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Prevalence and Correlates of Co-occurring Substance Use Disorder among Patients with Severe Mental Disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

Bereket Duko, Getinet Ayano, Lulu Bekana, Dawit Assefa

Introduction: Substance use disorder occurs significantly in patients with severe mental disorders. When substance use concurrently occurs with severe mental disorders, it is associated with poor treatment outcomes, more frequent use of hospitals, treatment noncompliance, more frequent suicidal attempt, frequent and longer episodes, and poor over all adjustments, violent behavior and greater risk of HIV infection. However; little is known about the prevalence of co-occurring substance use disorders in patients with severe mental disorders in Ethiopia. The objective of this study was to assess the prevalence and correlates of co-occurring substance use disorder among patients with severe mental disorders at Amanual mental specialized hospital, Addis Ababa, Ethiopia.
Method: Institution based cross sectional study design was conducted in June, 2014. Study Participants were recruited by using systematic random sampling technique. Substance use disorder was assessed through face to face interviews by trained psychiatry nurses using Structured Clinical Interview of DSM-IV (SCID). Correlates for substance use disorder were assessed using a structured questionnaire.
Results: A total of 260 schizophrenic and 261 bipolar patients were included in the study. About 84.4% (bipolar) and 82.7% (schizophrenic) patients were life time substance users, while 77.4% (bipolar) and 75% (schizophrenic) patients were current substance users. Of all substance users, 49.8% (bipolar) and 48.1% (schizophrenic) were poly substance users. When we adjusted for the effect of potential confounding variables Age [AOR=2.32, CI= (1.18-4.56), history of hospitalizations [AOR=3.12, CI= (1.20-8.27)] and history of relapse [AOR=3.35, CI= (1.13- 8.83)] were more likely to have substance use disorder as compared to schizophrenic patients who were in age group of <27, no history of hospitalizations and no history of relapse respectively. Bipolar patients, who were in age group of >38 AOR=2.32, CI= (1.18-4.56), history of hospitalizations [AOR=1.75, CI= (1.07-4.37) ] and history of relapse [AOR=5.18, CI=(1.72-15.64)] were more likely to have substance use disorder as compared to bipolar patients who were in age group of <27, no history of hospitalizations and no history of relapse respectively.
Conclusion and recommendation: In general, prevalence of co-occurring substance use disorder among patients with severe mental disorder is high. Patient’s age, history of hospitalization and relapses were associated with substance use disorder. Early identification and integrated management of co- occurring substance use disorder in patients with severe mental disorders is vital.