Mental Disorders as Risk factors for Substance Use, Abuse and Dependence: Results from the 10-year Follow-up of the National Comorbidity Survey

By J. Swendsen, K. Conway, L. Degenhardt, M. Glantz, R. Jin, Kathleen R. Merikangas, N. Sampson, Ronald C. Kessler. Addiction, 2010

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Aims The comorbidity of mental disorders and substance dependence is well-documented, but prospective investigations in community samples are rare. This investigation examines the role of primary mental disorders as risk factors for the later onset of nicotine, alcohol and illicit drug use, abuse, and dependence with abuse. Design The NCS was a nationally representative survey of mental and substance disorders in the US carried out in 1990 1992. The NCS-2 re-interviewed a probability sub-sample of NCS respondents in 2001-2003, a decade after the baseline survey. Participants A total of 5,001 NCS respondents were re-interviewed in the NCS-2 (87.6% of baseline sample). Results Aggregate analyses demonstrated significant prospective risks posed by baseline mental disorders for the onset of nicotine, alcohol and illicit drug dependence with abuse over the follow-up period. Particularly strong and consistent associations were observed for behavioral disorders and previous substance use conditions, as well as for certain mood and anxiety disorders. Conditional analyses demonstrated that many observed associations were limited to specific categories of use, abuse or dependence, including several mental disorders that were nonsignificant predictors in the aggregate analyses. Results suggest that secondary substance use disorders might be reduced substantially through the prevention of primary mental disorders. Conclusions Many mental disorders are associated with an increased risk of later substance use conditions but important differences in these associations are observed across the categories of use, abuse and dependence with abuse. These prospective findings have implications for the precision of prevention and treatment strategies targeting substance use disorders.

Subfields: Epidemiology, Physiology, Social Psychology

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