Compton W M, Cottler L B, Phelps D L, Ben Abdallah A, Spitznagel E L
Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo. 63108, USA.
Am J Addict. 2000 Spring;9(2):126-34. doi: 10.1080/10550490050173190.
The relationship between substance use disorders and comorbid psychiatric conditions was investigated among 425 persons in drug treatment who met DSM-III-R criteria for drug dependence. Using the NIMH Diagnostic Interview Schedule to ascertain DSM-III-R psychiatric disorders among these drug dependent subjects, lifetime prevalence rates were 64% for alcohol abuse/dependence, 44% for antisocial personality disorder, 39% for phobic disorders, 24% for major depression, 12% for dysthymia, and 10% for generalized anxiety disorder. We found that antisocial personality disorder and phobias generally had onsets prior to the onset of drug dependence (that is, they were primary disorders). The majority of drug dependent persons with generalized anxiety disorder reported an onset after the onset of drug dependence (that is, they had secondary generalized anxiety). Alcohol dependence, depression, and dysthymia were divided nearly evenly between earlier (primary disorder) and later (secondary disorder). These results are consistent with the body of literature indicating the importance of antisocial syndromes in the etiology of substance abuse and the literature indicating the complex, varying nature of the relationship of psychiatric disorders to substance dependence. Finally, a precise nomenclature for "age of onset," "primary," and "secondary" was developed for this study that is critical to understanding these issues and is recommended for other studies.
在425名符合《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）药物依赖标准的接受药物治疗的人员中，研究了物质使用障碍与共病精神疾病之间的关系。使用美国国立精神卫生研究所诊断访谈表来确定这些药物依赖受试者中的DSM-III-R精神疾病，终生患病率分别为：酒精滥用/依赖64%，反社会人格障碍44%，恐惧症39%，重度抑郁症24%，心境恶劣障碍12%，广泛性焦虑障碍10%。我们发现，反社会人格障碍和恐惧症通常在药物依赖发作之前就已发病（即它们是原发性疾病）。大多数患有广泛性焦虑障碍的药物依赖者报告在药物依赖发作之后发病（即他们患有继发性广泛性焦虑）。酒精依赖、抑郁症和心境恶劣障碍在早期（原发性疾病）和晚期（继发性疾病）之间的分布几乎均匀。这些结果与表明反社会综合征在物质滥用病因学中的重要性的文献以及表明精神疾病与物质依赖关系的复杂性和多变性的文献一致。最后，为本研究制定了关于“发病年龄”“原发性”和“继发性”的精确术语，这对于理解这些问题至关重要，并推荐其他研究使用。
