Condition

Co-occurring Substance Use Disorder and Mental Health Disorder

Editors: Stephen P. Jarvis MD; Esther Jolanda van Zuuren MD; Alexander Rae-Grant MD, FRCPC, FAAN

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Background Information

Description

  • co-occurring substance use and mental health disorders are complex, variable, and mutually influencing, and may share common features that contribute to the co-occurrence
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Definitions

  • substance - a psychoactive compound with the potential to cause health and social problems
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  • substance misuse - use of a substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them
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  • substance use disorder - a medical illness caused by repeated misuse of substance(s); see Further Assessment for Substance Use Disorder for details
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  • illicit drugs include
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    • cocaine, including crack
    • heroin
    • hallucinogens, including LSD (lysergic acid diethylamide), PCP (phencyclidine), ecstasy, peyote, mescaline, and psilocybin
    • methamphetamines, including crystal meth
    • marijuana, including hashish
    • synthetic drugs, including K2, Spice, and "bath salts"
    • prescription medications used for nonmedical purposes
      • opioid analgesics, including fentanyl, codeine, oxycodone, hydrocodone, and tramadol products
      • tranquilizers, including benzodiazepines, meprobamate products, and muscle relaxants
      • stimulants and methamphetamine, including amphetamine, dextroamphetamine, and phentermine products; mazindol products; and methylphenidate or dexmethylphenidate products
      • sedatives, including temazepam, flurazepam, or triazolam and any barbiturates

Overall Epidemiology and Complications

  • epidemiology of co-occurring substance use and mental health disorders
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    • reported rates of substance use disorder among adults in the United States in 2018
      • 5% without mental health disorder
      • 19% with any mental health disorder
      • 28% with serious mental health disorder
    • any affective or anxiety mental health disorder reported in 35% of adults with a substance use disorder in Australia in 2007
    • having a substance use or mental health disorder associated with increased risk of having the other
    • factors associated with co-occurring substance use and mental health disorders
      • unemployment
      • insecure housing
      • incarceration or other involvement in criminal justice system
      • suicidal ideation
  • co-occurring PubMed24784122American family physicianAm Fam Physician20140415898634-40634substance use and mental health disorders associated with increased risks of
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    • violence and other criminal behavior
    • socioeconomic factors that can challenge recovery, such as, unemployment, insecure housing, incarceration, and other involvement in criminal justice system
    • poor physical and mental health including
      • suicide
      • increased need for hospitalization
      • greater severity of clinical signs and symptoms of both substance use and mental health disorder
    • poor social and occupational functioning
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DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:

1Level 1 (likely reliable) Evidence
Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias.
There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.
2Level 2 (mid-level) Evidence
Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve Level 1 evidence labeling.
3Level 3 (lacking direct) Evidence
Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

Grades of Recommendation

Guideline producers are now frequently using classification approaches for their evidence and recommendations, and these classifications are recognized and requested by guideline users. When summarizing guideline recommendations for DynaMed users, the DynaMed Editors are using the guideline-specific classifications and providing guideline classification approach when this is done.

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