Results of two new studies, funded in part by the National Institute on Drug Abuse (NIDA), National Institutes of Health, show that people with substance abuse disorders often have accompanying medical or psychiatric conditions that can include bone fractures, muscle injuries, pain disorders, depression, anxiety, and even psychoses. The studies are published in the November issues of "Archives of Internal Medicine and Archives of General Psychiatry".

"The findings from these studies highlight the need for medical screening and treatment of comorbid conditions," says NIDA director Dr. Nora D. Volkow. "These studies provide more evidence that substance abuse does not occur in a vacuum, but rather often exists together with a number of conditions that have serious health consequences and may influence the success of substance abuse interventions provided alone. Physicians and other health care providers need to keep in mind that a diagnosis of substance abuse should be an important warning signal to look for co- existing medical or psychiatric conditions."

In the "Archives of Internal Medicine" article, Jennifer Mertens and her colleagues at Kaiser Permanente health maintenance organization and the University of California, San Francisco, reported results of their study. The researchers analyzed 12-month data from 747 people who entered the Kaiser Permanente substance abuse program, and 3,690 demographically matched control patients who were members of the managed care organization but who were not diagnosed with substance abuse. They found that people undergoing treatment for substance abuse had a significantly higher prevalence of injuries (such as fractures, sprains, strains, and burns), depression, and anxiety disorders. Substance abuse patients also were more likely to require treatment for lower back pain, headache, and arthritis. About one-third of the medical conditions described during the study period were significantly more common in people undergoing substance abuse treatment.

More than 25 percent of the substance abuse patients were diagnosed with injuries compared to only 12 percent of the controls. Also, 29 percent of the substance abuse patients were diagnosed with depression and 17 percent with anxiety disorders, versus only 3 percent and 2 percent of the control patients, respectively.

The second study, published in the "Archives of General Psychiatry", highlights data from the Northwestern Juvenile Project. Dr. Karen Abram, Dr. A. Linda Teplin, and their colleagues at Northwestern University Feinberg School of Medicine and Children's Memorial Hospital in Chicago interviewed 1,829 youth ages 10 to 18 at the Cook County Juvenile Temporary Detention Center. Overall, more than 10 percent of males and almost 14 percent of females had a substance abuse disorder and a major mental disorder, such as psychosis, manic episode, or major depressive episode. Approximately 600 of these 1,829 young people had substance abuse disorders and behavioral disorders.

In looking at a subset of 305 youth with major mental disorders at the center, the scientists found that more than 50 percent of females and nearly 75 percent of males also reported a substance abuse disorder.

When the scientists examined data from a different subset of 874 youth with substance abuse disorders, they found that 30 percent of the females and 21.4 percent of the males also had a major mental disorder.

About 25 percent of these juvenile justice system detainees with major mental disorders reported that their psychiatric problem preceded their substance abuse disorder by more than 1 year. Almost 67 percent of females and more than 54 percent of males developed their mental and drug abuse disorders within the same year. "As members of the medical community, we need to be aware of the high prevalence of comorbidity with substance abuse, and adjust our focus to include treating all of a person's health problems," says Dr. Volkow. "We need to recognize that these problems can be severe and can include physical injuries and serious mental disorders. Effectively addressing these concerns will be key to breaking the cycle of these disorders and substance abuse." "The findings indicate a need for additional research that delves further into substance abuse and comorbidity," says Dr. Volkow. "Improving our awareness of substance abuse as a condition that does not exist in isolation will contribute to more effective prevention and treatment interventions."