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Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
2.6 Referral
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
1. Levels of evidence
2. Management of people with comorbidity of mental disorders and substance use
3. The common drug groups
4. Tobacco
5. Depression and substance use- 5.1 Depression
- 5.2 Comorbidity with depression
- 5.3 Major clinical issues with depression and cannabis/ hallucinogen use
- 5.4 Major clinical issues with depression and alcohol use
- 5.5 Major clinical issues with depression and opioid use
- 5.6 Major clinical issues with depression and stimulant (including methamphetamine) use
- 5.7 Major clinical issues with depression and benzodiazepine use
- 5.8 Major clinical issues with depression and inhalant/ solvent use
6. Anxiety disorders and substance use- 6.1 Anxiety
- 6.2 Comorbidity with anxiety disorders
- 6.3 Major clinical issues with anxiety disorders and cannabis/ hallucinogen use
- 6.4 Major clinical issues with anxiety disorders and alcohol use
- 6.5 Major clinical issues with anxiety disorders and opioid use
- 6.6 Major clinical issues with anxiety disorders and stimulant (including methamphetamine) use
- 6.7 Major clinical issues with anxiety disorders and benzodiazepine use
- 6.8 Major clinical issues with anxiety disorders and inhalent/ solvent use
7. Psychosis (schizophrenia and bipolar disorder) and substance use- 7.1 Psychosis
- 7.2 Comorbidity with Psychosis
- 7.3 Major clinical issues with psychosis and cannabis/ hallucinogen use
- 7.4 Major clinical issues with psychosis and alcohol use
- 7.5 Major clinical issues with psychosis and opioid use
- 7.6 Major clinical issues with psychosis and stimulant (including methampetamine) use
- 7.7 Major clinical issues with psychosis and benzodiazepine use
- 7.8 Major clinical issues with psychosis and inhalent/ solvent use
8. Personality disorders and substance use- 8.1 Personality disorders
- 8.2 Comorbidity with personality disorders
- 8.3 Major clinical issues with personality disorders and cannabis/ hallucinogen use
- 8.4 Major clinical issues with personality disorders and alcohol use
- 8.5 Major clinical issues with personality disorders and opioid use
- 8.6 Major clinical issues with personality disorders and stimulant (including methamphetamine) use
- 8.7 Major clinical issues with personality disorders and benzodiazepine use
- 8.8 Major clinical issues with personality disorders and inhalant/ solvent use
9. Eating disorders and substance use- 9.1 Eating disorders
- 9.2 Comorbidity with eating disorders
- 9.3 Major clinical issues with eating disorders and cannabis/ hallucinogen use
- 9.4 Major clinical issues with eating disorders and alcohol use
- 9.5 Major clinical issues with eating disorders and opioid use
- 9.6 Major clinical issues with eating disorders and stimulant (including methamphetamine) use
- 9.7 Major clinical issues with eating disorders and benzodiazepine use
- 9.8 Major clinical issues with eating disorders and inhalant/ solvent use
10. Somatoform disorders and substance use- 10.1 Somatoform disorders
- 10.2 Comorbidity with somatoform disorders
- 10.3 Major clinical issues with somatoform disorders and cannabis/ hallucinogen use
- 10.4 Major clinical issues with somatoform disorders and alcohol use
- 10.5 Major clinical issues with somatoform disorders and opioid use
- 10.6 Major clinical issues with somatoform disorders and stimulant (including methamphetamine) use
- 10.7 Major clinical issues with somatoform disorders and benzodiazepine use
- 10.8 Major clinical issues with somatoform disorders and inhalant/ solvent use
11. Gambling and substance use- 11.1 Gambling
- 11.2 Comorbidity with gambling
- 11.3 Major clinical issues with gambling and cannabis/ hallucinogen use
- 11.4 Major clinical issues with gambling and alcohol use
- 11.5 Major clinical issues with gambling and opioid use
- 11.6 Major clinical issues with gambling and stimulant (including methamphetamine) use
- 11.7 Major clinical issues with gambling and benzodiazepine use
- 11.8 Major clinical issues with gambling and inhalant/ solvent use
12. Brain injury, mental disorders and substance use- 12.1 Brain injury
- 12.2 Do mental disorders predispose individuals to brain injury?
- 12.3 Does substance use predispose individuals to brain injury?
- 12.4 Does brain injury predispose individuals to mental disorders or to suicide?
- 12.5 Does brain injury predispose individuals to substance use?
- 12.6 Does brain injury impact on treatment approaches to mental disorders and substance use?
- 13. Bibliography
14. Appendices
People with comorbid mental disorders and substance use frequently need care from several different disciplines. It is important that communication between all clinicians and service providers is coordinated.
The use of a care plan in these instances is advisable.
Consider referral when:
- Self-harm risk or risk to others is present.
- Acute exacerbation of mental disorder occurs.
- Drug dependence with major associated problems (legal, health, social) is present.
- Complicated detoxification is anticipated.

