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Are most co-morbidities really substance-induced disorders?

Following on from the last two blogs we reblog an earlier blog which suggests caution over diagnosing some addicted individuals as having co-morbidities when they are still “using” as a number of symptomatic manifestations of so-called co-morbidity can dissipate in recovery. It is a very useful counterpoint to figures suggesting high co-morbidity with addictive behaviours. There are also issues outlined here over how accurately these diagnostics are often carried out. It is suggested ultimately that co-morbid conditions occur in a similar percentage in addicted individuals as in a normal population. Although we would argue this may be the case for certain disorders like Major Depression or anxiety disorders but that the incidence of PTSD for example is much higher in addicted individuals than than in the distribution in a normal population. Equally we have argued that addictive behaviours may share similar underlying conditions and neural mechanisms which appear in behaviours similar to a host of other conditions. We have used the term “amgydaloid disorders” to illustrate how many disorders centre on amgydala dysfunction and limited prefrontal cortex control over behaviour. It may be that addictive behaviour canalizies other aspects of disorders into the addiction cycle and that this needs to be treated first before the second stage of recovery, i.e. for other disorders can be successfully treated.

Inside The Alcoholic Brain

In this blog we re-emphasize the need for accurate diagnosis of co-morbidity with a substance use disorder. It appears form the article cited here (1) that diagnosis is often flawed in many studies and that the so-called diagnosis of co-morbidity is not borne out long term with many presumed co-morbid disorders disappearing in time.

Most diagnoses in medicine are based on a combination of symptoms, their time-course and a threshold beyond which the syndrome is felt to be clinically relevant [1].

No single indicator is likely to be sufficient to establish a diagnosis because these are rarely unique to one syndrome.

Potential problems with the diagnostic process increase almost exponentially when substance use disorders  (SUDs) and psychiatric syndromes occur together.

First, combinations of SUDs and psychiatric disorders may represent two or more independent conditions, each of which is likely to run the distinct clinical course relatively unique to that disorder. Here, both conditions must be treated comprehensively.

Secondly, the first…

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