DSM-IV Axis-I comorbidity among illicit drug users seeking treatment for substance use disorders: results from the Multi-centre Study of Psychiatric Comorbidity in Drug Addicts (MUPCDA)

Abstract

Background: To contribute to the discussion on Integrated Dual Disorders Treatment in persons seeking treatment for substance use disorders and carrying a substance dependence diagnosis.

Aims: To capture current (4 weeks) DSM-IV Axis-I comorbidity in a sample of German in-treatment substance use disorders patients.

Method: A clinical sample of n = 301 patients (75% male, 25% female; mean age 31 years, range 15–55 years) were interviewed face-to-face by 40 raters, using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule). In this multi-centre study, 19 German treatment centres participated.

Results: Diagnoses for opioid dependence were given to 86% and for polydrug dependence to 75% of the patients. Socio-demographic data revealed high unemployment, indebtedness and crime rates. Most frequent diagnoses of comorbidity were: generalized anxiety disorder (28%) and dysthymia (26%). Women were more likely to be dually diagnosed and to report lifetime substance-induced visual hallucinations relative to men. Prevalence of comorbid disorders (67% in this sample) may be higher than in other samples because of an increased prevalence of multiple substance use disorders.

Conclusions: Psychosocial interventions should supplement psychiatric care. Due to required diagnostic expertise, integrated treatment with high-quality clinical supervision should become the standard.

Keywords:

• clinical sample
• comorbidity
• drug dependence
• IDDT
• multi-centre study

Acknowledgements

The authors thank N.T. Bremermann and A.Z. Stankovic-Stahn for valuable assistance, and C. Baldus and K. Hoehne, who helped with the proof-reading of the manuscript. The authors are especially grateful for the work of participating researchers and clinicians listed below:

A. Altmann¹, M. Baumann², J. Bernzen³, B. Bertz⁴, U. Bimber⁵, T. Broese⁶, A. Broocks³, W. Burtscheidt⁷, K.F. Cimander⁸, P. Degkwitz⁹, M. Driessen³, H. Ehrenreich¹, E. Fischbach¹⁰, H. Folkerts¹¹, H. Frank¹¹, D. Gurth¹², U. Havemann-Reinecke¹, W. Heber¹³, J. Heuer¹⁰, A. Hingsammer¹⁴, S. Jacobs¹, H. Krampe¹, W. Lange¹⁰, T. Lay⁶, M. Leimbach¹¹, M.R. Lemke¹⁵, M. Leweke⁷, A. Mangholz¹, W. Massing¹⁶, R. Meyenberg¹⁴, J. Porzig¹, T. Quattert¹⁷, C. Redner⁷, G. Ritzel¹⁷, J.D. Rollnik, R. Sauvageoll⁵, D. Schlaefke⁶, G. Schmid⁶, U. Schneider²⁵, H. Schroeder¹⁸, U. Schwichtenberg¹⁹, D. Schwoon⁹, J. Seifert, I. Sickelmann, C.F. Sieveking²⁰, C. Spiess²¹, H.H. Stiegemann¹⁷, R. Stracke¹², H.D. Straetgen²², P. Subkowski²³, H. Tretzel⁴, L.J. Verner, J. Vitens²⁴, T. Wagner¹, S. Weirich⁶, I. Weiss¹⁴, T. Wendorff¹⁵, T. Wetterling², B. Wiese, and J. Wittfoot¹⁰

¹Georg-August-Universitaet, Goettingen; ²Johann-Wolfgang-Goethe Universitaet, Frankfurt; ³Medizinische Universitaet, Luebeck; ⁴Klinikum der Hansestadt Stralsund, Stralsund; ⁵Zentrum fuer Soziale Psychiatrie, Bad Emstal; ⁶Klinik fuer Psychiatrie und Psychotherapie der Universitaet Rostock, Rostock; ⁷Psychiatrische Klinik der Heinrich-Heine-Universitaet, Duesseldorf; ⁸Zentrum fuer Drogenkranke, Hannover; ⁹Universitaetsklinikum Hamburg-Eppendorf, Hamburg; ¹⁰Gilead, Psychiatrische Klinik, Bielefeld; ¹¹Reinhard-Nieter-Krankenhaus, Wilhelmshaven; ¹²Klinikum Nord, Hamburg; ¹³Niedersaechsisches Landeskrankenhaus, Goettingen; ¹⁴Klinik fuer Psychiatrie und Psychotherapie III des Zentralkrankenhauses Bremen Ost, Universitaet Oldenburg; ¹⁵Christian-Albrecht-Universitaet, Kiel; ¹⁶Tagesklinik Koenigstrasse, Hannover; ¹⁷Niedersaechsisches Landeskrankenhaus, Hildesheim; ¹⁸Klinik fuer Psychiatrie und Psychotherapie, Langenhagen; ¹⁹Niedersaechsisches Landeskrankenhaus, Osnabrueck; ²⁰Paracelsus-Wiehengebirgsklinik, Bad Essen; ²¹Charité Universitaetsmedizin Berlin, Berlin; ²²Fachklinik Holstein, Luebeck; ²³Paracelsus Berghof-Klinik, Bad Essen; ²⁴Niedersaechsisches Landeskrankenhaus Wehnen, Bad Zwischenahn; ²⁵Medizinische Hochschule Hannover; all centers Germany.