Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

272 IV. SPECIAL POPULATIONSAdditionally, non-SUD Axis I and II psychiatric disorders are here referred tosimply as “psychiatric disorders” to distinguish them from substance use disorders.In this chapter, we review psychosocial and psychopharmacological treatmentsfor dual-diagnosis populations. While increasing methodological rigor isbeing employed in many of these studies, this research is still at an early stage.Thus, some of the available evidence is from pilot or noncontrolled trials.When evidence from blinded and/or controlled trials is not available for a particulartreatment, we review the level of evidence that is available.EPIDEMIOLOGYStudies in SUD and psychiatric treatment-seeking populations (McLellan &Druley, 1977; Ross, Glaser, & Germanson, 1988; Rounsaville et al., 1991)have suggested high prevalence rates of co-occurring SUDs and psychiatricdisorders. However, treatment-seeking samples may not be representative ofcommunity populations, since they tend to have higher rates of comorbidityand may have more severe manifestations of the disorder for which they areseeking treatment. Thus, epidemiological studies of prevalence rates in communitypopulations are important in assessing the true comorbidity prevalencerate.The two largest U.S. psychiatric epidemiological studies to date, theEpidemiologic Catchment Area (ECA) study (Regier et al., 1990) and themore recent National Comorbidity Survey (NCS; Kessler et al., 1996) demonstratethat co-occurring SUDs and psychiatric disorders are prevalent in communitypopulations. Methodological advancements of the NCS included anexpanded scope of the community sample (e.g., the ECA sampled from withinfive U.S. communities, whereas the NCS sampled nationally representativehouseholds), and an advanced version of the Diagnostic and Statistical Manual ofMental Disorders (i.e., DSM-III-R [American Psychiatric Association, 1987]).Also, while both studies surveyed most of the more common psychiatric disorders,the ECA did not include posttraumatic stress disorder (PTSD), whereasthe NCS did. Neither epidemiological survey included Axis II disorders otherthan antisocial personality disorder (ASPD). Despite these limitations and differencesbetween the two studies, their results were often qualitatively similar,although the magnitude of their estimates differed somewhat at times. Amongpersons with psychiatric disorders, the ECA estimated that 30% had a cooccurringSUD. The prevalence varied by diagnosis, however; co-occurringSUDs were most common in individuals with ASPD, followed by those withbipolar I disorder. In SUD populations, the ECA and the NCS estimated thatover half will experience Axis I or II psychiatric disorders in their lifetime.These lifetime estimates do not merely reflect rare or historical periods in an