Age of onset of substance use in patients with dual diagnosis and its association with clinical characteristics, risk behaviors, course, and outcome: A retrospective study

Abstract

Research Question: Do patients with dual diagnosis (DD) with an early initiation of substance use and subsequent early onset substance use disorder (EOS) differ from those with late onset substance use disorder (LOS) regarding characteristics, sex-related risk behaviors, course, and outcome? Objectives: The aim is to study EOS and LOS groups of patients with DD attending a treatment center with regard to clinical characteristics, type of psychiatric disorders, risk behaviors, and short-term outcome. Materials and Methods: Retrospective chart review of patients diagnosed with DD ( n = 307) with regard to the above variables. Diagnoses of both substance use disorders (SUDs) and psychiatric disorders were made by qualified psychiatrists as per the International Classification of Diseases, 10 th revision. Results: Among 307 participants with DD, 100 were in EOS group (onset of SUD before 18 years of age as assessed clinically) and 207 in LOS group. Cannabis as the primary substance was more prevalent in the EOS (30%) than that of the LOS group (12%). Psychotic disorders were more prevalent in the EOS group (41%) followed by mood disorders (30%), while the reverse was true in the LOS group (27.5% and 56.5%, respectively). When compared to the LOS group, the EOS group had higher number of psychiatric admissions, reported higher prevalence of risky sexual behaviors (unprotected sexual intercourse, multiple sexual partners, and history of sexual intercourse with commercial sex workers), showed poorer treatment adherence, and worse outcome regarding both psychiatric disorder and SUD (all differences significant at P < 0.05). Conclusions: DD patients differ significantly based on the age of onset of substance use. These may have therapeutic and management implications.

TAPS-tool reveals severe under detection of substance use problems in patients with severe mental illness

“…In a SMI population, it would be helpful to know about substance use and consequent problems even if they don’t reach the SUD threshold because substance use can mimic many mental health symptoms such as depression, mania, or a personality disorder. Their use can also exacerbate symptoms and occurring use is likely associated with suicide [ 13 , 15 , 16 ]. The worsening of psychiatric symptoms due to substance use may also be the reason why significant others are concerned about a patient’s substance use.…”

“…Besides, they experience more stress, have insufficient social support and use substances as self-medication due to a lack of more healthy coping skills [ 14 ]. Consequences of SUD in patients with SMI are: more (re)admissions, homelessness, behavioral problems, suicide attempts, death, exacerbation of mental health problems as well as exacerbation of addiction problems, poorer treatment outcome and higher societal costs as result [ 13 , 15 , 16 ].…”

Neurotoxic or Protective Cannabis Components: Delta-9-Tetrahydrocannabinol (Δ9THC) and Cannabidiol (CBD)

“…99,160-162 Cannabis use in adolescents greatly increases the risk of psychosis by 3-4-fold and has been shown to lower the age of schizophrenia onset. 163, 164 Further, adolescent cannabis use will increase the probability of future drug use, 165 as shown by evidence from animal and epidemiological studies. 152,166,167 Adult exposure to Δ9 THC Acute adult effects in Long-Evans male rats as well as C57BL/6Arc and CD1 male mice showed behavioral effects (attention and learning, decreased anxiety and locomotor activity) at low Δ9 THC doses (i.p.…”

Clinical care of patients with dual disorders in India: diverse models of care delivery

“…These facilities also conduct weekly academic programs such as case conferences, journal clubs and seminars where issues related to dual diagnosis are also discussed. Faculty members at these facilities are engaged in research on dual disorders and the findings have been published in various peer reviewed academic journals, (Balhara et al, 2017b(Balhara et al, , 2017a(Balhara et al, , 2016aBalhara, 2022;Tripathi et al, 2021;Singh Balhara et al, 2021;Basu et al, 2013;Ghosh, 2015;Subodh et al, 2019;Subodh et al, 2017;Ghosh et al, 2022).…”