Co-occurrence of substance use disorders with other psychiatric disorders: Implications for treatment services
Co-occurrence of substance use disorders with other psychiatric disorders: Implications for treatment services
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DOI：
10.2478/nsad-2014-0002
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发表时间：
2014-02-01
影响因子：
1.7
通讯作者：
Robaina, Katherine A.
中科院分区：
文献类型：
--
作者：
Morisano, Dominique;Babor, Thomas F.;Robaina, Katherine A.
前言：本文批判性地评估了物质使用障碍（sud）与其他精神疾病共发的文献。我们的综述考虑了两者之间各种不同的关联，并提出了针对这两种疾病的治疗服务设计的文献含义。方法：对世界范围内共发精神疾病的流行病学、共发机制和治疗模式等方面的研究和理论进行综述。结果：流行病学研究记录了临床样本和一般人群中同时发生的疾病的高患病率，尽管文献主要基于高收入国家的研究，并且一些重叠可能是由于两种类型的疾病的较轻形式同时发生。与其他综述报道的结果一致，我们得出结论，与患有单一疾病的患者相比，患有合并障碍的患者往往有更严重的病程、更严重的健康和社会后果、更多的治疗困难和更差的治疗结果；我们讨论了这些发现对治疗服务设计的影响。结论：许多证据表明，单独治疗SUD和其他精神疾病在减少药物使用和改善行为、家庭和社会心理结果方面是有效的。证据进一步表明，如果在同时解决药物滥用和精神问题的综合治疗计划中结合提供治疗方式，这些结果可能会得到改善。结论是，从公共卫生的角度出发，努力在系统层面实施现有的循证实践，可能比目前在临床层面寻求更强大的个人层面干预的趋势更有收获。
Introduction: This paper critically evaluates the literature on the co-occurrence of substance-use disorders (SUDs) with other psychiatric conditions. Our review considers the variety of different associations between the two, and suggests the implications of the literature for the design of treatment services that address both types of disorders. Methods: A narrative review of research and theory was conducted, covering epidemiology of co-occurring psychiatric disorders worldwide, mechanisms underlying co-occurrence, and treatment models. Results: Epidemiological research has documented a high prevalence of co-occurring disorders in both clinical samples and the general population, although the literature is based primarily on studies in high-income countries and some of the overlap might be due to the co-occurrence of milder forms of both types of disorders. Consistent with what has been reported in other reviews, we conclude that clients with co-occurring disorders tend to have a more severe course of illness, more severe health and social consequences, more difficulties in treatment, and worse treatment outcomes than clients with a single disorder; we address the implications of these findings for the design of treatment services. Conclusions: Much of the evidence shows that separately, treatments for both SUD and other psychiatric disorders are effective in reducing substance use and in improving behavioral, familial, and psychosocial outcomes. The evidence further suggests that these outcomes might be improved when treatment modalities are offered in combination within an integrated treatment plan that simultaneously addresses substance abuse and psychiatric problems. It is concluded that there is potentially more to be gained from taking a public health perspective and working on efforts to implement existing evidence-based practices at the systems level, than from the current tendency to look for ever more powerful individual-level interventions at the clinical level.