Psychiatric co-morbidity among male heroin addicts: differences between hospital and incarcerated subjects in Taiwan.

AIMS: To examine the differences in psychiatric co-morbidity between hospital and incarcerated groups of heroin addicts in Taiwan. DESIGN: Life-time prevalence of DSM-III-R-based coexisting psychiatric disorders, including personality disorders, were surveyed. SETTINGS: A psychiatric hospital and two prisons. PARTICIPANTS: Two hundred and sixty heroin users who were incarcerated in prisons, and 47 heroin users who voluntarily sought help in a psychiatric hospital were interviewed by board-certified psychiatrists. MEASUREMENTS: Using two psychometric instruments, the Psychiatric Diagnostic Assessment (PDA) and the Structured Interview for DSM-III-R Personality Disorders (SIPD-R), psychiatric co-morbidity was assessed. FINDINGS: Different life-time rates of coexisting psychiatric disorders among heroin addicts in different settings were found: 83% of hospital subjects and 66% of incarcerated subjects were diagnosed as having at least one coexisting axis I or II disorder. The most prevalent coexisting DSM-III-R defined axis I disorders were additional substance use disorders (alcohol and methamphetamine), while the axis II disorder was antisocial personality disorder. The hospital group had a significantly higher prevalence rate of mood disorder (p < 0.001), paranoid personality disorder (p < 0.05) and antisocial personality disorder (p < 0.001) than the incarcerated group. CONCLUSIONS: We suggest that heroin addicts with coexisting psychiatric disorders receive relevant psychiatric treatment. Those with personality disorders, especially the antisocial type, should be considered for specialized therapeutic community programmes instead of incarceration.