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Primary Care Management of Patients with Co-occurring Disorders

Published online by Cambridge University Press:  07 November 2014

Larry Culpepper
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Abstract

Primary care physicians (PCPs) often provide the first line of care for the vast number of United States adults—∼30% at any given time—with either a psychiatric or a substance use disorder, or both. The widespread prevalence of this comorbidity bears reiterating: During the same 12-month period, 20% of national survey respondents with a substance use disorder (SUD) had at least one mood disorder, and 17% had at least one anxiety disorder. Conversely, at least one SUD was found among 20% of respondents with a mood disorder and 15% of those with an anxiety disorder. However, because PCPs are often not aware of or alerted to these problems, it would seem advisable that patients presenting with either a psychiatric or an alcohol use disorder should be evaluated for both conditions. Establishing the presence of co-occurring disorders may be difficult, but it is necessary for appropriate and realistic treatment planning.

Type
Expert Roundtable Supplement
Information
CNS Spectrums , Volume 13 , Issue S6: Bridging the Clinical Gap: Managing Patients with Co-occurring Mood, Anxiety, and Alcohol Use Disorders , April 2008 , pp. 13 - 15
Copyright
Copyright © Cambridge University Press 2008

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References

1.Kessler, RC, Demler, O, Frank, RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med. 2005;352(24):2515–2523.CrossRefGoogle ScholarPubMed
2.Grant, BF, Stinson, FS, Dawson, DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807–816.CrossRefGoogle ScholarPubMed
3.Ziedonis, D, Brady, K.Dual diagnosis in primary care: detecting and treating both the addiction and the mental illness. Med Clin N Amer. 1997;81(4):1017–1036.CrossRefGoogle Scholar
4. National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician's Guide. Updated 2005 ed. Washington, DC: National Institutes of Health; 2007. Publication No. 07–3769.Google Scholar
5.Institute for Clinical Systems Improvement. Health Care Guideline: Major depression in adults in primary care. 10th ed.Bloomington, MN: Institute for Clinical Systems Improvement; 2007.Google Scholar
6.Kranzler, HR, Rosenthal, RN.Dual diagnosis: alcoholism and co-morbid psychiatric disorders. Am J Addictions. 2003;12(Suppl 1):26–40.CrossRefGoogle ScholarPubMed
7.US Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554–556.CrossRefGoogle Scholar
8.Weiss, RD.Identifying and diagnosing co-occurring disorders. CNS Spectr. 2008;13:4(Suppl 6):4–6.CrossRefGoogle ScholarPubMed
9.Brown, RL, Rounds, LA.Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995;94(3):135–140.Google Scholar
10.CAGEAID. www.cadt.org/audit/cageaid.html. Accessed December 2007.Google Scholar
11.National Institute on Alcohol Abuse and Alcoholism. www.niaaa.nih.gov/publications. Accessed December 2007.Google Scholar
12.Kroenke, K, Spitzer, RL, Williams, JB, Monahan, PO, Löwe, B.Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–325.CrossRefGoogle ScholarPubMed
13.US Preventive Services Task Force. Screening for depression: recommendations and rationale. Ann Intern Med. 2002;136(10):760–764.CrossRefGoogle Scholar
14.Spitzer, RL, Kroenke, K, Williams, JB, Löwe, B.A brief measure for assessing generalized anxiety disorder—The GAD-7. Arch Intern Med. 2006;166(10):1092–1097.CrossRefGoogle ScholarPubMed
15.Hulse, GK, Tait, RJ.Six-month outcomes associated with a brief alcohol intervention for adult in-patients with psychiatric disorders. Drug Alcohol Rev. 2002;21(2):105–112.CrossRefGoogle ScholarPubMed
16.Miller, WR, Rollnick, S.Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, NY: The Guilford Press; 1991.Google Scholar
17.Hendrickson, EL, Schmal, MS, Ekleberry, SC.Treating Co-Occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals. Binghamton, NY: Haworth Press; 2004:97–105.Google Scholar
18.Brady, KT.Evidence-based pharmacotherapy for mood and anxiety disorders with concurrent alcoholism. CNS Spectr. 2008;13:4(Suppl 6):7–9.CrossRefGoogle ScholarPubMed
19.American Psychiatric Association. Practice Guideline for the Treatment of Patients with Substance Use Disorders. 2nd ed.New York, NY: American Psychiatric Association; 2006.Google Scholar
20.Nunes, E, Rubin, E, Carpenter, K, Hasin, D. Mood disorders and substance use. In: Stein, DJ, Kupfer, DJ, Schatzberg, AF, ed. The American Psychiatric Publishing Textbook of Mood Disorders. Washington, DC: American Psychiatric Publishing; 2005:653–671.Google Scholar
21.Brady, KT, Verduin, ML.Pharmacotherapy of comorbid mood, anxiety, and substance use disorders. Subst Use Misuse. 2005;40(13–13):2021–2041.CrossRefGoogle ScholarPubMed
22.Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services. Treatment Improvement Protocols (TIP) 9: Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse. Rockville, MD; 2002.Google Scholar
23.Petrakis, IL, Gonzalez, G, Rosenheck, R, Krystal, JH.Comorbidity of alcoholism and psychiatric disorders: an overview. Bethesda, Md: National Institute on Alcohol Abuse and Alcoholism; 2002.Google Scholar
24.Drake, RE, Essock, SM, Shaner, A, et al. Implementing dual diagnosis services for clients with severe mental illness. Psychiatr Serv. 2001;52(4):469–476.CrossRefGoogle ScholarPubMed