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6. CONCURRENT DISORDERS

Though this is an area with practical implications for treatment, few sytematic
studies of gender specific prevalence of substance dependence and
psychiatric disorders have been conducted. Findings from available studies
show that gender differences in the prevalence of psychiatric disorders among
people with substance dependence tend be consistent with findings from
general population surveys (Compton et al., 2000b; Frye et al., 2003). In one
of these studies (Frye et al., 2003), the risk of alcohol dependence in patients
with bipolar disorder was shown to be higher among women than among
men, when compared to risk in the general population. Escamilla et al. (2002)
also showed that among patients with bipolar disorder in Costa Rica, gender
was strongly associated with substance use disorders, primarily alcohol
dependence. Among adolescents with substance use problems, there were
no gender differences in the rate of bipolar disorder, but female users
exhibited a higher rate of major depression than male users (Latimer et al.,
2002).
Crosscultural studies are urgently needed to better assess and understand
the association between the use of psychoactive substances and the various
other mental disorders. The availability and increasing use of different
substances in various cultures, and specific policies related to these
substances are likely to influence the rates of comorbidity. Understanding
cultural differences that might be present will help to clarify the role of
neurobiology in the etiology of concurrent disorders.
Finally, the comorbidity of psychiatric disorders with substance
dependence, and the apparent neurobiological link between these disorders
has important implications for both the treatment of these diseases and
for public health policy. It is important for the community, health care
practitioners and policy-makers to recognize that this neurobiological link
clearly indicates that psychiatric disorders and substance dependence are
diseases stemming from underlying neuropathologies. Furthermore,
comorbidity indicates that many heavy users of psychoactive substances
have active mental disorders that would greatly benefit from psychiatric or
psychological services and treatments. There are several effective treatments
for depression and schizophrenia. Providing pharmacological and
behavioural therapies to patients with mental disorders would facilitate
abstinence or reduction of substance use, which would eventually improve
the patients’ prognosis. It should also be recognized that many of the
patients with substance dependence who are refractory to current
interventions may be so because abstinence worsens their psychiatric
symptoms. Thus, more intensive interventions may be required for people
with comorbidity to facilitate abstinence, including pharmacological
treatment to help with withdrawal symptoms. In conclusion, understanding
that there is a high degree of comorbidity of substance dependence with
psychiatric disorders will greatly facilitate the implementation of medical
treatments and public health policies that would directly address this social
and medical issue.

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