title: Correlates of dependence and treatment for substance use among people with comorbid severe mental and substance use disorders: findings from the "Psychiatric and Addictive Dual Disorder in Italy (PADDI)" Study.
abstract: OBJECTIVE
  People with severe mental illness (SMI) have often comorbid alcohol and other substance disorders but substantial barriers to addiction care remain. The study is aimed at describing correlates associated with dependence and with treatment for substance use among people with SMI and comorbid substance disorders cared in community mental health teams (CMHTs).
  
  
  METHODS
  This study capitalized on data from a national survey on comorbid severe mental and substance use disorders, among 2235 subjects in 42 CMHTs nationwide.
  
  
  RESULTS
  26% of people with SMI and comorbid misuse suffered from dependence on alcohol and 21% on any other substance. Use of opioids, liver diseases, involvement with criminal justice system, but also area of residence, all were associated with dependence in people with SMI. As regards treatment for substance use, only 50% of comorbid people with SMI were treated by specialist services in the past 12 months. This was associated with opioids and cocaine use, as well as with liver diseases, and involvement with criminal justice. People with schizophrenia and those living in Central and Southern Italy, had the lowest chances to be treated for their comorbid substance use disorder.
  
  
  CONCLUSIONS
  There are extensive unmet treatment needs among comorbid individuals with SMI. Better integration of substance abuse and mental health care systems, and more effective reciprocal referral procedures, are needed.
authors.affiliation: Division of Psychiatry, Faculty of Brain Sciences, University College London, Charles Bell House 67-73 Riding House Street, London W1W 7EJ, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carrà
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini, 2-27100 Pavia, Italy; Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore, 48-20900 Monza, Italy. Electronic address: c.crocamo1@campus.unimib.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Crocamo
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini, 2-27100 Pavia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Borrelli
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini, 2-27100 Pavia, Italy.
authors.forename: Ioana
authors.initials: I
authors.lastname: Popa
authors.affiliation: Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore, 48-20900 Monza, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ornaghi
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini, 2-27100 Pavia, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Montomoli
authors.affiliation: Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore, 48-20900 Monza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Clerici
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019970:Cocaine-Related Disorders / Q000150:complications; D015897:Comorbidity; D003415:Crime / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D012559:Schizophrenia / Q000453:epidemiology; D012565:Schizophrenic Psychology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult