Article type
Abstract
Background: Comorbidity between addictive and psychiatric disorders is common and leads to worse patient outcomes than for either condition alone. People with dual diagnosis generally have lower quality of life and life expectancy, with a significant effect on both family and society. Treatment is often complicated by the complexity and burden of disease.
Objectives: To assess pharmacological treatments for people with co-occurring addictive disorder and mental health disorders.
Methods: We searched Cinahl, Cochrane Library, Embase, Medline, PsycINFO and Scopus in April 2023. We included randomised controlled trials with outcomes of low to moderate risk of bias assessing pharmacological treatments, alone or in combination with any other treatments, versus any active or inactive control. The primary outcome was substance use. Other outcomes were psychiatric symptoms, functioning, quality of life and mortality. We synthesized the results for classes of drugs when we identified at least two studies that were sufficiently similar. For treatments targeting psychiatric symptoms, analyses were conducted per drug class for psychiatric/addiction dyads.
Results: We included 48 studies investigating 29 different pharmacological treatments. We had sufficient data to conduct analyses for six drug classes: SSRI or TCA for people with depression, quetiapine for people with bipolar disorder, stimulants for people with ADHD, alpha-1-antagonist for people with PTSD, and Naltrexone for people with alcohol use disorder. All of the analysed treatments were placebo controlled. We found low-quality evidence that Naltrexone may decrease alcohol consumption in people with alcohol dependence and co-occurring psychiatric disorder (Table 1 and 2). Due to very low-quality evidence, we are uncertain whether the other pharmacological treatments identified have a positive effect on addictive or psychiatric symptoms (Table 2).
Conclusions: There is insufficient evidence to determine whether most pharmacological treatments have a positive effect on either addictive or psychiatric symptoms for people with dual diagnosis. However, Naltrexone treatment in people with alcohol use disorder and co-occurring psychiatric disorders may help reduce alcohol use without affecting the co-morbid condition negatively.
Objectives: To assess pharmacological treatments for people with co-occurring addictive disorder and mental health disorders.
Methods: We searched Cinahl, Cochrane Library, Embase, Medline, PsycINFO and Scopus in April 2023. We included randomised controlled trials with outcomes of low to moderate risk of bias assessing pharmacological treatments, alone or in combination with any other treatments, versus any active or inactive control. The primary outcome was substance use. Other outcomes were psychiatric symptoms, functioning, quality of life and mortality. We synthesized the results for classes of drugs when we identified at least two studies that were sufficiently similar. For treatments targeting psychiatric symptoms, analyses were conducted per drug class for psychiatric/addiction dyads.
Results: We included 48 studies investigating 29 different pharmacological treatments. We had sufficient data to conduct analyses for six drug classes: SSRI or TCA for people with depression, quetiapine for people with bipolar disorder, stimulants for people with ADHD, alpha-1-antagonist for people with PTSD, and Naltrexone for people with alcohol use disorder. All of the analysed treatments were placebo controlled. We found low-quality evidence that Naltrexone may decrease alcohol consumption in people with alcohol dependence and co-occurring psychiatric disorder (Table 1 and 2). Due to very low-quality evidence, we are uncertain whether the other pharmacological treatments identified have a positive effect on addictive or psychiatric symptoms (Table 2).
Conclusions: There is insufficient evidence to determine whether most pharmacological treatments have a positive effect on either addictive or psychiatric symptoms for people with dual diagnosis. However, Naltrexone treatment in people with alcohol use disorder and co-occurring psychiatric disorders may help reduce alcohol use without affecting the co-morbid condition negatively.