Prevalence of co-morbidity in treatment settings

Table 7 gives details of some studies of co-morbidity in different drug treatment and psychiatric settings in Member States as presented in the national reports. Data on substance disorders in psychiatric settings are not as readily available as data on psychiatric disorders in drug treatment settings. Although the studies presented in this review are not comparable, they do give an indication of the situation in EU countries. There is considerable divergence in the populations studied, the diagnostic criteria selected, the instruments used and the time of diagnosis. For reasons discussed above, underdiagnosis is likely in many cases.


Table 7: Prevalence of co-morbidity in treatment settings in various countries of the EU

Country

Setting

Population

n

Prevalence of co-morbidity (%)

Diagnoses

Source

Belgium

Psychiatric hospitals and psychiatric services in general hospitals

Admissions for drug problems (1996–99)

18 920

86

Schizoid, paranoid, schizotypal: 86 %

Depression: 50 %

Personality disorders: 43 %

Minimum Psychiatric Data database (1)

Czech Republic

Therapeutic communities

Residential clients (2001–02)

200

35

Personality disorders: 14 %

Depression: 7 %

Neurotic disorders: 6 %

Eating disorders: 5 %

Czech national report (1)

Germany

Treatment centres

Opiate addicts

272

55

Stress and somatoform disorders: 43 %

Affective disorders: 32 %

Phobias: 32 %

Depressive episodes: 16 %

Krausz (1999b) (1)

Greece

Prison and treatment services

Opioid-dependent men

176

86

Anxiety: 32 %

Affective disorders: 25 %

Schizophrenia: 6 %

Kokkevi and Stefanis (1995) (1)

Spain

Methadone service

Opiate-dependent persons

150

n.a.

Borderline: 7 %

Antisocial disorder: 6 %

Social phobia: 6 %

Depression: 5 %

Spanish national report (1)

France

Methadone service

Opiate-dependent persons

3 936

n.a.

Anxiety: 4 %

Depression: 3 %

Behavioural disorders: 3 %

Eating disorders: 2 %

Facy (1999) (1)

Ireland

Inpatient acute psychiatric services

First admissions with a diagnosis of drug dependency (1996–2001)

1 874

26

Depression: 21 %

Schizophrenia and other psychoses: 11 %

Personality disorder: 19 %

National Psychiatric Inpatient Reporting System (1)

Italy

Mental health services

Lifelong drug users

58

> 22

Mood disorders: 22 %

Anxiety: 21 %

Schizophrenia: 16 %

Siliquini et al. (2002) (1)

Luxembourg

Specialised drug treatment services

Patients previously in contact with psychiatric services excluding detoxification (1996–2002)

380

32

n.a.

AST/RELIS (2002) (1)

Netherlands

Dutch population

Drug-dependent persons aged 18–64 (1996)

n.a.

n.a.

Depression: 29 %

Social phobia: 29 %

Bipolar disorder: 24 %

Dysthymia: 22 %

Ravelli et al. (1998) (1)

Austria

Different treatment services (review)

Drug clients

n.a.

41–96

Personality disorders, antisocial disorders, borderline, narcissism

Austrian national report (1)

Portugal

Xabregas CAT treatment centre

Drug clients

596

> 73

Obsessive–compulsive disorder: 73 %

Depression: 72 %

Somatisation: 60 %

Paranoid ideation: 58 %

Portuguese national report (1)

Finland

Hospitals

Drug-related hospital treatment periods (2002)

2 180

29

Paranoid ideation: 58 %

Psychotic disorders 32 %

Mood disorders 28 %

Neurotic disorders 10 %

Personality disorders 29 %

Hospital patient discharge register

Sweden

University Hospital, Lund

Patients on detoxication ward (1977–95)

1 052

83

Antisocial disorder: 23 %

Any psychosis: 14 %

Depressive disorder: 11 %

Fridell (1996) (1)

UK

Community and residential addiction treatment services

Drug dependent patients, 90 % opiate addicted

1 075

> 33

Psychoticism

Anxiety

Depression

Paranoia

Marsden et al. (2000) (1)

Notes

Data in this table refer to different time frames (e.g. lifetime or last year diagnoses).

n.a.: data not available.

(1) More details on this study can be found in Table 12 OL: Co-morbidity country tables.


A comparative study in Greece and France found that, although the overall rates of psychopathology in opiate users under treatment were quite similar in the two countries, the psychopathological patterns varied: the prevalence of affective disorders was higher in French than in Greek drug users (19 % vs. 7 %), whereas antisocial personality patterns were more prevalent in the Greek sample (20 % vs. 7 %). The authors attributed these differences to the lower prevalence of drug use in Greece: ‘the more limited the extent of socially unacceptable behaviour, the more likely it is that socially deviant individuals are involved in it’ (Kokkevi and Facy, 1995).

A Norwegian study examined gender differences between poly-substance abusers (of whom 85 % were heroin users) and pure alcoholics. The sample included a very high proportion of subjects with psychiatric and personality disorders (93 %). Overall, women had significantly higher levels of major depression, simple phobia and borderline personality disorder than men. The co-occurrence of an antisocial personality disorder was highest in male poly-substance abusers (Landheim et al., 2003).