Alcohol, Tobacco, and Prescription Drugs: The Relationship With Illicit Drugs in the Treatment of Substance Users

Abstract

Alcohol, tobacco, prescription drug, and illicit drug use frequently co-occur. This paper reviews the extent of this co-occurrence in both general population samples and clinical samples, and its impact on treatment outcome. We argue that the research base for understanding comorbidity among tobacco, alcohol, prescription, and illicit drugs needs to be broadened. We specifically advocate for: (1) more epidemiological studies of relationships among alcohol, tobacco, and other illicit drug use; and (2) increased research on treatment options that address the problematic use of all of these drugs.

Keywords :

• comorbidity
• alcohol use disorder
• substance use disorder
• treatment outcome

THE AUTHORS

Prof Maree Teesson is Acting Director at the National Drug and Alcohol Research Centre and NHMRC Research Fellow. The National Drug and Alcohol Research Centre is Australia's largest drug and alcohol research center and has over 150 academic, research, and administrative staff and an international reputation for drug and alcohol research. She has made a major contribution to Australia's health and medical research effort in the field of mental health and drug and alcohol. In particular, she is known nationally and internationally for her research on the comorbidity between mental disorders and drug and alcohol disorders. She has also been a key contributor in developing new approaches to the measurement and treatment of drug and alcohol problems and the evaluation of health service delivery. She has a strong track record of winning competitive scientific grant funding and has published more than 140 peer-reviewed papers, reports, and books. In addition to her position at NDARC, she is a prestigious Research Fellowship from Australia's leading medical research council. She is a founding member (since 1990) of the Mental Health Services Conference Inc, the largest mental health conference in Australia.

Ms Philippa Farrugia has been working as a research officer with the National Drug and Alcohol Research Centre, University of NSW, since October 2008. She is currently working as part of a team, co-ordinated by Dr Katherine Mills, looking at the integrated treatment of posttraumatic stress disorder and substance use. She completed a Bachelor of Psychology honors degree at Macquarie University in 2008 and has been volunteering as a telephone counselor with Lifeline Australia since 2007.

Dr Katherine Mill is a Senior Lecturer and National Health and Medical Research Council Research Fellow at the National Drug and Alcohol Research Centre, University of NSW. Her research focuses on the epidemiology and treatment of co-occurring substance use and mental health disorders, in particular, post traumatic stress disorder. She has published widely in the area, and the importance of her research has been recognized by awards from the Australasian Society for Traumatic Stress Studies (2004), the Australasian Professional Society for Alcohol and Other Drugs (2007), and the US College on Problems of Drug Dependence (2009).

Prof Wayne Hall is an NHMRC Australia Fellow in addiction neuroethics at the University of Queensland Centre for Clinical Research. He was formerly Professor of Public Health Policy in the School of Population Health (2005–2010), Director of the Office of Public Policy and Ethics at the Institute for Molecular Bioscience (2001–2005) at the University of Queensland, and Director of the National Drug and Alcohol Research Centre at UNSW (1994–2001). He has advised the World Health Organization on: the health effects of cannabis use; the effectiveness of drug substitution treatment; the scientific quality of the Swiss heroin trials; the contribution of illicit drug use to the global burden of disease; and the ethical implications of genetic and neuroscience research on addiction. In 2001, he was identified by the Institute for Scientific Analysis as one of the world's most highly cited social scientists in the past 20 years. He was awarded an NHMRC Australia Fellowship in 2009 to research the public health, social policy, and ethical implications of genetic and neuroscience research on drug use and addiction.

Dr Andrew Baillie is a Senior Lecturer and Director of Postgraduate Clinical Training at Macquarie University. Over the past years, he has been funded for two areas of research –the treatment of comorbid mental disorders (NHMRC and NSW Health Department), the empirical examination of psychiatric diagnostic criteria using psychometrics and epidemiological datasets (NHMRC). He has also been collaborating in an Australian Teaching and Learning Council Grant for curriculum renewal in clinical psychology training with A/Prof Nancy Pachana, Dr Kate Sofronoff, and others at the University of Queensland and at other Australian Universities. He is a registered clinical psychologist and is a member of the Clinical College of the Australian Psychological Society, with an honorary appointment as a clinical psychologist in the Drug Health Services at Royal Prince Alfred Hospital in Sydney.

Notes

1 Hill's criteria for causation were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated(Hill, 1965).