Comorbidity Data for Mental Disorders and Substance Abuse/Dependence Are of Little Predictive Value for the Clinical Practice: An Umbrella Review of Systematic Reviews

Among the many mental disorders possibly comorbid with the one of primary interest, sub-stance use disorders (SUDs; i.e., substance abuse/misuse and substance dependence) are of preëminent importance as the dropout rates are much higher for SUD than, say, depression. In order to obtain such a general risk assessment, this author performed an umbrella review, i.e., systematic review of systematic reviews on this topic. Secondary SUDs (SECSUDs) were more frequently found in patients suffering from the following mental disorders (in alphabetical order) than in the general population: Anorexia nervosa, anxiety disorders (any), attention-deficit hy-peractivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, depression, dysthymia, generalized anxiety disorder (GAD), pathological gambling, posttraumatic stress disorder (PTSD), and schizophrenia. These findings support the assumptions held by many in the therapeutic community, especially if one considers the consumption of a drug of abuse as self-medication to treat symptoms of the mental disorders listed above. One surprising finding for this author was the low prevalence of SECSUDs in bariatric surgery patients, which was only 4%, i.e., comparable or even lower to general population estimates.