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November 21, 1990, Vol 264, No. 19 >
ARTICLE | November 21, 1990

Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse: Title and subTitle BreakResults From the Epidemiologic Catchment Area (ECA) Study FREE

Darrel A. Regier, MD, MPH; Mary E. Farmer, MD, MPH; Donald S. Rae, MS; Ben Z. Locke, MSPH; Samuel J. Keith, MD; Lewis L. Judd, MD; Frederick K. Goodwin, MD
[+] Author Affiliations

Reprint requests to Division of Clinical Research, National Institute of Mental Health, 5600 Fishers Ln, Room 10-105, Rockville, MD 20857 (Dr Regier).


JAMA. 1990;264(19):2511-2518. doi:10.1001/jama.1990.03450190043026
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Published online
Article
References

The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20 291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non—substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders.

(JAMA. 1990;264:2511-2518)

REFERENCES

1 +
Regier DA, Myers JK, Kramer M, et al.  The NIMH Epidemiologic Catchment Area: historical context, major objectives, and study population characteristics . Arch Gen Psychiatry . 1984;;41:934-941.
2 +
Freedman DX.  Psychiatric epidemiology counts . Arch Gen Psychiatry . 1984;;41:931-933.
3 +
Regier DA, Boyd JH, Burke JD, et al.  One-month prevalence of mental disorders in the United States based on five Epidemiologic Catchment Area sites . Arch Gen Psychiatry . 1988;;45:977-986.
4 +
Koob GF, Bloom FE.  Cellular and molecular mechanisms of drug dependence . Science . 1988;; 242:715-723.
5 +
McLellan AT, Childress AR, Griffith J, Woody GE.  The psychiatrically severe drug abuse patient: methadone maintenance or therapeutic community? Am J Drug Alcohol Abuse . 1984;;10:77-95.
6 +
Regier DA, Hirschfeld RMA, Goodwin FK, Burke JD, Lazar JB, Judd LL.  The NIMH Depression Awareness, Recognition, and Treatment Program: structure, aims, and scientific basis . Am J Psychiatry . 1988;;145:1351-1357.
7 +
Pepper B, Ryglewicz H.  Treating the young adult chronic patient: an update . New Dir Ment Health Serv. 1984;;21:5-15.
8 +
Safer DJ.  Substance abuse by young adult chronic patients . Hosp Community Psychiatry . 1987;;38:511-514.
9 +
Koegel P, Burnam A.  The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles . Arch Gen Psychiatry . 1988;;45:1085-1092.
10 +
Breakey WR, Fischer PJ, Kramer M, et al.  Health and mental health problems of homeless men and women in Baltimore . JAMA . 1989;;262: 1352-1357.
11 +
Herrman H, McGorry P, Bennett P, van Riel R, Singh B.  Prevalence of severe mental disorders in disaffiliated and homeless people in inner Melbourne . Am J Psychiatry . 1989;;146:1179-1184.
12 +
Berkson J.  Limitations of the application of four-fold tables to hospital data . Biometric Bull. 1946;;2:47-53.
13 +
Boyd JH, Burke JD, Gruenberg E, et al.  Exclusion criteria of DSM-III: a study of co-occurrence of hierarchy-free syndromes . Arch Gen Psychiatry . 1984;;41:983-989.
14 +
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Third Edition. Washington, DC: American Psychiatric Association; 1980;.
15 +
Helzer JE, Pryzbeck TR.  The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment . J Stud Alcohol . 1988;;49:219-224.
16 +
Robins LN, Helzer JE, Przybeck TR, Regier DA.  Alcohol disorders in the community: a report from the Epidemiologic Catchment Area . In: Rose RM, ed. Alcoholism: Origins and Outcome . New York, NY: Raven Press; 1988;:15-29.
17 +
Christie KA, Burke JD, Regier DA, Rae DS, Boyd JH, Locke BZ.  Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults . Am J Psychiatry . 1988;;145:971-975.
18 +
Burke KC, Burke JD, Regier DA, Rae DS.  Age at onset of selected mental disorders in five community populations . Arch Gen Psychiatry . 1990;;47:511-518.
19 +
Weissman MM, Myers JK, Harding PS.  Prevalence and psychiatric heterogeneity of alcoholism in a United States urban community . J Stud Alcohol . 1980;;41:672-681.
20 +
Deykin EY, Levy JC, Wells V.  Adolescent depression, alcohol, and drug abuse . Am J Public Health . 1986;;77:178-182.
21 +
Lewis CE, Robins L, Rice J.  Association of alcoholism with antisocial personality in urban men . J Nerv Ment Dis. 1985;;173:166-174.
22 +
Wolf AW, Schubert DSP, Patterson MB, Grande TP, Brocco KJ, Pendleton L.  Associations among major psychiatric diagnoses . J Consult Clin Psychol. 1988;;56:292-294.
23 +
Hasin D, Endicott J, Lewis C.  Alcohol and drug abuse in patients with affective syndromes . Compr Psychiatry . 1985;;26:283-295.
24 +
Lewis CE, Helzer J, Cloninger CR, Croughan J, Whitman BY.  Psychiatric diagnostic predispositions to alcoholism . Compr Psychiatry . 1982;; 23:451-461.
25 +
Hall RCW, Popkin MK, Stickney SK, Gardner ER.  Covert outpatient drug abuse . J Nerv Ment Dis. 1978;;166:343-348.
26 +
Crowley TJ, Chesluk D, Dilts S, Hart R.  Drug and alcohol abuse among psychiatric admissions . Arch Gen Psychiatry . 1974;;30:13-20.
27 +
Hasin DS, Grant BF, Endicott J.  Lifetime psychiatric co-morbidity in hospitalized alcoholics: subject and familial correlates . Int J Addict . 1988;;23:827-850.
28 +
Hesselbrock MN, Meyer RE, Keener JJ.  Psychopathology in hospitalized alcoholics . Arch Gen Psychiatry . 1985;;42:1050-1055.
29 +
Schuckit MA.  Alcoholic patients with secondary depression . Am J Psychiatry . 1983;;140:711-714.
30 +
Powell BJ, Penick EC, Othmer E, Bingham SF, Rice AS.  Prevalence of additional psychiatric syndromes among male alcoholics . J Clin Psychiatry . 1982;;43:404-407.
31 +
Tyndel M.  Psychiatric study of one thousand alcoholic patients . Can Psychiatr Assoc J. 1974;;19:21-24.
32 +
Ross HE, Glaser FB, Germanson T.  The prevalence of psychiatric disorders in patients with alcohol and other drug problems . Arch Gen Psychiatry . 1988;;45:1023-1031.
33 +
Weiss RD, Mirin SM, Michael JL, Sollogub AC.  Psychopathology in chronic cocaine abusers . Am J Drug Alcohol Abuse . 1986;;12:17-29.
34 +
Khantzian EJ, Treece C.  DSM-III psychiatric diagnosis of narcotic addicts: recent findings . Arch Gen Psychiatry . 1985;;42:1067-1071.
35 +
Rounsaville BS, Weissman MM, Kleber HD, Wilber C.  Heterogeneity of psychiatric diagnosis in treated opiate addicts . Arch Gen Psychiatry . 1982;;39:161-166.
36 +
Croughan JL, Miller JP, Wagelin D, Whitman BY.  Psychiatric illness in male and female narcotic addicts . J Clin Psychiatry . 1982;;43:225-228.
37 +
Eaton WW, Holzer CE, Von Korff M, et al.  The design of the Epidemiologic Catchment Area surveys: the control and measurement of error . Arch Gen Psychiatry . 1984;;41:942-948.
38 +
Eaton WW, Kessler LG, eds. Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program . Orlando, Fla: Academic Press Inc; 1985;.
39 +
Robins LN, Regier DA, eds. Psychiatric Disorders in America . New York, NY: Free Press; 1990;.
40 +
Robins LN, Helzer JE, Croughan J, Williams JBW, Spitzer RL. NIMH Diagnostic Interview Schedule: Version III . Rockville, Md: National Institute of Mental Health; 1981;.
41 +
Bureau of the Census. Persons in Institutions and Other Group Quarters . Washington, DC: Bureau of the Census; 1980;. Bureau of the Census publication PC 80-2-4D.
42 +
Shah BV. SESUDAAN: Standard Errors Program for Computing of Standardized Rates From Sample Survey Data . Research Triangle, NC: Research Triangle Institute; 1981;.
43 +
Fleiss JL. Statistical Methods for Rates and Proportions . New York, NY: John Wiley & Sons Inc; 1973;.
44 +
SAS Institute Inc. SUGI Supplemental Library User's Guide, Version 5 . Cary, NC: SAS Institute Inc; 1986;:269-93.
45 +
Shah BV, Folsom RE, Harrell FE, Dillard CN. Survey Data Analysis Software for Logistic Regression . Research Triangle, NC: Research Triangle Institute; 1984;.
46 +
Snyder SH.  The dopamine hypothesis of schizophrenia: focus on the dopamine receptor . Am J Psychiatry . 1976;;133:197-202.
47 +
Ritz MC, Lamb RJ, Goldberg SR, Kuhar MJ.  Cocaine receptors on dopamine transporters are related to self-administration of cocaine . Science . 1987;;237:1219-1223.
48 +
Goodwin FK, Sack RL.  Affective disorders: the catecholamine hypothesis revisited . In: Usdin E, Snyder S, eds. Frontiers in Catecholamine Research . Elmsford, NY: Pergamon Press Inc; 1973;:1157-1164.
49 +
Ballenger JC, Goodwin FK, Major FL, Brown GL.  Alcohol and central serotonin metabolism in man . Arch Gen Psychiatry . 1979;;36:224-227.
50 +
Rounsaville BS, Weissman MM, Crits-Cristoph K, Wilber C, Kleber HD.  Diagnosis and symptoms of depression in opiate addicts . Arch Gen Psychiatry . 1982;;39:151-156.
51 +
Schuckit MA, Monteiro MG.  Alcoholism, anxiety, and depression . Br J Addict . 1988;;83:1373-1380.
52 +
Szuster RR, Pontrius EB, Campos PE.  Marijuana sensitivity and panic anxiety . J Clin Psychiatry . 1988;;49:427-429.
53 +
Kleber HD, Gawin FH.  Psychopharmacological trials in cocaine abuse treatment . Am J Drug Alcohol Abuse . 1986;;12:235-246.
54 +
Kosten TR, Schumann B, Wright D, et al.  A pilot study using desipramine for cocaine abusing methadone maintenance patients . J Clin Psychiatry . 1987;;48:442-444.
55 +
Kosten TR.  Pharmacotherapeutic interventions for cocaine abuse: matching patients to treatments . J Nerv Ment Dis. 1989;;177:379-89.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Regier DA, Myers JK, Kramer M, et al.  The NIMH Epidemiologic Catchment Area: historical context, major objectives, and study population characteristics . Arch Gen Psychiatry . 1984;;41:934-941.
2 +
Freedman DX.  Psychiatric epidemiology counts . Arch Gen Psychiatry . 1984;;41:931-933.
3 +
Regier DA, Boyd JH, Burke JD, et al.  One-month prevalence of mental disorders in the United States based on five Epidemiologic Catchment Area sites . Arch Gen Psychiatry . 1988;;45:977-986.
4 +
Koob GF, Bloom FE.  Cellular and molecular mechanisms of drug dependence . Science . 1988;; 242:715-723.
5 +
McLellan AT, Childress AR, Griffith J, Woody GE.  The psychiatrically severe drug abuse patient: methadone maintenance or therapeutic community? Am J Drug Alcohol Abuse . 1984;;10:77-95.
6 +
Regier DA, Hirschfeld RMA, Goodwin FK, Burke JD, Lazar JB, Judd LL.  The NIMH Depression Awareness, Recognition, and Treatment Program: structure, aims, and scientific basis . Am J Psychiatry . 1988;;145:1351-1357.
7 +
Pepper B, Ryglewicz H.  Treating the young adult chronic patient: an update . New Dir Ment Health Serv. 1984;;21:5-15.
8 +
Safer DJ.  Substance abuse by young adult chronic patients . Hosp Community Psychiatry . 1987;;38:511-514.
9 +
Koegel P, Burnam A.  The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles . Arch Gen Psychiatry . 1988;;45:1085-1092.
10 +
Breakey WR, Fischer PJ, Kramer M, et al.  Health and mental health problems of homeless men and women in Baltimore . JAMA . 1989;;262: 1352-1357.
11 +
Herrman H, McGorry P, Bennett P, van Riel R, Singh B.  Prevalence of severe mental disorders in disaffiliated and homeless people in inner Melbourne . Am J Psychiatry . 1989;;146:1179-1184.
12 +
Berkson J.  Limitations of the application of four-fold tables to hospital data . Biometric Bull. 1946;;2:47-53.
13 +
Boyd JH, Burke JD, Gruenberg E, et al.  Exclusion criteria of DSM-III: a study of co-occurrence of hierarchy-free syndromes . Arch Gen Psychiatry . 1984;;41:983-989.
14 +
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Third Edition. Washington, DC: American Psychiatric Association; 1980;.
15 +
Helzer JE, Pryzbeck TR.  The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment . J Stud Alcohol . 1988;;49:219-224.
16 +
Robins LN, Helzer JE, Przybeck TR, Regier DA.  Alcohol disorders in the community: a report from the Epidemiologic Catchment Area . In: Rose RM, ed. Alcoholism: Origins and Outcome . New York, NY: Raven Press; 1988;:15-29.
17 +
Christie KA, Burke JD, Regier DA, Rae DS, Boyd JH, Locke BZ.  Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults . Am J Psychiatry . 1988;;145:971-975.
18 +
Burke KC, Burke JD, Regier DA, Rae DS.  Age at onset of selected mental disorders in five community populations . Arch Gen Psychiatry . 1990;;47:511-518.
19 +
Weissman MM, Myers JK, Harding PS.  Prevalence and psychiatric heterogeneity of alcoholism in a United States urban community . J Stud Alcohol . 1980;;41:672-681.
20 +
Deykin EY, Levy JC, Wells V.  Adolescent depression, alcohol, and drug abuse . Am J Public Health . 1986;;77:178-182.
21 +
Lewis CE, Robins L, Rice J.  Association of alcoholism with antisocial personality in urban men . J Nerv Ment Dis. 1985;;173:166-174.
22 +
Wolf AW, Schubert DSP, Patterson MB, Grande TP, Brocco KJ, Pendleton L.  Associations among major psychiatric diagnoses . J Consult Clin Psychol. 1988;;56:292-294.
23 +
Hasin D, Endicott J, Lewis C.  Alcohol and drug abuse in patients with affective syndromes . Compr Psychiatry . 1985;;26:283-295.
24 +
Lewis CE, Helzer J, Cloninger CR, Croughan J, Whitman BY.  Psychiatric diagnostic predispositions to alcoholism . Compr Psychiatry . 1982;; 23:451-461.
25 +
Hall RCW, Popkin MK, Stickney SK, Gardner ER.  Covert outpatient drug abuse . J Nerv Ment Dis. 1978;;166:343-348.
26 +
Crowley TJ, Chesluk D, Dilts S, Hart R.  Drug and alcohol abuse among psychiatric admissions . Arch Gen Psychiatry . 1974;;30:13-20.
27 +
Hasin DS, Grant BF, Endicott J.  Lifetime psychiatric co-morbidity in hospitalized alcoholics: subject and familial correlates . Int J Addict . 1988;;23:827-850.
28 +
Hesselbrock MN, Meyer RE, Keener JJ.  Psychopathology in hospitalized alcoholics . Arch Gen Psychiatry . 1985;;42:1050-1055.
29 +
Schuckit MA.  Alcoholic patients with secondary depression . Am J Psychiatry . 1983;;140:711-714.
30 +
Powell BJ, Penick EC, Othmer E, Bingham SF, Rice AS.  Prevalence of additional psychiatric syndromes among male alcoholics . J Clin Psychiatry . 1982;;43:404-407.
31 +
Tyndel M.  Psychiatric study of one thousand alcoholic patients . Can Psychiatr Assoc J. 1974;;19:21-24.
32 +
Ross HE, Glaser FB, Germanson T.  The prevalence of psychiatric disorders in patients with alcohol and other drug problems . Arch Gen Psychiatry . 1988;;45:1023-1031.
33 +
Weiss RD, Mirin SM, Michael JL, Sollogub AC.  Psychopathology in chronic cocaine abusers . Am J Drug Alcohol Abuse . 1986;;12:17-29.
34 +
Khantzian EJ, Treece C.  DSM-III psychiatric diagnosis of narcotic addicts: recent findings . Arch Gen Psychiatry . 1985;;42:1067-1071.
35 +
Rounsaville BS, Weissman MM, Kleber HD, Wilber C.  Heterogeneity of psychiatric diagnosis in treated opiate addicts . Arch Gen Psychiatry . 1982;;39:161-166.
36 +
Croughan JL, Miller JP, Wagelin D, Whitman BY.  Psychiatric illness in male and female narcotic addicts . J Clin Psychiatry . 1982;;43:225-228.
37 +
Eaton WW, Holzer CE, Von Korff M, et al.  The design of the Epidemiologic Catchment Area surveys: the control and measurement of error . Arch Gen Psychiatry . 1984;;41:942-948.
38 +
Eaton WW, Kessler LG, eds. Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program . Orlando, Fla: Academic Press Inc; 1985;.
39 +
Robins LN, Regier DA, eds. Psychiatric Disorders in America . New York, NY: Free Press; 1990;.
40 +
Robins LN, Helzer JE, Croughan J, Williams JBW, Spitzer RL. NIMH Diagnostic Interview Schedule: Version III . Rockville, Md: National Institute of Mental Health; 1981;.
41 +
Bureau of the Census. Persons in Institutions and Other Group Quarters . Washington, DC: Bureau of the Census; 1980;. Bureau of the Census publication PC 80-2-4D.
42 +
Shah BV. SESUDAAN: Standard Errors Program for Computing of Standardized Rates From Sample Survey Data . Research Triangle, NC: Research Triangle Institute; 1981;.
43 +
Fleiss JL. Statistical Methods for Rates and Proportions . New York, NY: John Wiley & Sons Inc; 1973;.
44 +
SAS Institute Inc. SUGI Supplemental Library User's Guide, Version 5 . Cary, NC: SAS Institute Inc; 1986;:269-93.
45 +
Shah BV, Folsom RE, Harrell FE, Dillard CN. Survey Data Analysis Software for Logistic Regression . Research Triangle, NC: Research Triangle Institute; 1984;.
46 +
Snyder SH.  The dopamine hypothesis of schizophrenia: focus on the dopamine receptor . Am J Psychiatry . 1976;;133:197-202.
47 +
Ritz MC, Lamb RJ, Goldberg SR, Kuhar MJ.  Cocaine receptors on dopamine transporters are related to self-administration of cocaine . Science . 1987;;237:1219-1223.
48 +
Goodwin FK, Sack RL.  Affective disorders: the catecholamine hypothesis revisited . In: Usdin E, Snyder S, eds. Frontiers in Catecholamine Research . Elmsford, NY: Pergamon Press Inc; 1973;:1157-1164.
49 +
Ballenger JC, Goodwin FK, Major FL, Brown GL.  Alcohol and central serotonin metabolism in man . Arch Gen Psychiatry . 1979;;36:224-227.
50 +
Rounsaville BS, Weissman MM, Crits-Cristoph K, Wilber C, Kleber HD.  Diagnosis and symptoms of depression in opiate addicts . Arch Gen Psychiatry . 1982;;39:151-156.
51 +
Schuckit MA, Monteiro MG.  Alcoholism, anxiety, and depression . Br J Addict . 1988;;83:1373-1380.
52 +
Szuster RR, Pontrius EB, Campos PE.  Marijuana sensitivity and panic anxiety . J Clin Psychiatry . 1988;;49:427-429.
53 +
Kleber HD, Gawin FH.  Psychopharmacological trials in cocaine abuse treatment . Am J Drug Alcohol Abuse . 1986;;12:235-246.
54 +
Kosten TR, Schumann B, Wright D, et al.  A pilot study using desipramine for cocaine abusing methadone maintenance patients . J Clin Psychiatry . 1987;;48:442-444.
55 +
Kosten TR.  Pharmacotherapeutic interventions for cocaine abuse: matching patients to treatments . J Nerv Ment Dis. 1989;;177:379-89.

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