Psychiatric Comorbidities with Opioid Dependence
Over 40% of opioid dependent individuals have co-occuring psychiatric disorders. The most common are depression, anxiety disorders, and bipolar disorder.
Psychiatric comorbidities may complicate buprenorphine treatment in terms of treatment priorities, stabilization concerns, and medication interactions. To make a sound treatment decision, you need to distinguish between independent and substance-induced disorders using the criteria below:
- Independent Disorders (Primary): continue to occur even when an individual is not using drugs for a sustained period of time, or have an onset before the opioid use disorder.
- Substance-induced Disorders (Secondary): all or most of the symptoms are the direct result of substance use.
Try these techniques to determine if the psychiatric problem is related or unrelated to the substance abuse:
- Observe the patient during a period of abstinence from the substance use
- Take a thorough history and, if possible, talk to family members or friends treat both problems simultaneously. If one disorder is not treated adequately or at all, both can become more severe.
- When possible, use medications that treat both disorders (Brady, 2006)