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

12. Co-Occurring Substance Use Disorders and Other Psychiatric Disorders 273individual’s history; the 12-month comorbidity prevalence rate of these disorderswas also quite high. For example, the NCS estimated that over 33% ofthose with bipolar disorder would experience an SUD within 12 months, followedby nearly 20% of those with major depression and 15% of those with ananxiety disorder.THE ASSOCIATION BETWEEN DUAL DIAGNOSISAND TREATMENT OUTCOMEIn both SUD and psychiatric treatment-seeking populations, dually diagnosedpatients typically experience worse outcomes than their “singly diagnosed”peers (Ritsher et al., 2002; Schaar & Oejehagen, 2001). However, there arespecific populations in which the evidence regarding this is mixed, such as theseverely and persistently mentally ill (SPMI) (Farris et al., 2003; Gonzalez &Rosenheck, 2002) and ASPD populations (Cacciola, Alterman, Rutherford, &Snider, 1995; Kranzler, Del Boca, & Rounsaville, 1996). The effect of otherpsychiatric disorders on SUD outcomes may vary by SUD type. For example,co-occurring major depression appears to predict worse alcohol outcomes(Brown et al., 1998; Greenfield et al., 1998), while there is less evidence for itspredicting worse cocaine outcomes (McKay et al., 2002; Rohsenow, Monti,Martin, Michalec, & Abrams, 2002).There is also evidence (albeit somewhat inconsistent) that gender mayplay a role in mediating the effect of co-occurring psychiatric disorders onSUD outcome. Major depression in men has been associated with worseSUD outcome (Compton, Cottler, Jacobs, Ben-Abdallah, & Spitznagel, 2003;Rounsaville, Dolinsky, Babor, & Meyer, 1987), although this is not a consistentfinding (Kranzler et al., 1996; Powell et al., 1992). In contrast, some studiessuggest that female gender has been associated with similar or better SUD outcomesamong patients with co-occurring psychiatric disorders (Compton et al.,2003; Rounsaville et al., 1987), except for phobia, which was associated in onestudy with worse SUD outcome in women (Compton et al., 2003). Finally,ASPD in men has been associated with worse outcomes (Compton et al., 2003;Kranzler et al., 1996); although, the evidence in women has been mixed(Compton et al., 2003; Rounsaville et al., 1987).THE RELATIONSHIP BETWEEN SUBSTANCE ABUSEAND PSYCHOPATHOLOGYWhile determining which disorder is primary in dually diagnosed populationscan be useful in clinical research, it may provide little benefit in the clinicalmanagement of these patients. Patients with two disorders typically require