title: Chronology of illness in dual diagnosis heroin addicts: The role of mood disorders.
abstract: BACKGROUND
  Recent celebrity deaths have been widely reported in the media and turned the public attention to the coexistence of mood, psychiatric and substance-abuse disorders. These tragic and untimely deaths motivated us to examine the scientific and clinical data, including our own work in this area. The self-medication hypothesis states that individuals with psychiatric illness tend to use heroin to alleviate their symptoms. This study examined the correlations between heroin use, mood and psychiatric disorders, and their chronology in the context of dual diagnosis.
  
  
  METHODS
  Out of 506 dual diagnosed heroin addicts, 362 patients were implicated in heroin abuse with an onset of at least one year prior to the associated mental disorder (HER-PR), and 144 patients were diagnosed of mental illness at least one year prior to the associated onset of heroin use disorder (MI-PR). The retrospective cross-sectional analysis of the two groups compared their demographic, clinical and diagnostic characteristics at univariate and multivariate levels.
  
  
  RESULTS
  Dual diagnosis heroin addicts whose heroin dependences existed one year prior to their diagnoses (HER-PR) reported more frequent somatic comorbidity (p≤0.001), less major problems at work (p=0.003), more legal problems (p=0.004) and more failed treatment for their heroin dependence (p<0.001) in the past. More than 2/3 reached the third stage of heroin addiction (p=<0.001). Their length of dependence was longer (p=0.004). HER-PR patients were diagnosed more frequently as affected by mood disorders and less frequently as affected by psychosis (p=0.004). At the multivariate level, HER-PR patients were characterized by having reached stage 3 of heroin dependence (OR=2.45), diagnosis of mood disorder (OR=2.25), unsuccessful treatment (OR=2.07) and low education (OR=1.79).
  
  
  CONCLUSIONS
  The main limitation is its retrospective nature. Nonetheless, it does shed light on what needs to be done from a clinical and public health perspective and especially prevention.
  
  
  CONCLUSIONS
  The data emerging from this study, does not allow us to determine a causal relation between heroin use and mental illness onset. However, this data, even if requiring longitudinal studies, suggest that self-medication theory, in these patients, can be applied only for chronic psychoses, but should not be applied to patients with mood disorders using heroin.
authors: "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, "Santa Chiara" University Hospital, University of Pisa, Italy; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy. Electronic address: angelogimaremmani@gmail.com.
authors: Angelo G I
authors: AG
authors: Maremmani
authors: "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, "Santa Chiara" University Hospital, University of Pisa, Italy.
authors: Luca
authors: L
authors: Rovai
authors: "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, "Santa Chiara" University Hospital, University of Pisa, Italy.
authors: Fabio
authors: F
authors: Rugani
authors: "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, "Santa Chiara" University Hospital, University of Pisa, Italy.
authors: Silvia
authors: S
authors: Bacciardi
authors: "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, "Santa Chiara" University Hospital, University of Pisa, Italy.
authors: Enrico
authors: E
authors: Massimetti
authors: "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, "Santa Chiara" University Hospital, University of Pisa, Italy.
authors: Denise
authors: D
authors: Gazzarrini
authors: Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors: Liliana
authors: L
authors: Dell'Osso
authors: International Mood Center, University of California and Veterans Administration Hospital, San Diego, California, USA.
authors: Fengyi
authors: F
authors: Tang
authors: International Mood Center, University of California and Veterans Administration Hospital, San Diego, California, USA.
authors: Hagop S
authors: HS
authors: Akiskal
authors: "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, "Santa Chiara" University Hospital, University of Pisa, Italy; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy; (")G. De Lisio" Institute of Behavioral Sciences Pisa, Italy.
authors: Icro
authors: I
authors: Maremmani
mesh_terms: D000293:Adolescent; D000328:Adult; D002910:Chronology as Topic; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications / Q000523:psychology*; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Dual diagnosis; Heroin dependence; Mental disorder vs. heroin use temporal priority; Self-medication hypothesis