Psychiatric comorbidity and the persistence of drug use disorders in the United States

Authors

  • Miriam C. Fenton,

    1. Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
    2. New York State Psychiatric Institute, New York, NY, USA
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  • Katherine Keyes,

    1. Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
    2. New York State Psychiatric Institute, New York, NY, USA
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  • Timothy Geier,

    1. New York State Psychiatric Institute, New York, NY, USA
    2. Department of Psychology, University of Wisconsin, Madison, WI, USA
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  • Eliana Greenstein,

    1. New York State Psychiatric Institute, New York, NY, USA
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  • Andrew Skodol,

    1. New York State Psychiatric Institute, New York, NY, USA
    2. College of Physicians and Surgeons, Department of Psychiatry, Columbia University, New York, NY, USA
    3. University of Arizona College of Medicine, Tucson, AZ, USA
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  • Bob Krueger,

    1. Departments of Psychology, University of Minnesota, Minneapolis, MN, USA
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  • Bridget F. Grant,

    1. Intramural Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA
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  • Deborah S. Hasin

    Corresponding author
    1. Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
    2. New York State Psychiatric Institute, New York, NY, USA
    3. College of Physicians and Surgeons, Department of Psychiatry, Columbia University, New York, NY, USA
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Deborah S. Hasin, Department of Clinical Epidemiology (in Psychiatry), Columbia University, College of Physicians and Surgeons, 1051 Riverside Drive #123, New York, NY 10032, USA. E-mail: dsh2@columbia.edu

ABSTRACT

Aims  DSM-IV drug use disorders, a major public health problem, are highly comorbid with other psychiatric disorders, but little is known about the role of this comorbidity when studied prospectively in the general population. Our aims were to determine the role of comorbid psychopathology in the 3-year persistence of drug use disorders.

Design and setting  Secondary data analysis using waves 1 (2001–02) and 2 (2005–05) of the National Epidemiologic Survey on Alcohol and Related Conditions.

Participants  Respondents with current DSM-IV drug use disorder at wave 1 who participated in wave 2 (n = 613).

Measurements  Alcohol Use Disorders and Associated Disabilities Interview Schedule IV (AUDADIS-IV) obtained DSM-IV Axis I and II diagnoses. Persistent drug use disorder was defined as meeting full criteria for any drug use disorder between waves 1 and 2.

Findings  Drug use disorders persisted in 30.9% of respondents. No Axis I disorders predicted persistence. Antisocial [odds ratio (OR) = 2.75; 95% confidence interval (CI): 1.27–5.99], borderline (OR = 1.91; 95% CI: 1.06–3.45) and schizotypal (OR = 2.77; 95% CI: 1.42–5.39) personality disorders were significant predictors of persistent drug use disorders, controlling for demographics, psychiatric comorbidity, family history, treatment and number of drug use disorders. Deceitfulness and lack of remorse were the strongest antisocial criteria predictors of drug use disorder persistence, identity disturbance and self-damaging impulsivity were the strongest borderline criteria predictors, and ideas of reference and social anxiety were the strongest schizotypal criteria predictors.

Conclusions  Antisocial, borderline and schizotypal personality disorders are specific predictors of drug use disorder persistence over a 3-year period.

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