How do you manage Substance Use Disorders (SUDs) when the patient is also exhibiting signs of non SUD psychiatric disorders such as depression, bipolar, psychosis, PTSD or ADHD?

Substance Use Disorders (SUDs) and non SUD psychiatric disorders such as depression, bipolar, Post Traumatic Stress Disorder (PTSD) or Attention Deficit Hyperactivity Disorder (ADHD) frequently co-occur. The high rates of co-occurrence are explained by multiple theories based on whether it is thought that one causes the other (SUDs can cause substance related mood or anxiety disorders among others, and untreated depression, bipolar, schizophrenia, ADHD or PTSD can lead to substance use which can progress into a SUD) or whether both conditions share a common set of risk factors.

The Psychiatric Interview for Substances and Mental Diseases (PRISM) is helpful to identify independent and substance induced psychiatric disorders.

Having co-occurring disorders worsens the prognosis for either condition, but the literature shows that treating any underlying non-SUD psychiatric disorders will improve the odds of sustained recovery for the SUD, and vice versa. We note that in order to ensure accuracy in the diagnosis of the co-occurring non-SUD disorder, it is important to separate the expected effects of the substance from the observed symptoms (for example, increased energy after using cocaine, is an expected effect of cocaine, rather than evidence of mania). As such, the symptoms of these co-occurring disorders are best assessed after a few weeks following substance use discontinuation to ensure that the observed symptoms are not merely due to intoxication or withdrawal. As such, upon initial presentation, it might be prudent to start with treating the SUD and then treating residual symptoms. Once the initial diagnoses have been confirmed, it is reasonable to treat both conditions simultaneously.

Access “11: Psychiatric Comorbidities: Diagnosis and Treatment of Comorbid Psychiatric Disorders and Opioid Use Disorders” at: https://pcssnow.org/education-training/training-courses/11-psychiatric-comorbidities-diagnosis-treatment-comorbid-psychiatric-disorders-opioid-use-disorders/

More Information can be found here:

https://store.samhsa.gov/product/TIP-42-Substance-Abuse-Treatment-for-Persons-With-Co-Occurring-Disorders/SMA13-3992

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435098/

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