title: [Which psychiatric comorbidities in cannabis dependence during adolescence? Comparison of outpatients and controls].
abstract: BACKGROUND
  The use of illicit substances, in particular cannabis, among French adolescents and young adults has become an important public health concern. A better understanding of the mechanisms involved in pathological substance use is nowadays critical. Psychiatric comorbidities have been previously reported in adult substance abusers but are less documented in adolescents, especially regarding cannabis dependence.
  
  
  OBJECTIVE
  We investigated mental health problems in adolescents and young adults, seeking treatment for their problematic cannabis use, comparatively to healthy controls, taking into account the participant's gender and age. Moreover, we explored the relationships between psychiatric diagnosis and substance use modalities.
  
  
  METHODS
  In total, 100 young patients (80 males - mean age 18.2 (SD=2.9; [14 to 25] years old)) with a cannabis dependence (DSM-IV-TR criteria) seeking treatment in an addiction unit, and 82 healthy control subjects (50 males - mean age 18.3 (SD=3.4; [14 to 25] years old)) with no substance misuse diagnostic other than for alcohol, participated in the study. The MINI was administered to evaluate cannabis dependence, and DSM-IV axis I comorbid diagnosis, and a semi-structured interview was used to determine psychoactive substance use.
  
  
  RESULTS
  Statistical analyses revealed that 79 % of the patients reported at least one other non-drug or alcohol comorbid diagnosis, versus 30.5 % in the control group (χ2=16.83; P<0.001). Logistic regression indicated that participants with a psychiatric diagnosis had an 8.6 times higher risk (P<0.001; OR 95 % CI=[4.38-16.81]) of being patients. Significant inter-group differences and OR were noted for several diagnoses: dysthymia over the previous 2years (χ2=14.06; P<0.001; OR=10.63; OR 95 % CI=[2.41-46.87]), life-time panic attack disorder (χ2=4.15; P<0.042; OR=3.59; OR 95 % CI=[0.98-13.19]), alcohol abuse (χ2=47.72; P<0.001; OR=66.27; OR 95 % CI=[8.87-495.11]) and dependence (V=0.230; P=0.001) and generalized anxiety disorder (χ2=7.46; P=0.006-OR=3.57; OR 95 % CI=[1.37-9.30]). On the whole, the females (n=20) of our clinical sample presented significantly more comorbid diagnoses than the males (n=80) (95 % versus 75 %; χ2=6.25, P=0.011). These significant gender differences were found for life-time eating disorder (V=0.352; P=0.007) and generalized anxiety disorder diagnoses (V=0.278; P=0.013). Moreover, young adult patients (19-25years old; n=35) presented, on the whole, significantly more comorbid diagnoses than adolescent patients (14-18years old; n=65) (70.8 % versus 94.3 %; χ2=7.58, P=0.006). These age inter-group differences were found for several diagnoses: alcohol dependence (6.2 % versus 20 %; V=0.211, P=0.047), dysthymia over the past 2years (13.8 % versus 34.3 %; χ2=5.73, P=0.017) and generalized anxiety disorder (12.3 % versus 40 %; χ2=10.17, P=0.001). Various associations were observed between psychiatric comorbid diagnosis and substance use indicators.
  
  
  CONCLUSIONS
  This study demonstrates that cannabis dependence in adolescents and young adults is related to great psychological distress and puts emphasis on the importance of substance use prevention as early as middle school. Moreover, the psychiatric features of adolescents and young adults need to be taken into consideration for treatment planning.
authors.affiliation: Laboratoire de psychopathologie et processus de santé (EA 4057), institut Henri-Piéron, IUPDP, université Paris Descartes-Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France. Electronic address: geraldine.dorard@parisdescartes.fr.
authors.forename: G
authors.initials: G
authors.lastname: Dorard
authors.affiliation: Laboratoire de psychopathologie et processus de santé (EA 4057), institut Henri-Piéron, IUPDP, université Paris Descartes-Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.
authors.forename: C
authors.initials: C
authors.lastname: Bungener
authors.affiliation: Clinique Dupré, FSEF, Sceaux, CJC Pierre-Nicole, Croix-Rouge française, 92330 Sceaux, France; CESP, Inserm U1178, université Paris Sud, Cochin, maison des Adolescents, 75005 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Phan
authors.affiliation: Centre de référence en addictologie, hôpital universitaire de la Pitié-Salpêtrière, 75014 Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Edel
authors.affiliation: Département de psychiatrie de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 75014 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Corcos
authors.affiliation: CESP, Inserm U1178, université Paris Sud, Cochin, maison des Adolescents, 75005 Paris, France; Département de psychiatrie de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 75014 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Berthoz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications* / Q000453:epidemiology; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D010045:Outpatients; D015995:Prevalence; D000297:Psychology, Adolescent; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
keywords: Adolescence; Cannabis; Comorbidité; Consultations spécialisées; Dependence; Dual diagnosis; Dépendance; Specific setting; Substance misuse; Substances psychoactives; Treatment seeking