PSYCH 275 FINAL: comorbidity
4 potential explanatory models
(1) secondary alcoholism model, (2) secondary psychiatric disorder model, (3) common factor model, (4) bi directional model
why do these disorders often co-occur (cont...)
Involvement of similar brain regions. Brain systems that respond to reward and stress, for example, are affected by drugs of abuse and may show abnormalities in patients with certain mental disorders.
comorbidity:
Refers to the presence of two or more illnesses - medical or psychiatric conditions, including alcohol and other drug use disorders - in the same person
the common factor model
a third variable explains the co-occurrence of anxiety and AUDs
the self medication model
people consume alcohol to cope with anxiety disorders, leading to co-occurring AUDs
interpretational difficulties
Determining significance Diagnostic Issues Sampling Strategy
Treatment and Public Policy Implications
Need to implement and test integrated treatment Need to address policy barriers to increasing integrated treatment and evidence-based approaches
policy implications
Need to remove barriers to improved treatment access for comorbid individuals "Therapeutic Catch-22's" Integrated services through the use of multidisciplinary treatment teams that provide outreach, comprehensive, and stage-wise treatments
why do these disorders often co-occur (cont...)
Overlapping environmental triggers. Stress, trauma (such as physical or sexual abuse), and early exposure to drugs are common environmental factors that can lead to addiction and other mental illnesses.
why do these disorders often co-occur?
Overlapping genetic vulnerabilities. Predisposing genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears.
consideration of comorbidity is important because
Understanding etiology of alcohol and other psychiatric disorders Understanding course of alcohol use disorders Developing and testing integrated treatment approaches for AUD's co-occurring with other psychiatric disorders Developing optimal policies for best serving affected individuals and reducing costs to society
treatment implications
Use and evaluation of integrated treatment approaches is increasing but still rare Pharmacological Treatment Approaches Psychosocial Treatment Approaches
AUD and Anxiety three primary pathways
the common factor model, the self medication model, the substance induced anxiety model
Effects of AUD on Course and Outcome of Schizophrenia
AUD associated w/ more severe course and poorer prognosis although comparisons are methodologically complex
the substance induced anxiety model
AUDs lead to increased anxiety and vulnerability for co-occurring anxiety disorders
AUD and schizophrenia
Contributing Factors: Biological Factors Psychological and Social Factors
why do these disorders often co-occur (cont...)
Drug use disorders and other mental illnesses are developmental disorders. That means they often begin in the teen years or even younger—periods when the brain experiences dramatic developmental changes. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders. Also, early symptoms of a mental disorder may indicate an increased risk for later drug use.