., Bansal, R., Piantadosi, S., Takata, G., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03314-y · Cited by 13
“Early treatment of pediatric anxiety disorders may also mitigate the development or functional impact of common comorbid disorders [7, 8], including depression [1], Attention-Deficit/Hyperactivity Disorder (ADHD) [9], oppositional defiant or conduct disorder [10], substance abuse [5, 11, 12], and suicide attempts [13,…”
Background
Transdiagnostic preventative intervention for subclinical anxiety: Development and initial validation
Korte, K. J., & Schmidt, N. B. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.04.001 · Cited by 13
“Given the high comorbidity between anxiety and alcohol and substances use (Conway, Compton, Stinson, & Grant, 2006; Kessler et al, 1996), and the research demonstrating that individuals with elevated anxiety begin using alcohol and substances as a method to cope with anxiety (Back & Brady, 2008;…”
Behavioral and neurocognitive factors distinguishing post-traumatic stress comorbidity in substance use disorders
Houghton, D. C., Spratt, H. M., Keyser‐Marcus, L., Bjork, J. M., Neigh, G. N., Cunningham, K. A., Ramey, T., & Moeller, F. G. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02591-3 · Cited by 12
“The association between substance use disorders (SUDs) and post-traumatic stress is well-established [1 – 4].”
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Prevalence and correlates of major depression among N epalese patients in treatment for alcohol‐use disorders
Neupane, S. P., & Bramness, J. G. (2012) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2012.00487.x · Cited by 13
Characteristics of an Outpatient Treatment Sample by Primary Substance of Abuse
Campbell, A. N. C., Nunes, E. V., McClure, E. A., Hu, M., Turrigiano, E., Goldman, B., & Stabile, P. Q. (2013) · Journal of Addiction Medicine · doi:10.1097/adm.0b013e31829e3971 · Cited by 13
“Substance abuse populations frequently present to treatment with psychiatric comorbidities that may significantly impact treatment outcomes (Kessler et al., 1996; Watkins et al., 2004; Compton et al., 2007; Hasin et al., 2007; Flynn and Brown, 2008).”
Background
Critical Review of Dual Diagnosis Training for Mental Health Professionals
Pinderup, P., Thylstrup, B., & Hesse, M. (2016) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-016-9665-3 · Cited by 13
“In Denmark, a recent study found that the prevalence of any lifetime SUD among patients with MI to be 37% for schizophrenia, 35% for schizotypal disorder, 28% for other psychoses, 32% for bipolar disorder, 25% for depression, 25% for anxiety, 11% for OCD, 17% for PTSD, and 46% personality disorders (Toftdahl et al. 20…”
BackgroundInfluential
Common genetic substrates of alcohol and substance use disorder severity revealed by pleiotropy detection against GWAS catalog in two populations
Peng, Q., Wilhelmsen, K. C., & Ehlers, C. L. (2020) · Addiction Biology · doi:10.1111/adb.12877 · Cited by 13
“AUD and SUD can also be comorbid with other psychiatric disorders: for instance, schizophrenia, mood disorders (major depressive disorders [MDDs], bipolar disorder), anxiety disorders (panic disorder, post-traumatic stress disorder, and generalized anxiety disorder), and externalizing disorders (antisocial personality…”
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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