Comorbidity research
selected articles
Epidemiology
All of the surveys below are about associations between mental health and addiction and say nothing about causal links.
The Epidemiological Catchment Area Study in the US was conducted some time ago but is still one of the largest and most detailed surveys of comorbidity. 20,291 individuals were interviewed. People with mental health problems were nearly three times more likely also to have an addiction disorder compared to those without a mental health problem.
Surveys :: How common is comorbidity in the general population?
*PD personality disorder Source: Kessler RC et al (2005)
This more recent Australian national survey of 8,841 individuals was aimed at identifying mental health problems and the related disability. Overall 5.1% of the population had a past year substance use disorder and comorbidity was most common for mood and anxiety disorders…
Psychosis: Making and Inhabiting a Different Reality
In this extraordinarily engaging lecture Paul Fletcher talks about how the brain tries to make sense of all the sensory input that it receives. He describes in some depth research that demonstrates how the brain can add to or overwrite external realities. 50 minutes
Paul Fletcher, Bernard Wolfe Professor of Health Neuroscience at the University of Cambridge
Surveys :: Does severity of addiction increase comorbidity?
Averaged across survey data from six countries 20% of those peoples with alcohol problems and 26% with alcohol dependence also had a lifetime history of any mood disorder; for anxiety disorders the averages wee 25% and 32%. For people with drug dependence 35% met lifetime criteria for a mood disorder and 45% for an anxiety. There were strong associations across the board for conduct disorder (children) and antisocial behaviour…
In this analysis increasing problems of personality, as indicated by the number of personality disorders, is associated with more mental health problems…
Meta-analysis :: Are traumatic events associated with substance misuse?
Thege et al (2017) Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review. BMC Psychiatry 17:164
This meta-analysis of non help-seekers found an overall association of 35.1% between trauma and substance use. The association was 39.7% for trauma exposure in childhood compared to 29.7% for adult exposure. In a small proportion of cases, 1.3%, trauma had a negative association, meaning it seemed to have a protective, rather than causative, effect. Findings are mixed but broadly support stronger associations where there is more frequent trauma. It can be expected that help-seekers, notably the military and emergency services personnel, will have higher rates of positive association. Also bear in mind the typically long time lag between trauma and substance use or other mental health problems. Over the years many mediating factors could have influenced the route into or away from substance use.
Comorbidity Interventions
From a treatment point of view it is useful to get a timeline on when problems arose: it is often the case that the first problem was the trigger for the second. In general, personality disorders and anxiety disorders antedate substance use, whereas mood disorders more commonly post date substance use.
Meta-analysis :: Clinical outcomes from Dialectical Behaviour Therapy (DBT)
Stoffers-Winterling JM et al (2022) Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. British Journal of Psychiatry 221: 538-552
Pharmacotherapy is not associated with convincing, sustainable effects on Borderline Personality Disorder (Emotionally Expressive Disorder) and treatment is focused on psychotherapy. Individual therapies are less effective than individual work with group work add ons such as skills training. The analysis did not compare different interventions with each other and so it is not clear if other interventions are as effective as DBT.
