Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
The most common questions include:
- How to identify the presence of possible problems.
- Which problem to focus on first.
- Whether/how to address both problems concurrently1.
When a patient presents with either a substance-use2 related problem or a mental disorder then the clinician should routinely enquire about the other.
Comorbidity should be assumed to be present when progress or response to therapy for either mental disorders or substance use appears to be ineffective or not progressing as planned. Comorbidity should be actively sought and needs to be excluded.
1 Substance abuse is not a term favoured by the author but has been used in the context of information derived from publications using the DSM-IV diagnosis of substance abuse.
2 Substance use is intended to be a non-quantitative term for the consumption of a substance. The risk associated with the use may range from low to high. It does not necessarily imply dependent use.