Kidorf Michael, Disney Elizabeth R, King Van L, Neufeld Karin, Beilenson Peter L, Brooner Robert K
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, USA.
Drug Alcohol Depend. 2004 May 10;74(2):115-22. doi: 10.1016/j.drugalcdep.2003.11.014.
The present study evaluates the prevalence of psychiatric and substance use disorders in male and female intravenous opioid abusers participating at a community needle exchange program (NEP). All participants (n = 422) were administered the Structured Clinical Interview for the DSM-IV (SCID) for Axis I disorders and antisocial personality disorder (APD). Psychiatric and substance abuse comorbidity were highly prevalent. Major depression was the most common current and lifetime Axis I non-substance use disorder (6 and 21% of the sample, respectively); 37% were diagnosed with APD. Over 50% of the sample was diagnosed with at least one non-substance use Axis I disorder or APD. In addition to opioid dependence, cocaine dependence was the most prevalent current and lifetime substance use disorder (68 and 78% of the sample, respectively), followed by alcohol and cannabis dependence. Overall, participants reported a mean of over one current and over three lifetime substance use disorders in addition to opioid dependence. Women reported higher rates of post-traumatic stress disorder (PTSD), while men were more likely diagnosed with APD. Presence of a psychiatric disorder was associated with increased prevalence of substance use disorder for all drug classes. The high rates of comorbidity observed in this sample suggest that the harm reduction efforts of NEPs can be significantly enhanced through referral of participants to programs that treat substance use and/or other psychiatric disorders.
本研究评估了参与社区针头交换项目（NEP）的男性和女性静脉注射阿片类药物滥用者中精神障碍和物质使用障碍的患病率。所有参与者（n = 422）均接受了针对轴I障碍和反社会人格障碍（APD）的《精神疾病诊断与统计手册》第四版（DSM-IV）结构化临床访谈（SCID）。精神障碍和物质滥用共病情况极为普遍。重度抑郁症是最常见的当前及终生轴I非物质使用障碍（分别占样本的6%和21%）；37%的人被诊断为反社会人格障碍。超过50%的样本被诊断患有至少一种非物质使用轴I障碍或反社会人格障碍。除阿片类药物依赖外，可卡因依赖是最普遍的当前及终生物质使用障碍（分别占样本的68%和78%），其次是酒精和大麻依赖。总体而言，参与者报告除阿片类药物依赖外，平均有超过一种当前物质使用障碍和超过三种终生物质使用障碍。女性报告的创伤后应激障碍（PTSD）发生率较高，而男性更易被诊断为反社会人格障碍。精神障碍的存在与所有药物类别的物质使用障碍患病率增加相关。该样本中观察到的高共病率表明，通过将参与者转介至治疗物质使用和/或其他精神障碍的项目，可以显著加强针头交换项目的减少伤害努力。
