Treating Co-occurring Substance Abuse and Mood Disorders

Hello. I'mStephen M. Strakowski, professor of psychiatry, psychology, and biomedical engineering at the University of Cincinnati, where I also serve as senior vice president and chief strategy officer for the affiliated health system University of Cincinnati Health.

Today I want to talk about the co-occurrence of substance abuse disorders with mood disorders, a common clinical problem. While this discussion could also be relevant to substance abuse co-occurring with anxiety or other mental health conditions, I will use mood disorders as my primary example.

Substance use disorders very commonly co-occur with mood disorders, particularly bipolar disorder, where rates are as high as 40%-60% at some point in patients' lives. In depressive disorders, substance use rates are not quite as high, but at 30%-40% are about twice the rate in the general population.^[1,2]

Co-occurrence the Rule, Not the Exception

If you look at smoking, which is often excluded from these statistics, you will find very high rates of use in patients with bipolar disorder and major depression. With bipolar disorder you will find smoking rates as high as 80%^[1,2]and even higher in some studies. These co-occurrences are so common that they are often the rule rather than the exception. The types of drugs abused almost always reflect what is being widely used in the community.