Psychiatric comorbidity and opiate dependence disorder: From diagnosis to treatment

Diagnosing and treating psychiatric comorbidity in substance abusers has become increasingly important in the last 10 years because of important consequences from a health and social point of view. The identification of reliable and valid diagnosis of psychiatric co morbidity in substance abusers has being improved using the "Psychiatric Research Interview for Substance and Mental Disorders" for DSM-IV criteria. This instrument is a structured interview designed "ad hoc" to diagnoses nonsubstance use disorders in substance abuser population. Compared to the Longitudinal, Expert, All Data (LEAD) procedure, as a "gold standard", the Spanish version of PRISM-IV seemed to be a valid instrument for diagnosing major depression, induced psychosis, anxiety disorders, antisocial and borderline personality disorders. Also the Spanish PRISM-IV resulted in better kappa statistics than the Spanish version of SCID-IV for diagnosing major depression, and borderline personality disorders in substance abusers. Many clinical studies have revealed a high degree of co-occurrence of opioid dependence and other psychiatric disorders, ranging from 44% to 93%. Major depression, anxiety disorders, antisocial and borderline personality disorders are the most prevalent non-substance use disorders in opioid dependent subjects. Most studies are needed to determinate the evidence based treatments for comorbid psychiatric disorders in opioid dependence. In the case of comorbid major depression in opioid abusers, after a systematic review of the randomized and controlled clinical trials available, new studies to clarify the evidence based treatments are required.