title: The spectrum of substance use in mood and anxiety disorders.
abstract: This study evaluates the prevalence of threshold and subthreshold use of substances among patients with psychiatric disorders and 2 comparison groups. Participants were outpatients and inpatients with mood and anxiety disorders, subjects with opiate dependence, and a comparison group of individuals not undergoing treatment for psychiatric disorders. Assessments included the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , Axis I Disorders, an interview exploring the spectrum of substance use (Structured Clinical Interview for the Spectrum of Substance Use), and a self-report instrument exploring the spectrum of 5 psychiatric disorders (General 5-Spectrum Measure). The overall frequency of substance use disorder (SUD) and that of subthreshold use were 46% and 8% in patients with bipolar disorder, 4% and 26% in those with panic disorder, 8% and 26% in those with obsessive-compulsive disorder, and 6% and 10% in the control group, respectively ( Idouble dagger 2 = 51.6, P < .001). Inspection of standardized residuals indicated that alcohol use disorder and SUD were significantly ( P < .05) more frequent in subjects with bipolar disorder than among those with obsessive-compulsive disorder or panic disorder. The latter showed a significantly higher subthreshold use of substances than control subjects. The pattern of motivations for use varied according to the psychiatric disorder. Our results suggest that the well-established relationship between SUDs and psychiatric disorders might be the end point of a process that starts from increased proneness to substance use, which first leads to self-medication and then may eventually develop into substance abuse or dependence, among subjects with psychiatric symptoms.
authors.affiliation: Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, 56127 Pisa, Italy. alfredosbrana@virgilio.it
authors.forename: Alfredo
authors.initials: A
authors.lastname: Sbrana
authors.forename: Jacopo Vittoriano
authors.initials: JV
authors.lastname: Bizzarri
authors.forename: Paola
authors.initials: P
authors.lastname: Rucci
authors.forename: Chiara
authors.initials: C
authors.lastname: Gonnelli
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Doria
authors.forename: Sabrina
authors.initials: S
authors.lastname: Spagnolli
authors.forename: Laura
authors.initials: L
authors.lastname: Ravani
authors.forename: Federica
authors.initials: F
authors.lastname: Raimondi
authors.forename: Lilliana
authors.initials: L
authors.lastname: Dell'Osso
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Cassano
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D001008:Anxiety Disorders / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000534:rehabilitation; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology; D016584:Panic Disorder / Q000453:epidemiology; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation