Comorbidity Diagnoses and Treatment The high rate of comorbid substance abuse and mental illness points to the need for a comprehensive approach that identifies, evaluates and simultaneously treats both disorders. Patients with co-occurring disorders often exhibit more severe symptoms than either disorder alone, underscoring the need for integrated treatment. Careful diagnosis and monitoring helps ensure that doctors do not mistake symptoms related to drug abuse, like intoxication and withdrawal, for a discrete mental disorder.
Even in people whose comorbidities do not occur simultaneously, research shows that mental disorders can increase vulnerability to subsequent drug abuse and that drug abuse constitutes a risk factor for subsequent mental disorders. Therefore, diagnosis and treatment of one disorder will likely reduce risk for the other or at least improve its prognosis.
Many researchers strongly support the need to develop effective interventions to treat both conditions concurrently, but treatment has been difficult to implement in practice because the health care systems in place to treat substance abuse and mental illness are disjointed and inefficient. Physicians tend to treat patients with mental illnesses, whereas a mix of providers with varying backgrounds delivers drug abuse treatment.
Some substance abuse treatment centers do not administer any medications, including those necessary to treat patients with severe mental disorders.
Behavioral treatment options that doctors customize for a given age group or gender show promise for treating drug abuse and mental disorder comorbidities. Research is under way to identify medications that target both types of disorders. Clinicians and researchers generally agree that broad spectrum diagnosis and concurrent therapies, both pharmacological and behavioral, will lead to better outcomes for patients with comorbid disorders.
The stigma attached to substance abuse and mental disorders often hinders early diagnosis and proper treatment. Greater understanding resulting from recent scientific findings that substance abuse and mental illness disrupt some of the same brain functions will reduce the social stigma that hinders treatment seeking, quality and access by patients with either or both conditions.
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Substance-related disorders
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, is a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders. The coding system utilized by the DSM-IV is designed to correspond with codes from the International Classification of Diseases, commonly referred to as the ICD. Since early versions of the DSM did not correlate with ICD codes and updates of the publications for the ICD and the DSM are not simultaneous, some distinctions in the coding systems may still be present. For this reason, it is recommended that users of these manuals consult the appropriate reference when accessing diagnostic codes.
Alcohol-related disorders
Amphetamine (or amphetamine-like) related disorders
- Amphetamine (or amphetamine-like)
- 305.70 Abuse
- 304.40 Dependence
- 292.89 -Induced anxiety disorder
- 292.84 -Induced mood disorder
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 -Induced sexual dysfunction
- 292.89 -Induced sleep disorder
- 292.89 Intoxication
- 292.81 Intoxication delirium
- 292.9 -Related disorder NOS (includes Amphetamine Withdrawal Psychosis)
- 292.0 Withdrawal
Caffeine-related disorders
- Caffeine
- 292.89 -Induced anxiety disorder
- 292.89 -Induced sleep disorder
- 305.90 Intoxication
- 292.9 -Related disorder NOS
Cannabis-related disorders
- Cannabis
- 305.20 Abuse
- 304.30 Dependence
- 292.89 -Induced anxiety disorder
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 Intoxication
- 292.81 Intoxication delirium
- 292.9 -Related disorder NOS
Cocaine-related disorders
- Cocaine
- 305.60 Abuse
- 304.20 Dependence
- 292.89 -Induced anxiety disorder
- 292.84 -Induced mood disorder
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 -Induced sexual dysfunction
- 292.89 -Induced sleep disorder
- 292.89 Intoxication
- 292.81 Intoxication delirium
- 292.9 -Related disorder NOS
- 292.0 Withdrawal
Hallucinogen-related disorders
Inhalant-related disorders
- Inhalant
- 305.90 Abuse
- 304.60 Dependence
- 292.89 -Induced anxiety disorder
- 292.84 -Induced mood disorder
- 292.82 -Induced persisting dementia
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 Intoxication
- 292.81 Intoxication delirium
- 292.9 -Related disorder NOS
Nicotine-related disorders
- Nicotine
- 305.1 Dependence
- 292.9 -Related disorder NOS
- 292.0 Withdrawal
Opioid-related disorders
- Opioid
- 305.50 Abuse
- 304.00 Dependence
- 292.84 -Induced mood disorder
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 -Induced sexual dysfunction
- 292.89 -Induced sleep disorder
- 292.89 Intoxication
- 292.81 Intoxication delirium
- 292.9 -Related disorder NOS
- 292.0 Withdrawal
Phencyclidine (or phencyclidine-like) related disorders
- Phencyclidine (or phencyclidine-like)
- 305.90 Abuse
- 304.90 Dependence
- 292.89 -Induced anxiety disorder
- 292.84 -Induced mood disorder
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 Intoxication
- 292.81 Intoxication delirium
- 292.9 -Related disorder NOS
Sedative-, hypnotic-, or anxiolytic-related disorders
- Sedative, hypnotic, or anxiolytic
- 305.40 Abuse
- 304.10 Dependence
- 292.89 -Induced anxiety disorder
- 292.84 -Induced mood disorder
- 292.83 -Induced persisting amnestic disorder
- 292.82 -Induced persisting dementia
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 -Induced sexual dysfunction
- 292.89 -Induced sleep disorder
- 292.89 Intoxication
- 292.81 Intoxication delirium
- 292.9 -Related disorder NOS
- 292.0 Withdrawal
- 292.81 Withdrawal delirium
Polysubstance-related disorder
Other (or unknown) substance-related disorder
- Other (or unknown) substance
- 305.90 Abuse
- 304.90 Dependence
- 292.89 -Induced anxiety disorder
- 292.81 -Induced delirium
- 292.84 -Induced mood disorder
- 292.83 -Induced persisting amnestic disorder
- 292.82 -Induced persisting dementia
- 292.11 -Induced psychotic disorder, with delusions
- 292.12 -Induced psychotic disorder, with hallucinations
- 292.89 -Induced sexual dysfunction
- 292.89 -Induced sleep disorder
- 292.89 Intoxication
- 292.9 -Related disorder NOS
- 292.0 Withdrawal
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