Dual Diagnosis - A National Survey

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National Survey of Psychiatric Comorbidity
in Substance Abuse Patients

Robert Christopher, Ph.D.

INTRODUCTION

The following study examined prevalence rates and patterns of psychiatric comorbidity among 3,841 dually diagnosed substance abuse patients in various programs throughout the country. The programs and patient populations were matched for characteristics outlined in the Joint Commission on Accreditation of Healthcare Organizations Standards. The following excerpt represents the findings of this study.

One of the significant findings of this research was that the vast majority of dually diagnosed patients's profiles in all programs participating in this study, have met the DSM III-R diagnostic criteria for multiple diagnoses on both Axis I and Axis II. Although other studies have also observed the multiplicity of diagnoses among the substance abuse patients with psychiatric comorbidity, there is still insufficient evidence that this clinically significant issue has been given the amount of attention which it deserves in terms of assessment of effectiveness of current treatment approaches to substance abuse.

The findings of this study, supported by numerous other similar research, indicate that during the last three decades, the spontaneous rate or recovery (remission) among the substance abusers is equal to, or greater than the rate of recovery with intervention, both inpatient and outpatient type.

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                      PATIENT POPULATION
----------------------------------------------------------------------
    N = total number of patients
% TTL = percentage of the total number of patients
                                                          N     % TTL
- Total number of patients ...........................  3841   100.00
- Total number of patients without dual diagnoses ....  1360    35.41
- Total number of patients with dual diagnoses .......  2481    64.59
- Male patients ......................................  2773    72.19
- Males without dual diagnoses .......................   968    25.20
- Adult males without dual diagnoses .................   845    22.00
- Adolescent males without dual diagnoses ............   123     3.20
- Males with dual diagnoses ..........................  1805    46.99
- Adult males with dual diagnoses ....................  1637    42.62
- Adolescent males with dual diagnoses ...............   168     4.37
- Female patients ....................................  1066    27.75
- Females without dual diagnoses .....................   391    10.18
- Adult females without dual diagnoses ...............   324     8.44
- Adolescent females without dual diagnoses ..........    67     1.74
- Females with dual diagnoses ........................   675    17.57
- Adult females with dual diagnoses ..................   603    15.70
- Adolescent females with dual diagnoses .............    72     1.87
- Total number of primary suicidal patients...........  1359    35.38
- Primary suicidal males .............................  1042    27.13
- Primary suicidal females ...........................   316     8.23
- Primary suicidal patients without dual diagnoses ...   263     6.85
- Primary suicidal males without dual diagnoses ......   198     5.15
- Primary suicidal females without dual diagnoses ....    65     1.69
- Primary suicidal patients with dual diagnoses ......  1096    28.53
- Primary suicidal males with dual diagnoses .........   844    21.97
- Primary suicidal females with dual diagnoses .......   251     6.53
- Total number of primary aggressive patients.........   348     9.06
- Primary aggressive males ...........................   224     5.83
- Primary aggressive females .........................   116     3.02
- Primary aggressive patients without dual diagnoses .    67     1.74
- Primary aggressive males without dual diagnoses ....    48     1.25
- Primary aggressive females without dual diagnoses ..    19      .49
- Primary aggressive patients with dual diagnoses ....   281     7.32
- Primary aggressive males with dual diagnoses .......   176     4.58
- Primary aggressive females with dual diagnoses .....    97     2.53

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                               FINDINGS
----------------------------------------------------------------------

 1. Diagnoses of personality disorders occur with the highest
    frequency among all patient groups.

 2. Schizotypal (301.22) and Paranoid Personality Disorder (301.00)
    are most frequent personality disorders for total number of
    patients (301.22 prevalence: 498/1000; 301.00 prevalence:
    427/1000).

 3. Dysthymia (300.40) appears as the most frequent symptom disorder
    for total number of patients (prevalence: 383/1000).

 4. Prevalence of Antisocial Personality Disorder (301.70) secondary
    to Schizotypal Personality Disorder (301.22), Paranoid
    Personality Disorder (301.00), and Avoidant Personality Disorder
    (301.82):
                a. 301.22  prevalence:  498/1000
                b. 301.00  prevalence:  427/1000
                c. 301.82  prevalence:  403/1000
                d. 301.70  prevalence:  274/1000

 5. Schizotypal Personality Disorder (301.22) appears as the most
    frequent diagnosis among adult males (prevalence: 384/1000).

 6. Low prevalence of Pedophilia (302.20) among adult male patients
    (prevalence: 1/1000).

 7. Diagnosis of Schizophrenia, Undifferentiated Type (295.90)
    secondary only to Major Depression, Single Episode (296.2x) and
    Dysthymia (300.40) among adult male patients.

 8. Paranoid Personality Disorder (301.000 appears as the most
    frequent diagnosis among adult females (prevalence: 108/1000).

 9. Higher prevalence of Antisocial Personality Disorder (301.70)
    among males than females (male prevalence: 192/1000; female
    prevalence: 73/1000).

10. Diagnosis of Schizophrenia, Undifferentiated Type (295.90)
    secondary only to personality disorders among adult female
    patients.

11. Proximal prevalence of Dependent Personality Disorder(301.60)
    and diagnosis of Alcohol Abuse (305.00) among adult males:
                   301.60  prevalence:  207/1000
                   305.00  prevalence:  201/1000

12. Proximal prevalence of Major Depression, Single Episode
    (296.2x) and Alcohol Abuse (305.00) among adult females:
                   296.2x  prevalence:  61/1000
                   305.00  prevalence:  55/1000

13. Proximal prevalence of Schizophrenia, Paranoid Type (295.3x)
    and Borderline Personality Disorder (301.83) for adult male
    patients, but not for adult female patients.

14. Prevalence of Somatization Disorder (300.81) low but identical to
    prevalence of Delusional Disorder (297.01) for adult male
    patients:
                   300.81  prevalence:  63/1000
                   297.01  prevalence:  63/1000

15. Proximal prevalence of Organic Personality Disorder (310.10) and
    Somatization Disorder (300.81) for adult female patients:
                   310.10  prevalence:  17/1000
                   300.81  prevalence:  16/1000

16. Low but identical prevalence of Narcissistic Personality Disorder
    (301.81), Schizoid Personality Disorder (301.20), Opioid
    Intoxication/Abuse (305.50), and Organic Mental Disorder NOS
    (294.80) among adult female patients:
                   301.81  prevalence:  12/1000
                   301.20  prevalence:  12/1000
                   305.50  prevalence:  12/1000
                   294.80  prevalence:  12/1000

17. Prevalence of Alcohol Dependence (303.90) low but identical to
    prevalence of Obsessive Compulsive Disorder (300.30) among adult
    male patients:
                   303.90  prevalence:  61/1000
                   300.30  prevalence:  61/1000

18. Proximal prevalence of Major Depression, Single Episode (296.2x)
    and Dysthymia (300.40) among adult male patients:
                   296.2x  prevalence:  307/1000
                   300.40  prevalence:  304/1000

19. Proximal prevalence of Major Depression, Single Episode (296.2x)
    and Dysthymia (300.40) among adult female patients:
                   296.2x  prevalence:  61/1000
                   300.40  prevalence:  64/1000

20. Low but identical prevalence of Hypochondriasis (300.70) and
    Adjustment Disorder with Mixed Emotional Features (309.28) among
    adult female patients:
                   300.70  prevalence:  9/1000
                   309.28  prevalence:  9/1000

21. Low but proximal prevalence of Somatoform Pain Disorder (307.80)
    and Alcohol Intoxication (303.00) among adult female patients:
                   307.80  prevalence:  6/1000
                   303.00  prevalence:  5/1000

22. Identical prevalence of Antisocial Personality Disorder (301.70)
    and Generalized Anxiety Disorder (300.02) among adult male
    patients:
                   301.70  prevalence:  192/1000
                   300.02  prevalence:  192/1000

23. Low but identical prevalence of Social Phobia (300.23),
    Agoraphobia without History of Panic Disorder (300.22), and
    Panic Disorder with Agoraphobia (300.21) among adult male
    patients:
                   300.23  prevalence:  10/1000
                   300.22  prevalence:  10/1000
                   300.21  prevalence:  10/1000

24. Low prevalence of Social Phobia (300.23) in adult female patients
    (prevalence: >1/100).

25. Low prevalence of Obsessive Compulsive Disorder (300.30) among
    adult female patients (prevalence: 2/1000).

26. Low but identical prevalence of Adjustment Disorder with
    Physical Complaints (309.82) and Cyclothymia (301.13) among
    adult male patients:
                   309.82  prevalence:  8/1000
                   301.13  prevalence:  8/1000

27. Low but identical prevalence of Adjustment Disorder with Mixed
    Disturbance of Emotions and Conduct (309.40) and Opioid
    Intoxication/Abuse (305.50) among adult male patients:
                   309.40  prevalence:  6/1000
                   305.50  prevalence:  6/1000

28. Low prevalence of Adjustment Disorder with Mixed Disturbance of
    Emotions and Conduct (309.40) among adult female patients
    (prevalence: >1/1000).

29. Low prevalence of Polysubstance Dependence (304.90) among adult
    female patients (prevalence: >1/1000).

30. Low prevalence of Dissociative Disorder NOS (300.15) for both
    adult male and female patients (prevalence:  >1/1000).

31. Conduct Disorder (312.90) is the most frequent disorder among
    both adolescent males and females.

32. Attention-deficit Hyperactivity Disorder (314.01) more frequent
    among adolescent males than adolescent females.

33. Schizotypal Personality Disorder (301.22) equally frequent among
    both adolescent males and females.

34. Oppositional Defiant Disorder (313.81) more frequent among
    adolescent males than females.

35. Somatization Disorder (300.81) more frequent among adolescent
    males than females.

36. Borderline Personality Disorder (301.83) equally frequent among
    both adolescent males and females.

37. Equal prevalence of Psychoactive Substance Abuse (305.90)
    and Schizophrenia, Undifferentiated Type (295.90) among
    adolescent males:
                   305.90  prevalence:  5/1000
                   295.90  prevalence:  5/1000

38. Equal prevalence of Psychoactive Substance Abuse (305.90)
    and Schizophrenia, Undifferentiated Type (295.90) among
    adolescent females.
                   305.90  prevalence:  3/1000
                   295.90  prevalence:  3/1000

39. Equal prevalence of Developmental Disorder NOS (315.90) and
    personality disorders such as Passive Aggressive Personality
    Disorder (301.84) and Narcissistic Personality Disorder (301.81)
    among adolescent males:
                   315.90  prevalence:  3/1000
                   301.84  prevalence:  3/1000
                   301.81  prevalence:  3/1000

40. Equal prevalence of Alcohol Abuse (305.00) and Dependent
    Personality Disorder (301.60) among adolescent males:
                   305.00  prevalence:  2/1000
                   301.60  prevalence:  2/1000

41. Low but equal prevalence of Schizophrenia, Paranoid Type (295.3x)
    and Sexual Sadism (302.84) among adolescent males.

42. Low prevalence of diagnoses of Alcohol Dependence (303.90) and
    Alcohol Intoxication (303.00) among both adolescent males and
    females (prevalence: >1/1000).

43. Lower prevalence of Organic Mental Disorder NOS (294.80) among
    adolescent males than females (prevalence for males:  >1/1000;
    prevalence for females: 1/1000).

44. Higher prevalence of Hypochondriasis (300.70) among adolescent
    males than females (prevalence for males:  2/1000; prevalence
    for females: >1/1000)

45. Higher frequency of Gender Identity Disorder (302.85) among
    adolescent males than females (prevalence for males: 2/1000;
    prevalence for females: >1/1000).

46. Antisocial Personality Disorder (301.70) secondary only to
    Conduct Disorder, Undifferentiated Type (312.90) among
    adolescent females:
                   312.90  prevalence:  8/1000
                   301.70  prevalence:  5/1000

47. Equal prevalence of Alcohol Abuse (305.00) and Passive Aggressive
    Personality Disorder (301.84) among adolescent females.

48. Low but equal prevalence of Impulse Control Disorder NOS (312.39)
    and Specific Developmental Disorder NOS (315.90) among adolescent
    females (prevalence: 1/1000).

49. Equal prevalence of Overanxious Disorder (313.00) and Attention-
    deficit Hyperactivity Disorder (314.01) among adolescent females
    (prevalence: 4/1000).

50. Low but equal prevalence of Avoidant Personality Disorder
    (301.82), Somatization Disorder (300.81), and Major Recurrent
    Depression (296.3x) among adolescent females:
                   301.82  prevalence:  1/1000
                   300.81  prevalence:  1/1000
                   296.3x  prevalence:  1/1000

51. Most prevalent diagnosis among primary suicidal patients is
    Major Depression, Single Episode (296.2x) with a prevalence
    of 253/1000.

52. Paranoid Personality Disorder (301.00) is the most prevalent
    diagnosis among all primary aggressive patients,
    (prevalence: 52/1000)

53. Higher frequency of Antisocial Personality Disorder (301.70)
    among primary aggressive than suicidal patients.

54. Antisocial Personality Disorder (301.70) secondary only to
    Paranoid Personality Disorder (301.00) among primary aggressive
    patients:
                   301.00  prevalence:  52/1000
                   301.70  prevalence:  51/1000

55. Prevalence of Psychoactive Substance Abuse (305.90) secondary
    only to Antisocial Personality Disorder (301.70) and Paranoid
    Personality Disorder (301.00) among primary aggressive patients:
                   301.00  prevalence:  52/1000
                   301.70  prevalence:  51/1000
                   305.90  prevalence:  50/1000

56. Greater frequency of severe personality disorders among primary
    aggressive than suicidal patients.

57. Presence of Sexual Masochism disorder (302.83) and absence of
    Sexual Sadism disorder (302.84) among primary suicidal patients.

58. Presence of Sexual Sadism disorder (302.84) and absence of
    Sexual Masochism disorder (302.83) among primary aggressive
    patients.

59. Proximal prevalence of Organic Personality Disorder (310.10),
    Sexual Masochism (302.83), and Delusional Disorder (297.10)
    among primary suicidal patients:
                   310.10  prevalence:  12/1000
                   302.83  prevalence:  11/1000
                   297.10  prevalence:  10/1000

60. Proximal prevalence of Delusional Disorder (297.10), Bipolar
    Disorder, Depressed type (296.5x), and Sexual Sadism (302.84)
    among primary aggressive patients:
                   297.10  prevalence:  42/1000
                   296.5x  prevalence:  41/1000
                   302.84  prevalence   40/1000

61. Presence of Attention-deficit Hyperactivity Disorder (314.10)
    among primary aggressive but not suicidal patients,
    (prevalence: 5/1000).

62. Proximal prevalence of Organic Personality Disorder (310.10),
    Opioid Intoxication/Abuse (305.50), and Alcohol Dependence
    (303.90) among primary aggressive, but not suicidal patients.

63. Low but proximal prevalence of Alcohol Dependence (303.90) and
    Hypochondriasis (300.70) in both primary suicidal and aggressive
    patients.

64. Proximal prevalence of Delusional Disorder (297.10) and
    Schizophrenia, Paranoid Type (295.3x) in both primary suicidal
    and aggressive patients.

65. High frequency of Schizotypal Personality Disorder (301.22) among
    all patients with dual diagnoses (75.43%; prevalence: 498/1000).

66. High frequency of Paranoid Personality Disorder (301.00) among
    all patients with dual diagnoses (64.72%; prevalence: 427/1000).

67. High frequency of Avoidant Personality Disorder (301.82) among
    all patients with dual diagnoses (61.03%; prevalence: 403/1000).

68. High frequency of Schizophrenia, undifferentiated type (295.90)
    among all patients with dual diagnoses (53.10%; prevalence:
    375/1000).

69. Low frequency (0.35%) of diagnosis of Polysubstance Dependence
    (304.90) among patients with dual diagnoses (prevalence: 3/1000).

70. Low frequency (10.23%) of diagnosis of Alcohol Dependence
    (303.90) among patients with dual diagnoses,
    (prevalence: 70/1000).

71. Low frequency (5.36%) of diagnosis of Obsessive Compulsive
    Personality Disorder (301.40) among patients with dual diagnoses
    (prevalence: 36/1000).

72. Low frequency (2.71%) of diagnosis of Opioid Intoxication/Abuse
    (305.50) among patients with dual diagnoses (prevalence: 18/1000)


73. Low frequency (0.14%) of diagnoses of Pedophilia (302.20) among
    patients with dual diagnoses (prevalence: 1/1000).

74. Low frequency (0.07%) of diagnosis of Eating Disorder NOS
    (307.50) among patients with dual diagnoses (prevalence: 1/1000).

75. Within-group ranking order of median prevalence rates of DSM III
    diagnostic criteria for adult males with dual diagnoses
    (prevalence computed based on occurrence per 1000 cases):

         - Mood disorders - depressed type:         637/1000
         - Personality disorders:                   385/1000
         - Schizophrenia:                           294/1000
         - Psychoactive substance use disorders:    217/1000
         - Mood disorders - bipolar type:           179/1000
         - Psychotic disorders NOS:                 164/1000
         - Delusional disorders:                    138/1000
         - Anxiety disorders:                       120/1000
         - Adjustment disorders:                    101/1000
         - Somatoform disorders:                     96/1000
         - Sexual disorders:                         60/1000
         - Organic mental disorders:                 35/1000
         - Unspecified mental disorders:             15/1000
         - Dissociative disorders:                    1/1000
         - Eating disorders:                          1/1000

76. Within-group ranking order of median prevalence rates of DSM III
    diagnostic criteria for adult females with dual diagnoses
    (prevalence computed based on occurrence per 1000 cases):

         - Mood disorders - depressed type:         444/1000
         - Personality disorders:                   397/1000
         - Delusional disorders:                    356/1000
         - Schizophrenia:                           305/1000
         - Psychoactive substance use disorders:    214/1000
         - Mood disorders - bipolar type:           191/1000
         - Sexual disorders:                        138/1000
         - Adjustment disorders:                    123/1000
         - Anxiety disorders:                        86/1000
         - Psychotic disorders NOS:                  82/1000
         - Organic mental disorders:                 79/1000
         - Somatoform disorders:                     70/1000
         - Unspecified mental disorders:             24/1000
         - Dissociative disorders:                    3/1000

77. Within-group ranking order of median prevalence rates of DSM III
    diagnostic criteria for adolescent males with dual diagnoses
    (prevalence computed based on occurrence per 1000 cases):

         - Conduct disorder:                        370/1000
         - Psychotic disorders NOS:                 224/1000
         - Mood disorders - depressed type:         148/1000
         - Personality disorders:                    94/1000
         - Somatoform disorders:                     85/1000
         - Schizophrenia:                            53/1000
         - Adjustment disorders:                     50/1000
         - Anxiety disorders:                        45/1000
         - Psychoactive substance use disorders:     38/1000
         - Mood disorders - bipolar type:            36/1000
         - Delusional disorders:                     36/1000
         - Sexual disorders:                         27/1000
         - Organic mental disorders:                  9/1000

78. Within-group ranking order of median prevalence rates of DSM III
    diagnostic criteria for adolescent females with dual diagnoses
    (prevalence computed based on occurrence per 1000 cases):

         - Conduct disorder:                        513/1000
         - Psychotic disorders NOS:                 205/1000
         - Mood disorders - depressed type:         162/1000
         - Adjustment disorders:                    153/1000
         - Personality disorders:                   131/1000
         - Delusional disorders:                     77/1000
         - Schizophrenia:                            68/1000
         - Psychoactive substance use disorders:     60/1000
         - Anxiety disorders:                        51/1000
         - Somatoform disorders:                     43/1000
         - Organic mental disorders:                 38/1000
         - Mood disorders - bipolar type:             2/1000

79. Within-group ranking order of median prevalence rates of DSM III
    diagnostic criteria for primary suicidal patients (prevalence
    computed based on occurrence per 1000 cases):

         - Mood disorders - depressed type:         833/1000
         - Personality disorders:                   448/1000
         - Psychoactive substance use disorders:    298/1000
         - Schizophrenia:                           291/1000
         - Anxiety disorders:                       269/1000
         - Adjustment disorders:                    218/1000
         - Psychotic disorders NOS:                 192/1000
         - Mood disorders - bipolar type:           126/1000
         - Sexual disorders:                         37/1000
         - Delusional disorders:                     35/1000
         - Organic mental disorders:                 34/1000
         - Unspecified mental disorders:             18/1000
         - Somatoform disorders:                     17/1000
         - Conduct disorder:                          2/1000

80. Within-group ranking order of median prevalence rates of DSM III
    diagnostic criteria for primary aggressive patients (prevalence
    computed based on occurrence per 1000 cases):

         - Schizophrenia:                           736/1000
         - Delusional disorders:                    713/1000
         - Personality disorders:                   499/1000
         - Psychoactive substance use disorders:    258/1000
         - Mood disorders - bipolar type:           292/1000
         - Adjustment disorders:                     85/1000
         - Conduct disorder:                         77/1000
         - Mood disorders - depressed type:          72/1000
         - Sexual disorders:                         67/1000
         - Organic mental disorders:                 46/1000
         - Psychotic disorders NOS:                  38/1000
         - Somatoform disorders:                     19/1000
         - Anxiety disorders:                        15/1000
         - Unspecified mental disorders:              8/1000

81. Ranking order of DSM III-R categories by patient groups:

    Psychoactive Substance Use Disorders:

         - primary suicidal       298/1000
         - primary aggressive     257/1000
         - adult males            217/1000
         - adult females          214/1000
         - adolescent females      60/1000
         - adolescent males        38/1000

    Mood Disorders - Depressed Type:

         - primary suicidal       833/1000
         - adult males            637/1000
         - adult females          444/1000
         - adolescent females     162/1000
         - adolescent males       148/1000
         - primary aggressive      72/1000

    Mood Disorders - Bipolar Type:

         - primary aggressive     292/1000
         - adult females          191/1000
         - adult males            179/1000
         - primary suicidal       126/1000
         - adolescent males        36/1000
         - adolescent females       2/1000

    Schizophrenia:

         - primary aggressive     736/1000
         - adult females          305/1000
         - adult males            294/1000
         - primary suicidal       291/1000
         - adolescent females      68/1000
         - adolescent males        53/1000

    Adjustment  Disorders:

         - primary suicidal       218/1000
         - adolescent females     153/1000
         - adult females          123/1000
         - adult males            102/1000
         - primary aggressive      85/1000
         - adolescent males        50/1000

    Anxiety  Disorders:

         - primary suicidal       268/1000
         - adult males            120/1000
         - adult females           85/1000
         - adolescent females      51/1000
         - adolescent males        44/1000
         - primary aggressive      15/1000

    Delusional Disorders:

         - primary aggressive     713/1000
         - adult females          356/1000
         - adult males            138/1000
         - adolescent females      77/1000
         - adolescent males        36/1000
         - primary suicidal        35/1000

    Somatoform Disorders:

         - adult males             96/1000
         - adolescent males        85/1000
         - adult females           70/1000
         - adolescent females      43/1000
         - primary aggressive      19/1000
         - primary suicidal        17/1000

    Organic Mental Disorders:

         - adult females           79/1000
         - primary aggressive      46/1000
         - adolescent females      38/1000
         - adult males             35/1000
         - primary suicidal        34/1000
         - adolescent males         9/1000

    Sexual Disorders:

         - adult females          138/1000
         - primary aggressive      67/1000
         - adult males             60/1000
         - primary suicidal        37/1000
         - adolescent males        27/1000
         - adolescent females       0/1000

    Psychotic Disorders NOS:

         - adolescent males       224/1000
         - adolescent females     205/1000
         - primary suicidal       192/1000
         - adult males            164/1000
         - adult females           82/1000
         - primary aggressive      38/1000

    Dissociative Disorders:

         - adult females            3/1000
         - adult males              1/1000
         - adolescent males         0/1000
         - adolescent females       0/1000
         - primary suicidal         0/1000
         - primary aggressive       0/1000

    Unspecified Mental Disorders:

         - adult females           24/1000
         - primary suicidal        18/1000
         - adult males             15/1000
         - primary aggressive       8/1000
         - adolescent males         0/1000
         - adolescent females       0/1000

    Conduct Disorder:

         - adolescent females     513/1000
         - adolescent males       370/1000
         - primary aggressive      77/1000
         - primary suicidal         2/1000
         - adult males              0/1000
         - adult females            0/1000

    Eating Disorders:

         - adult males              1/1000
         - adult females            0/1000
         - adolescent males         0/1000
         - adolescent females       0/1000
         - primary suicidal         0/1000
         - primary aggressive       0/1000

    Personality  Disorders:

         - primary aggressive     499/1000
         - primary suicidal       448/1000
         - adult females          397/1000
         - adult males            385/1000
         - adolescent females     131/1000
         - adolescent males        94/1000

DISTRIBUTION OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
TOTAL POPULATION WITH DUAL DIAGNOSES
DSM III-R	% N1	% N2	N3
301.22 SCHIZOTYPAL PERSONALITY DISORDER	49.79	75.43	498
301.00 PARANOID PERSONALITY DISORDER	42.72	64.72	427
301.82 AVOIDANT PERSONALITY DISORDER	40.28	61.03	403
300.40 DYSTHYMIA	38.26	57.97	383
296.2x MAJOR DEPRESSION, SINGLE EPISODE, UNSPECIFIED	38.26	56.78	379
295.90 SCHIZOPHRENIA, UNDIFFERENTIATED TYPE, UNSPECIFIED	37.94	53.10	375
305.90 PSYCHOACTIVE SUBSTANCE ABUSE	37.48	48.78	350
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	35.05	41.54	322
301.70 ANTISOCIAL PERSONALITY DISORDER	32.20	40.78	274
296.5x BIPOLAR DISORDER, DEPRESSED, UNSPECIFIED	27.42	39.39	269
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	26.92	39.39	260
305.00 ALCOHOL ABUSE	26.00	38.83	260
301.60 DEPENDENT PERSONALITY DISORDER	26.00	36.81	256
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	25.63	34.79	243
300.02 GENERALIZED ANXIETY DISORDER	24.30	28.11	230
301.50 HISTRIONIC PERSONALITY DISORDER	22.97	22.06	186
295.70 SCHIZOAFFECTIVE DISORDER	18.56	21.43	146
295.3x SCHIZOPHRENIA, PARANOID TYPE, UNSPECIFIED	14.56	19.69	141
301.83 BORDERLINE PERSONALITY DISORDER	14.15	17.26	130
297.10 DELUSIONAL DISORDER	13.00	13.36	114
300.81 SOMATIZATION DISORDER	11.39	11.90	88
296.4x BIPOLAR DISORDER, MANIC, UNSPECIFIED	8.82	10.72	79
300.70 HYPOCHONDRIASIS	7.85	10.65	71
303.90 ALCOHOL DEPENDENCE	7.07	10.23	70
301.20 SCHIZOID PERSONALITY DISORDER	7.03	9.60	68
300.30 OBSESSIVE COMPULSIVE DISORDER	6.75	9.46	63
302.84 SEXUAL SADISM	6.34	8.91	62
300.01 PANIC DISORDER, WITHOUT AGORAPHOBIA	6.25	7.93	59
301.81 NARCISSISTIC PERSONALITY DISORDER	5.88	7.38	52
307.80 SOMATOFORM PAIN DISORDER	5.24	6.89	49
309.24 ADJUSTMENT DISORDER WITH ANXIOUS MOOD	4.87	6.40	45
303.00 ALCOHOL INTOXICATION	4.55	6.12	42
295.40 SCHIZOPHRENIFORM DISORDER	4.23	5.43	40
301.40 OBSESSIVE COMPULSIVE PERSONALITY DISORDER	4.04	5.36	36
309.30 ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT	3.58	4.94	35
294.80 ORGANIC MENTAL DISORDER NOS	3.54	4.66	33
310.10 ORGANIC PERSONALITY DISORDER	3.26	3.90	31
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	3.08	3.27	26
314.01 ATTENTION-DEFICIT HYPERACTIVITY DISORDER	2.57	2.99	22
309.28 ADJUSTMENT DISORDER WITH MIXED EMOTIONAL FEATURES	2.16	2.99	20
295.2x SCHIZOPHRENIA, CATATONIC TYPE, UNSPECIFIED	1.98	2.99	20
313.00 OVERANXIOUS DISORDER	1.98	2.78	20
305.50 OPIOID INTOXICATION/ABUSE	1.98	2.71	18
292.90 PSYCHOACTIVE SUBSTANCE ORGANIC MENTAL DISORDER	1.79	2.64	18
300.11 CONVERSION DISORDER	1.75	2.57	17
300.22 AGORAPHOBIA WITHOUT HISTORY OF PANIC DISORDER	1.70	2.57	17
300.21 PANIC DISORDER, WITH AGORAPHOBIA	1.70	2.02	17
313.81 OPPOSITIONAL DEFIANT DISORDER	1.33	1.88	13
302.83 SEXUAL MASOCHISM	1.24	1.74	12
301.13 CYCLOTHYMIA	1.15	1.67	11
300.23 SOCIAL PHOBIA	1.10	1.53	11
300.90 UNSPECIFIED MENTAL DISORDER	1.01	1.39	10
309.82 ADJUSTMENT DISORDER WITH PHYSICAL COMPLAINTS	.92	1.11	9
309.90 ADJUSTMENT DISORDER NOS	.73	1.04	7
309.40 ADJUSTMENT DISORDER WITH MIXED DISTURBANCE OF EMOTIONS & CONDUCT	.69	.97	7
295.6x SCHIZOPHRENIA, RESIDUAL TYPE, UNSPECIFIED	.64	.63	6
315.90 DEVELOPMENTAL DISORDER NOS	.41	.49	4
300.00 ANXIETY DISORDER NOS	.32	.42	3
304.90 POLYSUBSTANCE DEPENDENCE	.28	.35	3
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	.23	.35	2
302.85 GENDER IDENTITY DISORDER NOS	.23	.28	2
316.00 PSYCHOLOGICAL FACTORS AFFECTING PHYSICAL CONDITION	.18	.14	2
312.39 IMPULSE CONTROL DISORDER NOS	.09	.14	1
302.20 PEDOPHILIA	.09	.14	1
300.15 DISSOCIATIVE DISORDER NOS	.09	.14	1
298.80 BRIEF REACTIVE PSYCHOSIS	.09	.07	1
307.50 EATING DISORDER NOS	.05	.07	1
309.83 ADJUSTMENT DISORDER WITH WITHDRAWAL	.05	.07	1
296.21 MAJOR DEPRESSION, SINGLE EPISODE, MILD	.05	.07	1
295.94 SCHIZOPHRENIA, UNDIFF. TYPE, CHRONIC, WITH ACUTE EXACERBATION	.05	.07	1
300.9x UNSPECIFIED MENTAL DISORDER (NONPSYCHOTIC)	.05	.07	1
302.72 MALE/FEMALE SEXUAL ERECTILE/AROUSAL DISORDER	.05	.07	1
302.82 VOYEURISM	.05	.07	1
311.00 DEPRESSIVE DISORDER NOS	.05	.07	1
302.40 EXHIBITIONISM	.05	.07	1

DISTRIBUTION OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
ADULT MALES
DSM III-R	% N1	% N2	% N3	% N4	N5
301.22 SCHIZOTYPAL PERSONALITY DISORDER	38.40	58.18	56.15	83.85	384
301.82 AVOIDANT PERSONALITY DISORDER	32.94	49.90	48.15	71.92	329
301.00 PARANOID PERSONALITY DISORDER	31.10	47.11	45.47	67.90	311
296.2x MAJOR DEPRESSION, SINGLE EPISODE, UNSPECIFIED	30.68	46.49	44.86	67.00	307
300.40 DYSTHYMIA	30.36	46.00	44.39	66.30	304
295.90 SCHIZOPHRENIA, UNDIFFERENTIATED TYPE, UNSPECIFIED	29.90	45.30	43.72	65.30	299
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	26.50	40.15	38.75	57.87	265
305.90 PSYCHOACTIVE SUBSTANCE ABUSE	25.68	38.90	37.54	56.07	257
296.5x BIPOLAR DISORDER, DEPRESSED, UNSPECIFIED	21.68	32.85	31.70	47.34	217
301.60 DEPENDENT PERSONALITY DISORDER	20.67	31.32	30.22	45.14	207
305.00 ALCOHOL ABUSE	20.12	30.48	29.42	43.93	201
301.70 ANTISOCIAL PERSONALITY DISORDER	19.25	29.16	28.14	42.03	192
300.02 GENERALIZED ANXIETY DISORDER	19.20	29.09	28.07	41.93	192
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	18.97	28.74	27.74	41.42	190
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	18.60	28.18	27.20	40.62	186
301.50 HISTRIONIC PERSONALITY DISORDER	12.91	19.55	18.87	28.18	129
295.70 SCHIZOAFFECTIVE DISORDER	12.36	18.72	18.07	26.98	124
295.3x SCHIZOPHRENIA, PARANOID TYPE, UNSPECIFIED	8.96	13.57	13.10	19.56	90
301.83 BORDERLINE PERSONALITY DISORDER	8.22	12.46	12.02	17.95	82
300.81 SOMATIZATION DISORDER	6.34	9.60	9.27	13.84	63
297.10 DELUSIONAL DISORDER	6.34	9.60	9.27	13.84	63
303.90 ALCOHOL DEPENDENCE	6.16	9.32	9.00	13.44	61
300.30 OBSESSIVE COMPULSIVE DISORDER	6.11	9.26	8.93	13.34	61
300.70 HYPOCHONDRIASIS	5.93	8.98	8.66	12.94	59
296.4x BIPOLAR DISORDER, MANIC, UNSPECIFIED	5.14	7.79	7.52	11.23	51
300.01 PANIC DISORDER, WITHOUT AGORAPHOBIA	4.92	7.45	7.19	10.73	49
301.20 SCHIZOID PERSONALITY DISORDER	4.87	7.38	7.12	10.63	49
302.84 SEXUAL SADISM	4.27	6.47	6.25	9.33	43
309.24 ADJUSTMENT DISORDER WITH ANXIOUS MOOD	4.18	6.33	6.11	9.13	42
307.80 SOMATOFORM PAIN DISORDER	4.13	6.26	6.04	9.03	41
301.81 NARCISSISTIC PERSONALITY DISORDER	3.72	5.64	5.44	8.12	37
303.00 ALCOHOL INTOXICATION	3.63	5.50	5.31	7.92	36
301.40 OBSESSIVE COMPULSIVE PERSONALITY DISORDER	3.40	5.15	4.97	7.42	34
295.40 SCHIZOPHRENIFORM DISORDER	2.66	4.04	3.90	5.82	27
309.30 ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT	2.25	3.41	3.29	4.91	22
294.80 ORGANIC MENTAL DISORDER NOS	1.98	2.99	2.89	4.31	20
295.2x SCHIZOPHRENIA, CATATONIC TYPE, UNSPECIFIED	1.56	2.37	2.28	3.41	16
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	1.52	2.30	2.22	3.31	15
310.10 ORGANIC PERSONALITY DISORDER	1.29	1.95	1.88	2.81	13
300.11 CONVERSION DISORDER	1.24	1.88	1.81	2.71	12
302.83 SEXUAL MASOCHISM	1.24	1.88	1.81	2.71	12

DISTRIBUTION OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
ADULT FEMALES
DSM III-R	% N1	% N2	% N3	% N4	N5
301.00 PARANOID PERSONALITY DISORDER	10.84	16.42	54.00	81.66	108
301.22 SCHIZOTYPAL PERSONALITY DISORDER	10.01	15.17	49.89	75.43	100
305.90 PSYCHOACTIVE SUBSTANCE ABUSE	8.64	13.08	43.02	65.05	86
301.70 ANTISOCIAL PERSONALITY DISORDER	7.26	11.00	36.16	54.67	73
295.90 SCHIZOPHRENIA, UNDIFFERENTIATED TYPE, UNSPECIFIED	6.94	10.51	34.55	52.25	69
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	6.89	10.44	34.32	51.90	69
301.82 AVOIDANT PERSONALITY DISORDER	6.84	10.37	34.10	51.56	68
300.40 DYSTHYMIA	6.38	9.67	31.81	48.10	64
296.2x MAJOR DEPRESSION, SINGLE EPISODE, UNSPECIFIED	6.11	9.26	30.43	46.02	61
305.00 ALCOHOL ABUSE	5.47	8.28	27.23	41.18	55
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	5.19	7.86	25.86	39.10	52
296.5x BIPOLAR DISORDER, DEPRESSED, UNSPECIFIED	4.96	7.52	24.71	37.37	50
301.50 HISTRIONIC PERSONALITY DISORDER	4.96	7.52	24.71	37.37	50
295.3x SCHIZOPHRENIA, PARANOID TYPE, UNSPECIFIED	4.92	7.45	24.49	37.02	49
297.10 DELUSIONAL DISORDER	4.73	7.17	23.57	35.64	47
301.60 DEPENDENT PERSONALITY DISORDER	4.69	7.10	23.34	35.29	47
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	4.55	6.89	22.65	34.26	45
301.83 BORDERLINE PERSONALITY DISORDER	3.81	5.78	18.99	28.72	38
300.02 GENERALIZED ANXIETY DISORDER	3.08	4.66	15.33	23.18	31
296.4x BIPOLAR DISORDER, MANIC, UNSPECIFIED	2.43	3.69	12.13	18.34	24
295.70 SCHIZOAFFECTIVE DISORDER	2.07	3.13	10.30	15.57	21
302.84 SEXUAL SADISM	1.84	2.78	9.15	13.84	18
310.10 ORGANIC PERSONALITY DISORDER	1.75	2.64	8.70	13.15	17
300.81 SOMATIZATION DISORDER	1.65	2.51	8.24	12.46	16
301.81 NARCISSISTIC PERSONALITY DISORDER	1.24	1.88	6.18	9.34	12
301.20 SCHIZOID PERSONALITY DISORDER	1.19	1.81	5.95	9.00	12
305.50 OPIOID INTOXICATION/ABUSE	1.15	1.81	5.95	9.00	12
294.80 ORGANIC MENTAL DISORDER NOS	1.15	1.74	5.72	8.65	12
309.30 ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT	.96	1.46	4.81	7.27	10
300.01 PANIC DISORDER, WITHOUT AGORAPHOBIA	.96	1.46	4.81	7.27	10
300.70 HYPOCHONDRIASIS	.92	1.39	4.58	6.92	9
309.28 ADJUSTMENT DISORDER WITH MIXED EMOTIONAL FEATURES	.87	1.32	4.35	6.57	9
303.90 ALCOHOL DEPENDENCE	.78	1.18	3.89	5.88	8
300.21 PANIC DISORDER, WITH AGORAPHOBIA	.73	1.11	3.66	5.54	7
300.22 AGORAPHOBIA WITHOUT HISTORY OF PANIC DISORDER	.73	1.11	3.66	5.54	7
307.80 SOMATOFORM PAIN DISORDER	.64	.97	3.20	4.84	6
303.00 ALCOHOL INTOXICATION	.51	.77	2.52	3.81	5
300.11 CONVERSION DISORDER	.51	.77	2.52	3.81	5
300.90 UNSPECIFIED MENTAL DISORDER	.32	.49	1.60	2.42	3
301.13 CYCLOTHYMIA	.32	.49	1.60	2.42	3
295.2x SCHIZOPHRENIA, CATATONIC TYPE, UNSPECIFIED	.32	.49	1.60	2.42	3
292.90 PSYCHOACTIVE SUBSTANCE ORGANIC MENTAL DISORDER	.28	.42	1.37	2.08	3
301.40 OBSESSIVE COMPULSIVE PERSONALITY DISORDER	.18	.28	.92	1.38	2
300.30 OBSESSIVE COMPULSIVE DISORDER	.18	.28	.92	1.38	2
309.24 ADJUSTMENT DISORDER WITH ANXIOUS MOOD	.14	.21	.69	1.04	1
300.00 ANXIETY DISORDER NOS	.09	.14	.46	.69	1
295.6x SCHIZOPHRENIA, RESIDUAL TYPE, UNSPECIFIED	.09	.14	.46	.69	1
295.40 SCHIZOPHRENIFORM DISORDER	.09	.14	.46	.69	1
309.82 ADJUSTMENT DISORDER WITH PHYSICAL COMPLAINTS	.09	.14	.46	.69	1
316.00 PSYCHOLOGICAL FACTORS AFFECTING PHYSICAL CONDITION	.05	.07	.23	.35	>1
300.15 DISSOCIATIVE DISORDER NOS	.05	.07	.23	.35	>1
300.9x UNSPECIFIED MENTAL DISORDER (NONPSYCHOTIC)	.05	.07	.23	.35	>1
300.23 SOCIAL PHOBIA	.05	.07	.23	.35	>1
309.40 ADJUSTMENT DIS. WITH MIXED DISTURBANCE OF EMOTIONS & CONDUCT	.05	.07	.23	.35	>1
298.80 BRIEF REACTIVE PSYCHOSIS	.05	.07	.23	.35	>1
304.90 POLYSUBSTANCE DEPENDENCE	.05	.07	.23	.35	>1

TABLE 13

DISTRIBUTION OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
ADOLESCENT MALES
DSM III-R	% N1	% N2	% N3	% N4	N5
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	1.79	2.71	22.94	34.82	18
314.01 ATTENTION-DEFICIT HYPERACTIVITY DISORDER	1.75	2.64	22.35	33.93	17
313.00 OVERANXIOUS DISORDER	1.61	2.44	20.59	31.25	16
300.40 DYSTHYMIA	1.15	1.74	14.71	22.32	11
313.81 OPPOSITIONAL DEFIANT DISORDER	1.10	1.67	14.12	21.43	11
301.22 SCHIZOTYPAL PERSONALITY DISORDER	1.01	1.53	12.94	19.64	10
295.40 SCHIZOPHRENIFORM DISORDER	.92	1.39	11.76	17.86	9
296.2x MAJOR DEPRESSION, SINGLE EPISODE, UNSPECIFIED	.78	1.18	10.00	15.18	8
300.81 SOMATIZATION DISORDER	.69	1.04	8.82	13.39	7
301.83 BORDERLINE PERSONALITY DISORDER	.64	.97	8.24	12.50	6
309.90 ADJUSTMENT DISORDER NOS	.64	.97	8.24	12.50	6
300.02 GENERALIZED ANXIETY DISORDER	.60	.90	7.65	11.61	6
301.00 PARANOID PERSONALITY DISORDER	.55	.84	7.06	10.71	5
301.50 HISTRIONIC PERSONALITY DISORDER	.55	.84	7.06	10.71	5
301.20 SCHIZOID PERSONALITY DISORDER	.51	.77	6.47	9.82	5
295.90 SCHIZOPHRENIA, UNDIFFERENTIATED TYPE, UNSPECIFIED	.51	.77	6.47	9.82	5
305.90 PSYCHOACTIVE SUBSTANCE ABUSE	.46	.70	5.88	8.93	5
301.70 ANTISOCIAL PERSONALITY DISORDER	.46	.70	5.88	8.93	5
295.6x SCHIZOPHRENIA, RESIDUAL TYPE, UNSPECIFIED	.37	.56	4.71	7.14	4
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	.37	.56	4.71	7.14	4
301.82 AVOIDANT PERSONALITY DISORDER	.37	.56	4.71	7.14	4
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	.32	.49	4.12	6.25	3
315.90 DEVELOPMENTAL DISORDER NOS	.32	.49	4.12	6.25	3
309.30 ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT	.32	.49	4.12	6.25	3
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	.32	.49	4.12	6.25	3
301.81 NARCISSISTIC PERSONALITY DISORDER	.28	.42	3.53	5.36	3
296.5x BIPOLAR DISORDER, DEPRESSED, UNSPECIFIED	.28	.42	3.53	5.36	3
305.00 ALCOHOL ABUSE	.23	.35	2.94	4.46	2
297.10 DELUSIONAL DISORDER	.18	.28	2.35	3.57	2
301.60 DEPENDENT PERSONALITY DISORDER	.18	.28	2.35	3.57	2
302.85 GENDER IDENTITY DISORDER NOS	.18	.28	2.35	3.57	2
300.70 HYPOCHONDRIASIS	.18	.28	2.35	3.57	2
296.4x BIPOLAR DISORDER, MANIC, UNSPECIFIED	.14	.21	1.76	2.68	1
295.3x SCHIZOPHRENIA, PARANOID TYPE, UNSPECIFIED	.14	.21	1.76	2.68	1
295.70 SCHIZOAFFECTIVE DISORDER	.14	.21	1.76	2.68	1
302.84 SEXUAL SADISM	.14	.21	1.76	2.68	1
309.24 ADJUSTMENT DISORDER WITH ANXIOUS MOOD	.14	.21	1.76	2.68	1
298.80 BRIEF REACTIVE PSYCHOSIS	.09	.14	1.18	1.79	1
295.2x SCHIZOPHRENIA, CATATONIC TYPE, UNSPECIFIED	.09	.14	1.18	1.79	1
300.23 SOCIAL PHOBIA	.05	.07	.59	.89	>1
300.30 OBSESSIVE COMPULSIVE DISORDER	.05	.07	.59	.89	>1
294.80 ORGANIC MENTAL DISORDER NOS	.05	.07	.59	.89	>1
307.80 SOMATOFORM PAIN DISORDER	.05	.07	.59	.89	>1
303.90 ALCOHOL DEPENDENCE	.05	.07	.59	.89	>1
303.00 ALCOHOL INTOXICATION	.05	.07	.59	.89	>1

TABLE 14

DISTRIBUTION OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
ADOLESCENT FEMALES
DSM III-R	% N1	% N2	% N3	% N4	N5
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	.78	1.18	20.99	43.59	8
301.70 ANTISOCIAL PERSONALITY DISORDER	.46	.70	12.35	25.64	5
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	.46	.70	12.35	25.64	5
314.01 ATTENTION-DEFICIT HYPERACTIVITY DISORDER	.41	.63	11.11	23.08	4
313.00 OVERANXIOUS DISORDER	.37	.56	9.88	20.51	4
301.22 SCHIZOTYPAL PERSONALITY DISORDER	.37	.56	9.88	20.51	4
300.40 DYSTHYMIA	.37	.56	9.88	20.51	4
295.40 SCHIZOPHRENIFORM DISORDER	.37	.56	9.88	20.51	4
296.2x MAJOR DEPRESSION, SINGLE EPISODE, UNSPECIFIED	.37	.56	9.88	20.51	4
301.83 BORDERLINE PERSONALITY DISORDER	.32	.49	8.64	17.95	3
305.90 PSYCHOACTIVE SUBSTANCE ABUSE	.28	.42	7.41	15.38	3
301.00 PARANOID PERSONALITY DISORDER	.23	.35	6.17	12.82	2
313.81 OPPOSITIONAL DEFIANT DISORDER	.23	.35	6.17	12.82	2
301.20 SCHIZOID PERSONALITY DISORDER	.18	.28	4.94	10.26	2
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	.18	.28	4.94	10.26	2
305.00 ALCOHOL ABUSE	.18	.28	4.94	10.26	2
295.90 SCHIZOPHRENIA, UNDIFFERENTIATED TYPE, UNSPECIFIED	.14	.21	3.70	7.69	1
301.50 HISTRIONIC PERSONALITY DISORDER	.14	.21	3.70	7.69	1
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	.14	.21	3.70	7.69	1
296.4x BIPOLAR DISORDER, MANIC, UNSPECIFIED	.14	.21	3.70	7.69	1
297.10 DELUSIONAL DISORDER	.14	.21	3.70	7.69	1
301.82 AVOIDANT PERSONALITY DISORDER	.14	.21	3.70	7.69	1
300.81 SOMATIZATION DISORDER	.14	.21	3.70	7.69	1
295.3x SCHIZOPHRENIA, PARANOID TYPE, UNSPECIFIED	.14	.21	3.70	7.69	1
315.90 SPECIFIC DEVELOPMENTAL DISORDER NOS	.09	.14	2.47	5.13	1
312.39 IMPULSE CONTROL DISORDER NOS	.09	.14	2.47	5.13	1
309.90 ADJUSTMENT DISORDER NOS	.09	.14	2.47	5.13	1
300.02 GENERALIZED ANXIETY DISORDER	.09	.14	2.47	5.13	1
309.24 ADJUSTMENT DISORDER WITH ANXIOUS MOOD	.09	.14	2.47	5.13	1
301.60 DEPENDENT PERSONALITY DISORDER	.09	.14	2.47	5.13	1
295.6x SCHIZOPHRENIA, RESIDUAL TYPE, UNSPECIFIED	.09	.14	2.47	5.13	1
294.80 ORGANIC MENTAL DISORDER NOS	.09	.14	2.47	5.13	1
305.50 OPIOID INTOXICATION/ABUSE	.05	.07	1.23	2.56	>1
310.10 ORGANIC PERSONALITY DISORDER	.05	.07	1.23	2.56	>1
311.00 DEPRESSIVE DISORDER NOS	.05	.07	1.23	2.56	>1
303.00 ALCOHOL INTOXICATION	.05	.07	1.23	2.56	>1
307.80 SOMATOFORM PAIN DISORDER	.05	.07	1.23	2.56	>1
295.94 SCHIZOPHRENIA, UNDIFF. TYPE, CHRONIC WITH ACUTE EXACERBATION	.05	.07	1.23	2.56	>1
300.70 HYPOCHONDRIASIS	.05	.07	1.23	2.56	>1
303.90 ALCOHOL DEPENDENCE	.05	.07	1.23	2.56	>1
302.85 GENDER IDENTITY DISORDER OF ADOLESCENCE	.05	.07	1.23	2.56	>1

TABLE 15

DISTRIBUTION OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
PRIMARY SUICIDAL
DSM III-R	% N1	% N2	% N3	% N4	N5
296.2x MAJOR DEPRESSION, SINGLE EPISODE, UNSPECIFIED	25.31	38.34	73.76	88.87	253
301.82 AVOIDANT PERSONALITY DISORDER	25.26	38.27	73.63	88.71	253
295.40 SCHIZOPHRENIFORM DISORDER	24.90	37.72	72.56	87.42	249
301.22 SCHIZOTYPAL PERSONALITY DISORDER	24.48	37.09	71.35	85.97	245
295.90 SCHIZOPHRENIA, UNDIFFERENTIATED TYPE, UNSPECIFIED	23.52	35.63	68.54	82.58	235
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	20.99	31.80	61.18	73.71	210
301.00 PARANOID PERSONALITY DISORDER	20.12	30.48	58.63	70.65	201
305.90 PSYCHOACTIVE SUBSTANCE ABUSE	17.59	26.65	51.27	61.77	176
305.00 ALCOHOL ABUSE	15.53	23.52	45.25	54.52	155
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	14.88	22.55	43.37	52.26	149
300.02 GENERALIZED ANXIETY DISORDER	14.19	21.50	41.37	49.84	142
301.60 DEPENDENT PERSONALITY DISORDER	12.40	18.79	36.14	43.55	124
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	12.36	18.72	36.01	43.39	124
296.5x BIPOLAR DISORDER, DEPRESSED, UNSPECIFIED	12.17	18.44	35.48	42.74	122
301.70 ANTISOCIAL PERSONALITY DISORDER	11.62	17.61	33.87	40.81	116
301.50 HISTRIONIC PERSONALITY DISORDER	11.62	17.61	33.87	40.81	116
295.70 SCHIZOAFFECTIVE DISORDER	8.08	12.25	23.56	28.39	81
300.30 OBSESSIVE COMPULSIVE DISORDER	5.47	8.28	15.93	19.19	55
301.83 BORDERLINE PERSONALITY DISORDER	3.63	5.50	10.58	12.74	36
300.01 PANIC DISORDER, WITHOUT AGORAPHOBIA	3.31	5.01	9.64	11.61	33
301.40 OBSESSIVE COMPULSIVE PERSONALITY DISORDER	3.12	4.73	9.10	10.97	31
309.24 ADJUSTMENT DISORDER WITH ANXIOUS MOOD	3.03	4.59	8.84	10.65	30
301.20 SCHIZOID PERSONALITY DISORDER	2.99	4.52	8.70	10.48	30
295.40 SCHIZOPHRENIFORM DISORDER	2.85	4.31	8.30	10.00	28
310.10 ORGANIC PERSONALITY DISORDER	1.19	1.81	3.48	4.19	12
302.83 SEXUAL MASOCHISM	1.06	1.60	3.08	3.71	11
297.10 DELUSIONAL DISORDER	1.01	1.53	2.95	3.55	10
295.3x SCHIZOPHRENIA, PARANOID TYPE, UNSPECIFIED	.92	1.39	2.68	3.23	9
313.00 OVERANXIOUS DISORDER	.87	1.32	2.54	3.06	9
294.80 ORGANIC MENTAL DISORDER NOS	.78	1.18	2.28	2.74	8
309.28 ADJUSTMENT DISORDER WITH MIXED EMOTIONAL FEATURES	.73	1.11	2.14	2.58	7
296.4x BIPOLAR DISORDER, MANIC, UNSPECIFIED	.73	1.11	2.14	2.58	7
301.13 CYCLOTHYMIA	.73	1.11	2.14	2.58	7
305.50 OPIOID INTOXICATION/ABUSE	.60	.90	1.74	2.10	6
300.81 SOMATIZATION DISORDER	.55	.84	1.61	1.94	5
300.11 CONVERSION DISORDER	.55	.84	1.61	1.94	5
300.90 UNSPECIFIED MENTAL DISORDER	.51	.77	1.47	1.77	5
295.6x SCHIZOPHRENIA, RESIDUAL TYPE, UNSPECIFIED	.46	.70	1.34	1.61	5
300.70 HYPOCHONDRIASIS	.37	.56	1.07	1.29	4
303.90 ALCOHOL DEPENDENCE	.28	.42	.80	.97	3
300.22 AGORAPHOBIA WITHOUT HISTORY OF PANIC DISORDER	.23	.35	.67	.81	2
307.80 SOMATOFORM PAIN DISORDER	.23	.35	.67	.81	2
300.21 PANIC DISORDER, WITH AGORAPHOBIA	.23	.35	.67	.81	2
300.00 ANXIETY DISORDER NOS	.14	.21	.40	.48	1
303.00 ALCOHOL INTOXICATION	.14	.21	.40	.48	1
309.30 ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT	.09	.14	.27	.32	1
301.81 NARCISSISTIC PERSONALITY DISORDER	.09	.14	.27	.32	1
309.40 ADJUSTMENT DIS. WITH MIXED DISTRB. OF EMOTIONS & CONDUCT	.09	.14	.27	.32	1
309.82 ADJUSTMENT DISORDER WITH PHYSICAL COMPLAINTS	.09	.14	.27	.32	1
309.83 ADJUSTMENT DISORDER WITH WITHDRAWAL	.05	.07	.13	.16	>1
302.40 EXHIBITIONISM	.05	.07	.13	.16	>1
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	.05	.07	.13	.16	>1
313.81 OPPOSITIONAL DEFIANT DISORDER	.05	.07	.13	.16	>1
309.90 ADJUSTMENT DISORDER NOS	.05	.07	.13	.16	>1
302.85 GENDER IDENTITY DISORDER NOS	.05	.07	.13	.16	>1
302.84 SEXUAL SADISM	.05	.07	.13	.16	>1
296.21 MAJOR DEPRESSION, SINGLE EPISODE, MILD	.05	.07	.13	.16	>1
302.82 VOYEURISM	.05	.07	.13	.16	>1
295.2x SCHIZOPHRENIA, CATATONIC TYPE, UNSPECIFIED	.05	.07	.13	.16	>1
300.23 SOCIAL PHOBIA	.05	.07	.13	.16	>1

TABLE 16

DISTRIBUTION OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
AGGRESSIVE, HOSTILE, HOMICIDAL
DSM III-R	% N1	% N2	% N3	% N4	N5
301.00 PARANOID PERSONALITY DISORDER	5.24	7.93	76.51	88.37	52
301.70 ANTISOCIAL PERSONALITY DISORDER	5.10	7.72	74.50	86.05	51
305.90 PSYCHOACTIVE SUBSTANCE ABUSE	5.05	7.65	73.83	85.27	50
301.83 BORDERLINE PERSONALITY DISORDER	4.59	7.10	68.46	79.07	47
301.22 SCHIZOTYPAL PERSONALITY DISORDER	4.69	7.10	68.46	79.07	47
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	4.64	7.03	67.79	78.29	46
295.90 SCHIZOPHRENIA, UNDIFFERENTIATED TYPE, UNSPECIFIED	4.46	6.75	65.10	75.19	45
295.3x SCHIZOPHRENIA, PARANOID TYPE, UNSPECIFIED	4.27	6.47	62.42	72.09	43
297.10 DELUSIONAL DISORDER	3.23	6.40	61.74	71.32	42
296.5x BIPOLAR DISORDER, DEPRESSED, UNSPECIFIED	4.09	6.19	59.73	68.99	41
302.84 SEXUAL SADISM	4.00	6.05	58.39	67.44	40
301.50 HISTRIONIC PERSONALITY DISORDER	.87	1.32	12.75	14.73	9
305.00 ALCOHOL ABUSE	.73	1.11	10.74	12.40	7
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	.55	.84	8.05	9.30	5
301.82 AVOIDANT PERSONALITY DISORDER	.55	.84	8.05	9.30	5
296.4x BIPOLAR DISORDER, MANIC, UNSPECIFIED	.55	.84	8.05	9.30	5
301.81 NARCISSISTIC PERSONALITY DISORDER	.46	.70	6.71	7.75	5
309.30 ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT	.46	.70	6.71	7.75	5
300.40 DYSTHYMIA	46	70	6.71	7.75	5
296.2x MAJOR DEPRESSION, SINGLE EPISODE, UNSPECIFIED	.46	.70	6.71	7.75	5
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	.46	.70	6.71	7.75	5
314.01 ATTENTION-DEFICIT HYPERACTIVITY DISORDER	41	63	6.04	6.98	4
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	.37	.56	5.37	6.20	4
295.40 SCHIZOPHRENIFORM DISORDER	.37	.56	5.37	6.20	4
301.60 DEPENDENT PERSONALITY DISORDER	.37	.56	5.37	6.20	4
310.10 ORGANIC PERSONALITY DISORDER	.28	.42	4.03	4.65	3
305.50 OPIOID INTOXICATION/ABUSE	.18	.28	2.68	3.10	2
303.90 ALCOHOL DEPENDENCE	.14	.21	2.01	2.33	1
300.70 HYPOCHONDRIASIS	.14	.21	2.01	2.33	1
300.02 GENERALIZED ANXIETY DISORDER	.14	.21	2.01	2.33	1
295.70 SCHIZOAFFECTIVE DISORDER	.09	.14	1.34	1.55	1
300.81 SOMATIZATION DISORDER	.09	.14	1.34	1.55	1
309.90 ADJUSTMENT DISORDER NOS	.09	.14	1.34	1.55	1
307.80 SOMATOFORM PAIN DISORDER	.05	.07	.67	.78	>1
300.23 SOCIAL PHOBIA	.05	.07	.67	.78	>1
303.00 ALCOHOL INTOXICATION	.05	.07	.67	.78	>1
295.94 SCHIZOPHRENIA, UNDIFF. TYPE, CHRONIC WITH ACUTE EXACERBATION	05	.07	.67	.78	>1
312.39 IMPULSE CONTROL DISORDER NOS	05	.07	.67	.78	>1
301.20 SCHIZOID PERSONALITY DISORDER	.05	.07	.67	.78	>1
300.11 CONVERSION DISORDER	.05	.07	.67	.78	>1
295.2x SCHIZOPHRENIA, CATATONIC TYPE, UNSPECIFIED	.05	.07	.67	.78	>1
309.28 ADJUSTMENT DISORDER WITH MIXED EMOTIONAL FEATURES	.05	.07	.67	.78	>1
300.90 UNSPECIFIED MENTAL DISORDER	.05	.07	.67	.78	>1
301.20 SCHIZOID PERSONALITY DISORDER	.05	.07	.67	.78	>1

TABLE 17

PREVALENCE OF PSYCHIATRIC COMORBIDITY IN SUBSTANCE ABUSE PATIENTS
ACROSS DIAGNOSTIC CATEGORIES - TOTAL POPULATION COMPARISON
DSM III-R	N1	N2	N3	N4	N5	N6
PSYCHOACTIVE SUBSTANCE USE DISORDERS
305.90 PSYCHOACTIVE SUBSTANCE ABUSE, NOS	257	86	5	3	176	50
305.00 ALCOHOL ABUSE	201	55	2	2	155	7
303.90 ALCOHOL DEPENDENCE	61	8	>1	>1	3	1
305.50 OPIOID ABUSE	6	12	-	1	6	2
303.00 ALCOHOL INTOXICATION	36	5	>1	-	1	>1
304.90 POLYSUBSTANCE DEPENDENCE	2	>1	-	-	-	-
303.00 ALCOHOL INTOXICATION	36	>1	-	-	-	-
MOOD DISORDERS - DEPRESSED TYPE
300.40 DYSTHYMIA	304	64	11	4	-	5
296.2x MAJOR DEPRESSION, SINGLE EPISODE	307	61	8	4	253	5
296.21 MAJOR DEPRESSION, SINGLE EPISODE, MILD	>1	-	-	-	-	-
296.3x MAJOR DEPRESSION, RECURRENT, UNSPECIFIED	265	1	-	-	-	-
MOOD DISORDERS - BIPOLAR TYPE
296.5x BIPOLAR DISORDER, DEPRESSED TYPE	217	50	3	-	122	41
296.4x BIPOLAR DISORDER, MANIC TYPE	51	24	1	1	7	5
301.13 CYCLOTHYMIA	8	3	-	-	7	-
296.44 BIPOLAR DISORDER, MANIC TYPE WITH PSYCHOTIC FEATURES	-	-	-	-	7	-
SCHIZOPHRENIA
295.9x SCHIZOPHRENIA, UNDIFFERENTIATED TYPE	299	69	5	1	235	45
295.3x SCHIZOPHRENIA, PARANOID TYPE	90	49	1	1	9	43
295.2x SCHIZOPHRENIA, CATATONIC TYPE	16	3	1	-	>1	>1
295.1x SCHIZOPHRENIA, DISORGANIZED TYPE	-	-	1	-	-	-
295.6x SCHIZOPHRENIA, RESIDUAL TYPE	1	1	4	1	5	-
ADJUSTMENT DISORDERS
309.00 ADJUSTMENT DISORDER WITH DEPRESSED MOOD	190	5	3	5	149	5
309.24 ADJUSTMENT DISORDER WITH ANXIOUS MOOD	42	1	1	1	30	-
309.30 ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT	22	10	3	-	1	5
309.28 ADJUSTMENT DISORDER WITH MIXED EMOTIONAL FEATURES	11	9	-	-	7	>1
309.40 ADJ. DISORDER WITH MIXED DISTURBANCE OF EMOTIONS & CONDUCT	6	>1	-	-	1	-
309.82 ADJUSTMENT DISORDER WITH PHYSICAL COMPLAINTS	8	1	-	-	-	-
309.83 ADJUSTMENT DISORDER WITH WITHDRAWAL	>1	-	-	-	-	-
309.90 ADUSTMENT DISORDER NOS	>1	-	-	-	-	-
ANXIETY DISORDERS
300.02 GENERALIZED ANXIETY DISORDER	192	31	6	1	142	1
300.01 ANXIETY DISORDER WITHOUT AGORAPHOBIA	49	10	-	-	33	-
300.30 OBSESSIVE COMPULSIVE DISORDER	61	-	>1	-	55	-
300.22 AGORAPHOBIA WITHOUT HISTORY OF PANIC DISORDERS	10	7	-	-	2	-
300.21 PANIC DISORDER WITH AGORAPHOBIA	10	7	-	-	2	-
300.23 SOCIAL PHOBIA	10	>1	>1	-	>1	>1
300.00 ANXIETY DISORDER, NOS	2	1	-	-	1	-
DELUSIONAL (PARANOID) DISORDERS
297.10 DELUSIONAL (PARANOID) DISORDER	63	47	2	1	11	42
SOMATOFORM DISORDERS
300.81 SOMATIZATION DISORDER	63	47	7	1	5 1
300.70 HYPOCHONDRIASIS	59	9	2	>1	4 1
300.11 CONVERSION DISORDER	12	5	-	-	5 >1
307.80 IDIOPATHIC PAIN DISORDER (SOMATOFORM DISORDER)	41	6	>1	>1	2 >1
316.00 PSYCHOLOGICAL FACTORS AFFECTING PHYSICAL CONDITION	1	-	-	-	- -
ORGANIC MENTAL DISORDERS
310.10 ORGANIC PERSONALITY SYNDROME	13	17	-	>1	12	3
294.80 ORGANIC MENTAL SYNDROME, NOS	20	12	>1	1	8	-
292.90 PSYCHOACTIVE SUBSTANCE-INDUCED ORGANIC MENTAL DISORDER	-	-	-	-	-	-
SEXUAL DISORDERS
302.83 SEXUAL MASOCHISM	12	-	-	-	-	-
302.84 SEXUAL SADISM	43	18	1	-	>1	40
302.20 PEDOPHILIA	1	-	-	-	-	-
302.82 VOYEURISM	1	-	-	-	-	-
302.40 EXHIBITIONISM	>1	-	-	-	-	-
302.72 MALE/FEMALE SEXUAL ERECTILE/AROUSAL DISORDER	>1	>1	-	-	-	-
PSYCHOTIC DISORDERS NOS
295.70 SCHIZOAFFECTIVE DISORDER	124	21	1	-	81	1
295.40 SCHIZOPHRENIFORM DISORDER	27	1	9	4	249	4
DISSOCIATIVE DISORDERS
300.15 DISSOCIATIVE DISORDER, NOS	-	>1	-	-	-	-
UNSPECIFIED MENTAL DISORDERS
300.90 UNSPECIFIED MENTAL DISORDER (NONPSYCHOTIC)	7	>1	-	-	5	>1
312.90 CONDUCT DISORDER, UNDIFFERENTIATED TYPE	15	8	-	-	-	-
307.50 EATING DISORDER NOS	>1	-	-	-	-	-
PERSONALITY DISORDERS
301.22 SCHIZOTYPAL PERSONALITY DISORDER	384	100	10	4	245	47
301.00 PARANOID PERSONALITY DISORDER	311	108	5	2	201	52
301.70 ANTISOCIAL PERSONALITY DISORDER	192	73	5	5	116	51
301.82 AVOIDANT PERSONALITY DISORDER	329	68	4	1	253	5
301.84 PASSIVE AGGRESSIVE PERSONALITY DISORDER	186	69	3	2	124	46
301.60 DEPENDENT PERSONALITY DISORDER	207	47	2	1	124	4
301.50 HISTRIONIC PERSONALITY DISORDER	129	50	5	1	116	9
301.83 BORDERLINE PERSONALITY DISORDER	82	38	6	3	36	47
301.81 NARCISSISTIC PERSONALITY DISORDER	37	12	3	-	1	5
301.40 OBSESSIVE COMPULSIVE PERSONALITY DISORDER	34	2	-	-	31	-
301.20 SCHIZOID PERSONALITY DISORDER	49	12	5	2	30	>1

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Last update 06/25/1997

Dual Diagnosis - A National Survey

National Survey of Psychiatric Comorbidity in Substance Abuse Patients

INTRODUCTION

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National Survey of Psychiatric Comorbidity
in Substance Abuse Patients