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| COMMENTARY |
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| Year : 2018 | Volume
: 34
| Issue : 2 | Page : 137-138 |
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Comment on psychiatric morbidity in opioid dependence
Siddharth Sarkar
Department of Psychiatry and NDDTC, AIIMS, New Delhi, India
| Date of Web Publication | 29-Jun-2018 |
Correspondence Address:
Dr. Siddharth Sarkar
Department of Psychiatry and NDDTC, Room No. 4096, Teaching Block, AIIMS, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijsp.ijsp_3_18
How to cite this article:
Sarkar S. Comment on psychiatric morbidity in opioid dependence. Indian J Soc Psychiatry 2018;34:137-8 |
Patients with dual diagnosis often present a clinical challenge as attention needs to be paid to both substance use disorder and the additional psychiatric disorder. However, services are often geared with the premise of tackling one of them effectively. This results in a void in comprehensive care of patients with dual diagnosis. Understanding the types of co-occurring disorders would be the logical initial step in understanding the disorders that would help clinicians in looking for, diagnosing, and then treating dual diagnosis. The article by Mohanty et al.[1] offers an important perspective in the co-occurring disorders with opioid dependence syndrome. The systematic prospective methodology offers more robust findings as compared to the large-scale retrospective studies.[2],[3]
A considerable majority of the participants in this study had an additional psychiatric disorder, predominantly depressive and anxiety disorders. These disorders can both be treated with pharmacotherapy and/or psychotherapeutic measures. The challenge lies in discerning the nature and characteristics of intertwining of these disorders and opioid dependence syndrome. One needs to consider that opioid dependence may result in or stem from adverse life circumstances, both of which might ameliorate from effective treatment of opioid dependence. Conversely, apt treatment of depressive and anxiety conditions may result in better engagement with treatment services and lead to better treatment outcomes of opioid dependence syndrome. Further research is required to critically examine the course and trajectory of depression, anxiety, and opioid dependence as these patients with dual diagnosis progress through treatment.
An important finding of the study was that there was no patient with antisocial personality disorder. Various reasons could be attributed to this result. First, patients with antisocial personality disorders may not be seeking treatment, and the present study was based in a treatment setting. Second, the assessment measure in the present study (MINI–Plus) is based on self-report and may miss out on antisocial personality disorder based on either willful deception or positive expectancy bias. Third, framing the threshold for antisocial personality is difficult as what behavior is considered as markedly abnormal would be based on societal construct of extreme.[4]
A major issue among patients with dual diagnosis is the problem of stigma. This stigma is due to the “double whammy” of substance use disorder and additional psychiatric disorder.[5] The stigma is related to the treatment-seeking process and engagement, and hence may influence the long-term outcomes of the patients with dual diagnosis. Cognizant of the stigma that these individuals face, services need to play a proactive role in providing support and facilitating treatment seeking. Sensitization of the health-care providers may help in promoting the stigma reduction measures in this population.
An important consideration in the treatment of patients with dual diagnosis (or substance use disorders) in India is the family context.[6] Families are not only affected by the substance use disorders, but they are also a source of support for treatment. Patients with dual diagnosis of opioid dependence and additional psychiatric disorders may have greater dependency and needs, for which it is expected that the family members would provide succor. Thus, treatment would need to engage the family members as well. Given the prevalent misconceptions in the society regarding etiology and remediation of substance use disorders and other psychiatric illnesses, it would be prudent to incorporate educating family members as a part of the treatment process.
Dual diagnosis has received lesser attention in psychiatric research, primarily because of the complexities in conceptualization, operationalization, and conduct of research. Yet, further research is required to provide better care for patients with co-occurring substance use disorders and psychiatric disorders. The clinical practice guidelines of the Indian Psychiatric Society proffer some guidelines to the clinicians as well present the comprehensive body of literature in the field to researchers and academicians.[7]
| References | |  |
| 1. | Mohanty R, Senjam G, Singh NH. Psychiatric comorbidities among opioid-dependent patients attending department of psychiatry, regional institute of medical sciences hospital, Manipur. Indian J Soc Psychiatry 2018;34:128-32. [DOI: 10.4103/ijsp.ijsp_102_17].  |
| 2. | Basu D, Sarkar S, Mattoo SK. Psychiatric comorbidity inpatients with substance use disorders attending an addiction treatment center in India over 11 years: Case for a specialized “Dual Diagnosis Clinic”. J Dual Diagn 2013;9:23-9. |
| 3. | Balhara YP, Sarkar S, Bera SC, Gupta R, Chawla N, Lal R. Who seeks treatment for dual disorders? Observations from a dual disorder clinic at the national drug dependence treatment centre in India over a 12 year period. Int J High Risk Behav Addict 2017;6:e32501. |
| 4. | Cooke DJ. Psychopathic personality in different cultures: What do we know? What do we need to find out? J Pers Disord 1996;10:23-40. |
| 5. | Balhara YP, Parmar A, Sarkar S, Verma R. Stigma in dual diagnosis: A narrative review. Indian J Soc Psychiatry 2016;32:128-33. [Full text] |
| 6. | Sarkar S, Patra BN, Kattimani S. Substance use disorder and the family: An Indian perspective. Med J DY Patil Univ 2016;9:7-14. [Full text] |
| 7. | Basu D, Sarkar S. Dual diagnosis. In: Basu D, Dalal PK, editors. Clinical Practice Guidelines for the Assessment and Management of Substance Use Disorders. Gurgaon: Indian Psychiatric Society; 2014. |
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