GGZ Oost Brabant, Boekel, The Netherlands.
Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands.
PLoS One. 2024 Jul 24;19(7):e0305142. doi: 10.1371/journal.pone.0305142. eCollection 2024.
Substance use disorders (SUD) and associated problems are highly prevalent but often undetected in patients with Severe Mental Illness (SMI). This study investigates the prevalence, under-detection, and variables associated with a high risk of SUD in a Dutch sample of adult outpatient SMI patients (N = 83).
Substance use (The Tobacco, Alcohol, Prescription medication, and other Substance use -TAPS-tool), quality of life (Manchester Short Assessment of Quality of Life-MANSA), general functioning (Health of the Nation Outcome Scale-HoNOS), DSM-5 classifications and patient characteristics (age, education, marital status) were assessed. Detection of SUD was determined by calculating % agreement of DSM-5 classification to TAPS outcome. A logistic regression analysis was performed to determine the association of patient characteristics, quality of life and general functioning to an increased risk of SUD as determined by the TAPS.
Concerning prevalence, 89% of the patients used tobacco, above guideline-recommended daily limits of alcohol, illicit drugs or prescription medications for nonmedical purposes. Almost all smokers, half of the alcohol users and three-quarter of the patients that use marihuana or stimulant drugs had a high risk of SUD. All patients with high risk of SUD associated with alcohol, drugs or medications also had SUD associated with tobacco use. Concerning under detection less than half of the patients with a high risk of SUD according the TAPS had a SUD in their DSM-5 classification. Gender, partner, age and satisfaction about the relationship with family had a significant association with a high risk of SUD.
Screening for addiction in an SMI sample with the TAPS-tool revealed a high prevalence of substance use and a high risk of SUD. TAPS outcomes compared to the clinically obtained DSM-5 classification revealed a high degree of under-detection of substance use problems. Smoking seems to pose a specific additional risk of addiction and deserves more attention in treatment to achieve greater health care benefits.
物质使用障碍（SUD）及其相关问题在患有严重精神疾病（SMI）的患者中非常普遍，但往往未被发现。本研究调查了荷兰成年门诊 SMI 患者（N=83）样本中 SUD 的患病率、漏诊率以及与 SUD 高风险相关的变量。
使用物质使用（烟草、酒精、处方药物和其他物质使用-TAPS 工具）、生活质量（曼彻斯特短期生活质量评估-MANSA）、一般功能（国民健康结果量表-HoNOS）、DSM-5 分类和患者特征（年龄、教育程度、婚姻状况）进行评估。通过计算 DSM-5 分类与 TAPS 结果的%一致性来确定 SUD 的检出情况。进行逻辑回归分析，以确定患者特征、生活质量和一般功能与 TAPS 确定的 SUD 高风险的关联。
关于患病率，89%的患者使用烟草，超过了酒精、非法药物或处方药物的每日建议限量，用于非医疗目的。几乎所有的吸烟者、一半的饮酒者和四分之三的使用大麻或兴奋剂药物的患者都有 SUD 的高风险。所有 TAPS 确定的与酒精、药物或药物相关的 SUD 高风险患者也与烟草使用相关的 SUD。关于漏诊，根据 TAPS，不到一半的 SUD 高风险患者在 DSM-5 分类中有 SUD。性别、伴侣、年龄和对家庭关系的满意度与 SUD 高风险有显著关联。
使用 TAPS 工具对 SMI 样本进行成瘾筛查显示，物质使用的患病率很高，SUD 的风险很高。TAPS 结果与临床获得的 DSM-5 分类相比，显示出物质使用问题的漏诊程度很高。吸烟似乎构成了成瘾的特定附加风险，值得在治疗中给予更多关注，以实现更大的医疗保健效益。
