Comorbid dysthymia and substance disorder: treatment history and cost.
OBJECTIVE
The purpose of this study was to determine the treatment history and cost of previous treatment among patients with comorbid substance-related disorder and dysthymia, as compared to patients with substance-related disorder only.


METHODS
Retrospective data were obtained regarding past treatment. Treatment cost was calculated on the basis of the 1996 cost of various treatment modalities. The setting was alcohol-drug programs located within departments of psychiatry in two centers. A total of 642 patients were assessed, of whom 39 had substance-related disorder and dysthymia and 308 had substance-related disorder only (the remaining patients had other comorbid conditions). Data collection instruments included an interview-based questionnaire regarding previous psychiatric and substance abuse treatment. Current cost of treatment in various settings was assessed on the basis of a survey of facilities used by patients in this area.


RESULTS
Patients with substance-related disorder and dysthymia had received more substance-related disorder treatment in 18 of 20 measures. Patients with substance-related disorder and dysthymia used 4.7 times more substance-related disorder treatment dollars than patients with substance-related disorder only, although their demographic characteristics were similar. Past self-help activities and pharmacotherapy were remarkably similar for both groups. Although substance-related disorder treatment differed considerably between the two groups of patients, other types of psychiatric treatment (i.e., non-substance-related treatment) did not differ between the two groups.


CONCLUSIONS
Patients with substance-related disorder and dysthymia are referred to (or seek) substance-related disorder treatment more often than patients with substance-related disorder only but are referred to (or seek) non-substance-related psychiatric treatment no more often than patients with substance-related disorder only. The cost of previous substance-related disorder treatment was several times higher for the patients with substance-related disorder and dysthymia.
Westermeyer
J
J
Minneapolis VA Medical Center, University of Minnesota 55417, USA.
Eames
S L
SL
Nugent
S
S
D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D015897:Comorbidity; D004221:Disulfiram / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D019263:Dysthymic Disorder / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006208:Halfway Houses / Q000191:economics; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008691:Methadone / Q000191:economics / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D013808:Therapeutic Community
D004221:Disulfiram; D008691:Methadone