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Subject of this chapter is the often found combination of personality disorders and ­substance abuse disorders. The serious nature of this comorbidity is shown through the discussion of prevalence and epidemiological data. Literature shows that the comorbidity, hampering the diagnostic process, is seen as complicating for treatment planning. Therefore, etiological models that explain the co-occurrence of both disorders are helpful. Several models, among them the Behavioral Disinhibition Pathway, the Stress Reduction Pathway, and the Reward Sensitivity Pathway are described. Next, treatment programs, focusing on one or on both disorders are described, and research results are shown. Finally, clinical implications are described. The most important conclusion drawn is that treatment of dually diagnosed patients with severe problems needs to include both foci, and because of that conclusion, therapists need to be trained to address a range of symptomatic manifestations of personality pathology in the impulse control spectrum.

Forty inpatients on an alcohol detoxication unit of a large municipal hospital were administered a battery of tests consisting of a Coping Styles scale, a Personality Profile scale, a Depression scale and the Brief MAST. A demographically comparable comparison group of 40 outpatients attending the medical screening clinic at the same hospital also completed the battery. The two groups did not differ in terms of age, education or the ratio of men to women. There were significant differences in coping styles and personality characteristics between alcoholics and nonalcoholics and, to a large extent, between men and women within the alcoholic group. Practically no significant differences were found between the men in the two groups, but female alcoholics differed greatly from nonalcoholic women in terms of coping styles, personality variables and also in terms of conflict. These findings indicate that the differences between alcoholic and nonalcoholics in the sample were due largely to patterns uniquely characterizing the female alcoholic group. Results are discussed in terms of cultural expectations.

Phenomena associated with contemporary charismatic religious sects raise questions about the combined impact of group influence and intensely held beliefs on group members' psychological functioning. The author considers the stages of membership in these sects, with emphasis on psychiatric aspects of conversion, long-term membership, and leaving. He discusses options for psychiatric intervention, including psychotherapy, conservatorships, and deprogramming. Systems theory is used to provide a psychological model for the relationship between group influence in these sects and current conceptions of individual psychopathology and normal adaptation.

The authors describe a program that is directed at assuring effective treatment and referral for alcoholic and addicted patients in a general hospital; the program was developed to assure maximal utlization of available addiction treatment facilities without adding to the hospital staff. Drawing on systems theory, the authors review both a pragmatic and a conceptual basis for psychiatric intervention with paraprofessional support to provide consultation to the general medical staff who treat alcoholic and addicted patients. They stress the feasibility of altering the nature of the hospital system to achieve more effective treatment for these patients.

A national movement of parent self-help groups has recently emerged to combat drug abuse in children and adolescents. This innovative modality addresses a major mental health problem in an area where manpower shortages are anticipated. On the basis of self-report data from 135 parent group members, the drug and behavior problems of their children were evaluated. Improvement was reported in the community at large but more frequently in the children of members. The parent groups differed notably in structure and activities; nonetheless, the underlying psychology of membership, i.e., the shared attitudes and social cohesiveness of the members, facilitated the achieving of common goals.

Objectives: Despite growing concerns for non-medical use of prescription pain relievers (NMUPPRs), little is known about the role of comorbid, untreated depressive disorders. Methods: We examined past year rates of NMUPPRs and major depressive episode (MDE), using data between 2008 and 2014 from the National Survey on Drug Use and Health for both youths (12–17years) and adults (18 or older). Prevalence estimates with 95% confidence intervals were computed. Stratified analyses and generalized linear models were run to examine the association between NMUPPRs and MDE, controlling for treatments received for mental health and/or substance misuse. In order to explore whether MDE effect might change by treatment received, a model with an interaction term including MDE and treatment was fit. Results: Among respondents, about 9% (youths) and 7% (adults) reported past year MDE and about 6% (youths), and 4% (adults) NMUPPRs. About 1.2% (youths) and 0.7% (adults) reported both MDE and NMUPPRs. Those with past year MDE were more likely to report NMUPPRs (RR, 95%CI: 2.60, 2.42–2.80, and 2.64, 2.47–2.82, for youths and adults). Considering the any treatment/MDE interaction on NMUPPRs, MDE risk ratio for subjects who received some treatment (youths: adjusted risk ratio (ARR)=1.15; adults: ARR=1.25) was about 70–80%as compared with their untreated counterpart (youths: ARR=1.57; adults: ARR=1.54). The likelihood of reporting NMUPPRs amongst respondents who did not receive any treatment was higher for those with past year MDE (main effect: youths ARR=1.57, p

Basic Sciences and Clinical Foundations.- Screening and Early Interventions.- Drugs of Abuse and Pharmacotherapies for Substance Disorders.- Behavioural Approaches.- Social Therapies and Treatment Settings.- Main Elements of a Systems Approach to Addiction Treatment.- Behavioural Addictions and Management Applications.- Medical Disorders and Complications of Alcohol and Other Drugs, Pain Addiction.- Psychiatric Comorbidities and Complications of Alcohol and Other Drugs.- Special Populations.- Children, Adolescents and Young Adults.- Education and Training.

The comorbidity of psychotic and substance use disorders (SUDs) is a major issue in mental health because of its high frequency and poor prognosis. Moreover, it is often neglected both for the difficulty to assess SUDs in psychotic patients and for scarce attitude to evaluate and treat substance misuse by psychiatric service staff. On the other hand, psychotic patients with SUDs can receive inadequate treatment for psychosis by SUD services for similar reasons. Assessing and treating this comorbidity require the knowledge and the integration of specific tools and interventions that should be tailored toward patients’ clinical condition and that can be difficult to manage in daily clinical practice.

The comorbidity between anxiety and alcohol or substance use disorders represents a common and serious clinical challenge, characterized by a high worldwide prevalence. The co-occurrence of these disorders complicates treatment, management and prognosis of both disorders, but it remains often unrecognized and untreated. Mental health professionals should accurately assess and evaluate this comorbidity, although related etiological links and temporal relationships are still unclear and, probably, heterogeneous and multi-factorial. Individuals may misuse alcohol and substances to self-medicate their anxiety, avoidant and phobic symptoms, and, on the other hand, anxiety disorders may be induced by alcohol and/or substance misuse. Integrated treatment appears the most promising approach, but there is paucity of evidence on pharmacological and non-pharmacological treatments addressed to both anxiety and substance use disorders. This chapter provides a comprehensive overview of main epidemiological and clinical issues, etiological/temporal links hypotheses, and treatment options for the comorbidity between anxiety and addictive behaviors.