The co-occurrence of psychiatric and substance use diagnoses in adolescents in different service systems: frequency, recognition, cost, and outcomes.

The frequency, severity, recognition, cost, and outcomes of adolescent substance use comorbidity were analyzed in the Fort Bragg Demonstration Project. Comorbidity was defined as the co-occurrence of substance use disorder (SUD) with other psychiatric diagnosis. The sample consisted of 428 adolescent clients whose providers' diagnoses were compared with research diagnoses. The project identified 59 clients (13.8%) with SUD, all with additional psychiatric diagnoses. Providers recognized only 21 of these 59 comorbid cases. The frequency and severity of comorbidity did not differ between service system samples, although recognition did. Comorbid clients had more behavior problems and more functioning impairment, and their average treatment cost ($29,057) was more than twice as high as that of noncomorbid clients ($13,067). Mental health outcomes were not influenced by type of service system, comorbid diagnosis, or treatment. Screening for and prevention of SUD are discussed as a potential cost-savings opportunity in mental health services.

Psychological differentiation, event uncertainty, and heart rate.

Psychological differentiation and uncertainty about receiving a painful noise were examined for their effects on heart rate during the anticipatory, impact and recovery phases of the tone presentation. Psychologically differentiated and nondifferentiated subjects were randomly assigned to three event uncertainty conditions (5 percent, 50 percent, 95 percent probability of noise). Subjects were informed of the probability of receiving the noise, as well as the time of occurrence as indicated by a sequentially numbered visual display. Subjects received the noise on the second of the experiment's two trials. Cognitive style and event uncertainty interacted during the anticipatory phase--i.e., differentiated subjects showed a monotonic increase in heart rate with increasing probability of receiving the noise that represents preparation for instrumental activity. Results are consistent with the theory that meaningful personality-stress relationships may be obtained when examining stimulus-oriented dispositions.