Addiction in developmental perspective: influence of conduct disorder severity, subtype, and attention-deficit hyperactivity disorder on problem severity and comorbidity in adults with opioid dependence.

This retrospective cross-sectional study examines whether conduct disorder and attention deficit hyperactivity disorder are associated with problem severity and psychiatric comorbidity in 193 middle-aged, opioid-dependent patients. Conduct disorder history, attention deficit hyperactivity disorder, psychiatric comorbidity, and problem severity were assessed by structured interviews and validated instruments. A conduct disorder history was confirmed in 116 (60.1%) participants. Conduct disorder patients had significantly higher problem severity scores, more frequent comorbid substance use disorders, and more severe psychiatric comorbidity. Attention deficit hyperactivity disorder was found to increase the risk for psychiatric comorbidity. Conduct disorder persistence is a useful model for elucidating complex psychiatric comorbidity of opioid-dependent patients.

Psychiatric comorbidity reduces quality of life in chronic methadone maintained patients.

Despite the efficacy of methadone maintenance treatment (MMT), opioid dependence still involves severe impairment of functioning and low quality of life. This study examines the influence of the psychiatric comorbidity of MMT patients on their quality of life. A total of 193 middle-aged patients in long-term MMT were assessed for current and lifetime Axis I psychiatric disorders, substance use disorders, and personality disorders using the MINI, the CIDI-SAM, and the SIDP-IV. Quality of life (Qol) was assessed using the EQ-5D. Psychiatric comorbidity was documented in 78% of the patients. Mood disorders (60%) and anxiety disorders (46%) were the most common diagnoses. Additional substance use disorders were diagnosed in 70% of the MMT patients. While a probable personality disorder was documented for 65% of the patients, 66 of these patients actually showed an antisocial personality disorder. Qol was severely diminished to a level comparable to that for patients with chronic psychiatric and/or somatic disorders. Multivariate analyses showed the occurrence of comorbid psychiatric disorders to explain about 32% of the variance in Qol. The quality of life for MMT patients is generally low. The present results showed a high rate of psychiatric comorbidity for this patient group with mood disorders, additional substance use disorders, and personality disorders occurring in particular. Such comorbid psychopathology substantially affects quality of life. The negative influence of comorbid psychopathology on quality of life is an important reason to provide additional mental health services for MMT patients.