Abstract
Purpose
The comorbidity of any substance use disorder and another mental disorder is defined as dual diagnosis. Dual diagnosis is very common and clinical and therapeutic consequences have been described. This cross-sectional study aimed to analyse health-related quality of life (HRQoL) according to clinical characteristics and psychiatric comorbidities in patients with substance dependence.
Methods
A total of 1276 substance-dependent patients seeking treatment were recruited. HRQoL was evaluated by the Short-Form 36 (SF-36) questionnaire. The SCID-I, SCID-II and Conners’ adult ADHD diagnostic interview were used to evaluate dual diagnosis. A visual analogue scale was used to measure craving. Bivariate and multivariate analyses were performed, and correction for multiple tests was conducted.
Results
Substance-dependent patients had impaired quality of life, especially in the mental component. SF-36 physical and mental component scores were 47.7 ± 10.9 and 36.1 ± 14.1, respectively. Furthermore, 65% of the patients had dual diagnosis, 51% had an Axis I DSM-IV-TR mental disorder and 35% had some personality disorder. Impaired physical quality of life was independently associated with medical condition, age, being female, depressive disorder and anxiety disorder. Depression disorder, any personality disorder, active consumption last month, Attention deficit hyperactivity disorder, anxiety disorder, suicide attempt were independently associated with worse mental quality of life.
Conclusion
These findings emphasize the significance of dual diagnosis in the impairment of HRQoL in substance-dependent patients, particularly with regard to mental component. In addicted patients with low scores on SF-36, psychiatric comorbidity should be evaluated and treated in an integrated approach.
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References
Gowing, L. R., Ali, R. L., Allsop, S., Marsden, J., Turf, E. E., West, R., et al. (2015). Global statistics on addictive behaviours: 2014 status report. Addiction (Abingdon, England), 110(6), 904–919. doi:10.1111/add.12899.
EMCDDA (2016). European Drug Report 2016: Trends and developments. http://www.pnsd.msc.es. Lisbon.
Luquiens, A., Reynaud, M., Falissard, B., & Aubin, H. J. (2012). Quality of life among alcohol-dependent patients: how satisfactory are the available instruments? A systematic review. Drug and Alcohol Dependence, 125(3), 192–202. doi:10.1016/j.drugalcdep.2012.08.012.
Roncero, C., Díaz-Morán, S., Comín, M., Miquel, L., Gonzalvo, B., & Casas, M. (2011). Quality of life concept evolution: The subjective dimension as a relevant factor on drug addiction. Vertex, 22(99), 343–349.
Hasin, D., & Kilcoyne, B. (2012). Comorbidity of psychiatric and substance use disorders in the United States: Current issues and findings from the NESARC. Current Opinion in Psychiatry, 25(3), 165–171. doi:10.1097/YCO.0b013e3283523dcc.
Roncero, C., Barral, C., Rodríguez-Cintas, L., Pérez-Pazos, J., Martinez-Luna, N., Casas, M., et al. (2016). Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study. Psychiatry Research, 243, 174–181. doi:10.1016/j.psychres.2016.06.024.
Daigre, C., Roncero, C., Grau-López, L., Martínez-Luna, N., Prat, G., Valero, S., et al. (2013). Attention deficit hyperactivity disorder in cocaine-dependent adults: A psychiatric comorbidity analysis. The American Journal on Addictions, 22(5), 466–473. doi:10.1111/j.1521-0391.2013.12047.x.
Weaver, T., Madden, P., Charles, V., Stimson, G., Renton, A., Tyrer, P., et al. (2003). Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. The British Journal of Psychiatry, 183, 304–313.
Calsyn, D. A., Saxon, A. J., Bush, K. R., Howell, D. N., Baer, J. S., Sloan, K. L., et al. (2004). The Addiction Severity Index medical and psychiatric composite scores measure similar domains as the SF-36 in substance-dependent veterans: Concurrent and discriminant validity. Drug and Alcohol Dependence, 76(2), 165–171. doi:10.1016/j.drugalcdep.2004.04.018.
de Moreira, T. C., Figueiró, L. R., Fernandes, S., Justo, F. M., Dias, I. R., Barros, H. M. T., et al. (2013). Quality of life of users of psychoactive substances, relatives, and non-users assessed using the WHOQOL-BREF. Ciência & Saúde Coletiva, 18(7), 1953–1962.
Lugoboni, F., Mirijello, A., Faccini, M., Casari, R., Cossari, A., Musi, G., et al. (2014). Quality of life in a cohort of high-dose benzodiazepine dependent patients. Drug and Alcohol Dependence, 142, 105–109. doi:10.1016/j.drugalcdep.2014.06.020.
Mcpherson, A., & Martin, C. R. (2013). A review of the measurement properties of the 36-item short-form health survey (SF-36) to determine its suitability for use in an alcohol-dependent population: Use of SF-36 in alcohol-dependency. Journal of Psychiatric and Mental Health Nursing, 20(2), 114–123. doi:10.1111/j.1365-2850.2012.01896.x.
Román, E., Córdoba, J., Torrens, M., Guarner, C., & Soriano, G. (2013). Falls and cognitive dysfunction impair health-related quality of life in patients with cirrhosis. European Journal of Gastroenterology and Hepatology, 25(1), 77–84.
Chahua, M., Sánchez-Niubò, A., Torrens, M., Sordo, L., Bravo, M. J., Domingo-Salvany, A., et al. (2015). Quality of life in a community sample of young cocaine and/or heroin users: The role of mental disorders. Quality of Life Research, 24(9), 2129–2137. doi:10.1007/s11136-015-0943-5.
Astals, M., Domingo-Salvany, A., Buenaventura, C. C., Tato, J., Vazquez, J. M., Martín-Santos, R., et al. (2008). Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Substance Use and Misuse, 43(5), 612–632. doi:10.1080/10826080701204813.
Yen, C. N., Wang, C. S. M., Wang, T. Y., Chen, H. F., & Chang, H. C. (2011). Quality of life and its correlates among heroin users in Taiwan. The Kaohsiung Journal of Medical Sciences, 27(5), 177–183. doi:10.1016/j.kjms.2010.09.003.
Miranda, J. F., García-Portilla, M. G., Martínez, P. S., Cienfuegos, E. G., & García, J. B. (1999). Calidad de vida y severidad de la adicción en heroinómanos en mantenimiento prolongado con metadona. Adicciones, 11(1), 43–52.
Costenbader, E. C., Zule, W. A., & Coomes, C. M. (2007). The impact of illicit drug use and harmful drinking on quality of life among injection drug users at high risk for hepatitis C infection. Drug and Alcohol Dependence, 89(2–3), 251–258. doi:10.1016/j.drugalcdep.2007.01.006.
Díaz-Morán, S., Palma-Álvarez, R. F., Grau-López, L., Daigre, C., Barral, C., Ros-Cucurull, E., et al. (2015). Self-perceived quality of life in cocaine dependents with or without dual diagnosis. Salud Mental, 38(6), 397–402. doi:10.17711/SM.0185-3325.2015.053.
Bagheri, M., Mokri, A., Khosravi, A., & Kabir, K. (2015). Effect of abstinence on depression, anxiety, and quality of life in chronic methamphetamine users in a therapeutic community. International Journal of High Risk Behaviors and Addiction. doi:10.5812/ijhrba.23903.
Iraurgi Castillo, I., Póo, M., & Márkez Alonso, I. (2004). Valoración del índice de salud sf-36 aplicado a usuarios de programas de metadona: valores de referencia para la Comunidad Autónoma Vasca. Revista española de salud pública, 78(5), 609–621.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.
Ware, J. E., & Kosinski, M. (2001). Interpreting SF-36 summary health measures: a response. Quality of Life Research, 10(5), 405–413.
Apolone, G., Brazier, J., Bullinger, M., Kama, S., Leplège, A., Prieto, L., et al. (1998). The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: Results from the 1QOLA project. Journal of Clinical Epidemiology, 51(11), 1167–1170.
Lee, J. W., Brown, E. S., Perantie, D. C., & Bobadilla, L. (2002). A comparison of single-item visual analog scales with a multiitem likert-type scale for assessment of cocaine craving in persons with bipolar disorder. Addictive Disorders & Their Treatment, 1(4), 140–142.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2012). Structured clinical interview for DSM-IV ® Axis I disorders (SCID-I), Clinician Version, Administration Booklet. New York: American Psychiatric Pub.
First, M. B. (1997). User’s guide for the structured clinical interview for DSM-IV Axis II personality disorders: SCID-II. New York: American Psychiatric Pub.
Epstein, J. N., & Kollins, S. H. (2006). Psychometric properties of an adult ADHD diagnostic interview. Journal of Attention Disorders, 9(3), 504–514. doi:10.1177/1087054705283575.
Heslin, K. C., Stein, J. A., Heinzerling, K. G., Pan, D., Magladry, C., & Hays, R. D. (2011). Clinical correlates of health-related quality of life among opioid-dependent patients. Quality of Life Research, 20(8), 1205–1213. doi:10.1007/s11136-011-9858-y.
Vilagut, G., Ferrer, M., Rajmil, L., Rebollo, P., Permanyer-Miralda, G., Quintana, J. M., et al. (2005). El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos. Gaceta Sanitaria, 19(2), 135–150.
Alonso, J., Regidor, E., Barrio, G., Prieto, L., Rodríguez, C., & de la Fuente, L. (1998). Population reference values of the Spanish version of the Health Questionnaire SF-36. Medicina Clínica, 111(11), 410–416.
Moore, A. A., Seeman, T., Morgenstern, H., Beck, J. C., & Reuben, D. B. (2002). Are there differences between older persons who screen positive on the CAGE questionnaire and the Short Michigan Alcoholism Screening Test—Geriatric Version? Journal of the American Geriatrics Society, 50(5), 858–862.
Malmusi, D., Artazcoz, L., Benach, J., & Borrell, C. (2012). Perception or real illness? How chronic conditions contribute to gender inequalities in self-rated health. The European Journal of Public Health, 22(6), 781–786. doi:10.1093/eurpub/ckr184.
Strine, T. W., Mokdad, A. H., Dube, S. R., Balluz, L. S., Gonzalez, O., Berry, J. T., et al. (2008). The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. General Hospital Psychiatry, 30(2), 127–137. doi:10.1016/j.genhosppsych.2007.12.008.
Goldstein, B. I., Carnethon, M. R., Matthews, K. A., McIntyre, R. S., Miller, G. E., Raghuveer, G., et al. (2015). Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: A scientific statement from the American heart association. Circulation, 132(10), 965–986. doi:10.1161/CIR.0000000000000229.
Celano, C. M., Daunis, D. J., Lokko, H. N., Campbell, K. A., & Huffman, J. C. (2016). Anxiety disorders and cardiovascular disease. Current Psychiatry Reports, 18(11), 101. doi:10.1007/s11920-016-0739-5.
Dinkel, A., Kremsreiter, K., Marten-Mittag, B., & Lahmann, C. (2014). Comorbidity of fear of progression and anxiety disorders in cancer patients. General Hospital Psychiatry, 36(6), 613–619. doi:10.1016/j.genhosppsych.2014.08.006.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51(1), 8–19.
Herrero, M. J., Domingo-Salvany, A., Torrens, M., Brugal, M. T., & ITINERE Investigators. (2008). Psychiatric comorbidity in young cocaine users: induced versus independent disorders. Addiction (Abingdon, England), 103(2), 284–293. doi:10.1111/j.1360-0443.2007.02076.x.
Srisurapanont, M., Likhitsathian, S., Chua, H. C., Udomratn, P., Chang, S., Maneeton, N., et al. (2015). Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder. Journal of Affective Disorders, 186, 26–31. doi:10.1016/j.jad.2015.06.032.
Martínez, J. M., Graña, J. L., & Trujillo, H. (2011). Longitudinal study on quality of life, craving and psychological adjustment in alcohol-dependent patients: variations depending on the personality disorders. Adicciones, 23(3), 227–235.
Walter, K. N., & Petry, N. M. (2016). Lifetime suicide attempt history, quality of life, and objective functioning among HIV/AIDS patients with alcohol and illicit substance use disorders. International Journal of STD and AIDS, 27(6), 476–485. doi:10.1177/0956462415585668.
Wilcox, H. C., Conner, K. R., & Caine, E. D. (2004). Association of alcohol and drug use disorders and completed suicide: An empirical review of cohort studies. Drug and Alcohol Dependence, 76(Suppl), S11–S19. doi:10.1016/j.drugalcdep.2004.08.003.
Hasin, D. S., & Grant, B. F. (2015). The national epidemiologic survey on alcohol and related conditions (NESARC) waves 1 and 2: Review and summary of findings. Social Psychiatry and Psychiatric Epidemiology, 50(11), 1609–1640. doi:10.1007/s00127-015-1088-0.
Compton, W. M., Thomas, Y. F., Stinson, F. S., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 64(5), 566–576. doi:10.1001/archpsyc.64.5.566.
McGovern, M. P., Lambert-Harris, C., Gotham, H. J., Claus, R. E., & Xie, H. (2014). Dual diagnosis capability in mental health and addiction treatment services: An assessment of programs across multiple state systems. Administration and Policy In Mental Health, 41(2), 205–214. doi:10.1007/s10488-012-0449-1.
Szerman, N., Vega, P., Grau-López, L., Barral, C., Basurte-Villamor, I., Mesías, B., et al. (2014). Dual diagnosis resource needs in Spain: A national survey of professionals. Journal of Dual Diagnosis, 10(2), 84–90. doi:10.1080/15504263.2014.906195.
Acknowledgements
We are grateful to our research team for their collaboration and support, particularly Raul-Felipe Palma, María Robles, Angel Egido, Joan Alvarós (Psychiatrist), Eduardo Castrillo, Manuel Pelaez (Nurse), Marta Perea and Diana Romero (Psychologists).
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The study was supported by a Grant from the Delegación del Gobierno para el Plan Nacional sobre Drogas 2013I044: “Complicaciones clínicas y accidentabilidad asociadas a la presencia de síntomas psicóticos en consumidores de cocaína”.
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All authors declare that they have no conflicts of interest concerning this article.
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Informed consent was obtained from all individual participants included in the study. The project was approved by the Ethics Committee of the Vall d’Hebron Hospital. Patients did not receive any financial compensation.
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Daigre, C., Grau-López, L., Rodríguez-Cintas, L. et al. The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain. Qual Life Res 26, 3201–3209 (2017). https://doi.org/10.1007/s11136-017-1668-4
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DOI: https://doi.org/10.1007/s11136-017-1668-4