Effects of independent and substance-induced major depressive disorder on remission and relapse of alcohol, cocaine and heroin dependence

Authors

  • Sharon Samet,

    1. School of Social Work, Columbia University, New York, NY, USA
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  • Miriam C. Fenton,

    1. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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  • Edward Nunes,

    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    2. New York State Psychiatric Institute, New York, NY, USA
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  • Eliana Greenstein,

    1. New York State Psychiatric Institute, New York, NY, USA
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  • Efrat Aharonovich,

    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    2. New York State Psychiatric Institute, New York, NY, USA
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  • Deborah Hasin

    Corresponding author
    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    2. New York State Psychiatric Institute, New York, NY, USA
    • Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Correspondence to: Deborah Hasin, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 123, New York, NY 10032, USA. E-mail: dsh2@columbia.edu

Abstract

Aims

Little is known about the differential effects of independent and substance-induced major depression on the longitudinal course of alcohol, cocaine and heroin disorders when studied prospectively.

Design

Consecutively admitted in-patients, evaluated at baseline, 6-, 12- and 18-month follow-ups.

Setting

Baseline evaluations in a short-stay in-patient urban community psychiatric hospital unit.

Participants

Adults (n = 250) with current DSM-IV cocaine, heroin and/or alcohol dependence at baseline.

Measurements

The Psychiatric Research Interview for Substance and Mental Disorders (PRISM), used to evaluate independent and substance-induced major depression, alcohol, cocaine and heroin dependence, and other psychiatric disorders. Outcomes for each substance: (i) time (weeks) from hospital discharge to first use; (ii) time from discharge to onset of sustained (≥26 weeks) remission from dependence; (iii) time from onset of sustained remission to relapse.

Findings

Substance-induced major depression significantly predicted post-discharge use of alcohol, cocaine and heroin (hazard ratios 4.7, 5.3 and 6.5, respectively). Among patients achieving stable remissions from dependence, independent major depression predicted relapse to alcohol and cocaine dependence (hazard ratios 2.3 and 2.7, respectively).

Conclusions

Substance-induced and independent major depressions were both related to post-discharge use of alcohol, cocaine and heroin. The findings suggest the importance of clinical attention to both types of depression in substance abusing patients.

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