Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-05T02:52:17.219Z Has data issue: false hasContentIssue false
  • English
  • Français

Primary Care Management of Patients with Co-occurring Disorders

Published online by Cambridge University Press:  07 November 2014

Larry Culpepper
Get access Rights & Permissions [Opens in a new window]

Abstract

Primary care physicians (PCPs) often provide the first line of care for the vast number of United States adults—∼30% at any given time—with either a psychiatric or a substance use disorder, or both. The widespread prevalence of this comorbidity bears reiterating: During the same 12-month period, 20% of national survey respondents with a substance use disorder (SUD) had at least one mood disorder, and 17% had at least one anxiety disorder. Conversely, at least one SUD was found among 20% of respondents with a mood disorder and 15% of those with an anxiety disorder. However, because PCPs are often not aware of or alerted to these problems, it would seem advisable that patients presenting with either a psychiatric or an alcohol use disorder should be evaluated for both conditions. Establishing the presence of co-occurring disorders may be difficult, but it is necessary for appropriate and realistic treatment planning.

Type
Expert Roundtable Supplement
Information
CNS Spectrums , Volume 13 , Issue S6: Bridging the Clinical Gap: Managing Patients with Co-occurring Mood, Anxiety, and Alcohol Use Disorders , April 2008 , pp. 13 - 15
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kessler, RC, Demler, O, Frank, RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med. 2005;352(24):2515–2523.CrossRefGoogle ScholarPubMed
2.Grant, BF, Stinson, FS, Dawson, DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807–816.CrossRefGoogle ScholarPubMed
3.Ziedonis, D, Brady, K.Dual diagnosis in primary care: detecting and treating both the addiction and the mental illness. Med Clin N Amer. 1997;81(4):1017–1036.CrossRefGoogle Scholar
4. National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician's Guide. Updated 2005 ed. Washington, DC: National Institutes of Health; 2007. Publication No. 07–3769.Google Scholar
5.Institute for Clinical Systems Improvement. Health Care Guideline: Major depression in adults in primary care. 10th ed.Bloomington, MN: Institute for Clinical Systems Improvement; 2007.Google Scholar
6.Kranzler, HR, Rosenthal, RN.Dual diagnosis: alcoholism and co-morbid psychiatric disorders. Am J Addictions. 2003;12(Suppl 1):26–40.CrossRefGoogle ScholarPubMed
7.US Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554–556.CrossRefGoogle Scholar
8.Weiss, RD.Identifying and diagnosing co-occurring disorders. CNS Spectr. 2008;13:4(Suppl 6):4–6.CrossRefGoogle ScholarPubMed
9.Brown, RL, Rounds, LA.Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995;94(3):135–140.Google Scholar
10.CAGEAID. www.cadt.org/audit/cageaid.html. Accessed December 2007.Google Scholar
11.National Institute on Alcohol Abuse and Alcoholism. www.niaaa.nih.gov/publications. Accessed December 2007.Google Scholar
12.Kroenke, K, Spitzer, RL, Williams, JB, Monahan, PO, Löwe, B.Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–325.CrossRefGoogle ScholarPubMed
13.US Preventive Services Task Force. Screening for depression: recommendations and rationale. Ann Intern Med. 2002;136(10):760–764.CrossRefGoogle Scholar
14.Spitzer, RL, Kroenke, K, Williams, JB, Löwe, B.A brief measure for assessing generalized anxiety disorder—The GAD-7. Arch Intern Med. 2006;166(10):1092–1097.CrossRefGoogle ScholarPubMed
15.Hulse, GK, Tait, RJ.Six-month outcomes associated with a brief alcohol intervention for adult in-patients with psychiatric disorders. Drug Alcohol Rev. 2002;21(2):105–112.CrossRefGoogle ScholarPubMed
16.Miller, WR, Rollnick, S.Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, NY: The Guilford Press; 1991.Google Scholar
17.Hendrickson, EL, Schmal, MS, Ekleberry, SC.Treating Co-Occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals. Binghamton, NY: Haworth Press; 2004:97–105.Google Scholar
18.Brady, KT.Evidence-based pharmacotherapy for mood and anxiety disorders with concurrent alcoholism. CNS Spectr. 2008;13:4(Suppl 6):7–9.CrossRefGoogle ScholarPubMed
19.American Psychiatric Association. Practice Guideline for the Treatment of Patients with Substance Use Disorders. 2nd ed.New York, NY: American Psychiatric Association; 2006.Google Scholar
20.Nunes, E, Rubin, E, Carpenter, K, Hasin, D. Mood disorders and substance use. In: Stein, DJ, Kupfer, DJ, Schatzberg, AF, ed. The American Psychiatric Publishing Textbook of Mood Disorders. Washington, DC: American Psychiatric Publishing; 2005:653–671.Google Scholar
21.Brady, KT, Verduin, ML.Pharmacotherapy of comorbid mood, anxiety, and substance use disorders. Subst Use Misuse. 2005;40(13–13):2021–2041.CrossRefGoogle ScholarPubMed
22.Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services. Treatment Improvement Protocols (TIP) 9: Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse. Rockville, MD; 2002.Google Scholar
23.Petrakis, IL, Gonzalez, G, Rosenheck, R, Krystal, JH.Comorbidity of alcoholism and psychiatric disorders: an overview. Bethesda, Md: National Institute on Alcohol Abuse and Alcoholism; 2002.Google Scholar
24.Drake, RE, Essock, SM, Shaner, A, et al. Implementing dual diagnosis services for clients with severe mental illness. Psychiatr Serv. 2001;52(4):469–476.CrossRefGoogle ScholarPubMed