Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits

Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncert...

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Bibliographic Details
Published in:Psychological medicine 2009-08, Vol.39 (8), p.1365-1377
Main Authors: Glantz, M. D., Anthony, J. C., Berglund, P. A., Degenhardt, L., Dierker, L., Kalaydjian, A., Merikangas, K. R., Ruscio, A. M., Swendsen, J., Kessler, R. C.
Format: Article
Language:English
Subjects:
Addictive behaviors
Adolescent
Adult
Adult and adolescent clinical studies
Age of Onset
Alcoholism
Alcoholism - economics
Alcoholism - epidemiology
Alcoholism - prevention & control
Alcoholism - rehabilitation
Anxiety Disorders - economics
Anxiety Disorders - epidemiology
Anxiety Disorders - prevention & control
Anxiety Disorders - rehabilitation
Attention Deficit and Disruptive Behavior Disorders - economics
Attention Deficit and Disruptive Behavior Disorders - epidemiology
Attention Deficit and Disruptive Behavior Disorders - prevention & control
Attention Deficit and Disruptive Behavior Disorders - rehabilitation
Attention Deficit Disorder with Hyperactivity - economics
Attention Deficit Disorder with Hyperactivity - epidemiology
Attention Deficit Disorder with Hyperactivity - prevention & control
Attention Deficit Disorder with Hyperactivity - rehabilitation
Biological and medical sciences
Causality
Comorbidity
Computer Simulation
Conduct Disorder - epidemiology
Conduct Disorder - prevention & control
Conduct Disorder - psychology
Conduct Disorder - rehabilitation
Cost effectiveness
Cost-Benefit Analysis
Cross-Sectional Studies
Drug use
Female
Health Surveys
Humans
Internal-External Control
Interventions
Male
Medical sciences
Mental disorders
Mental Disorders - economics
Mental Disorders - epidemiology
Mental Disorders - prevention & control
Mental Disorders - rehabilitation
Miscellaneous
Mood Disorders - economics
Mood Disorders - epidemiology
Mood Disorders - prevention & control
Mood Disorders - rehabilitation
Prevention
Probability
Psychiatric disorders
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Retrospective Studies
Risk Factors
Simulation
Street Drugs
substance dependence
Substance dependency
Substance-Related Disorders - economics
Substance-Related Disorders - epidemiology
Substance-Related Disorders - prevention & control
Substance-Related Disorders - rehabilitation
Survival Analysis
treatment
Treatment Outcome
Young Adult
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Summary:Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders. Data came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios. Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders). Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.
ISSN:0033-2917
1469-8978
DOI:10.1017/S0033291708004510