Co-Occurring Psychiatric Condition and Relation with Substance Disorders

Conduct disorder is a common problem across the globe. We live in a world of stress. We are constantly under pressure. Our brain works 24/7 to cope with different challenges we are facing in our daily life. We have to focus on our studies, feel the stress of our work, and think of social anxiety. We are running and running all the time to compete with the world. This stress leads us towards mental and physical health issues. We feel more physical health problems than our ancestors felt one hundred years back. Our lifestyle has completely changed, so the psychological and physical health issues are also changed, and leads to conduct disorder. All this is the result of day by day increasing mental pressure in terms of finance, work, and evolving diseases, as well as different changes in our daily routine cause various mental health problems. People take different types of drugs to get relief from mental stress. No doubt, they get what they want from these drugs.

But as a consequence, they get addicted to these drugs. If these drugs are used for long periods, it becomes difficult to withdraw these drugs. This addiction ends up with conduct disorder, and with our life.

Numerous surveys examining the incidence of co-occurring illnesses indicate that the majority of people pursuing conduct disorder, mental health care or substance abuse treatment do so because they have corresponding substance use disorders or co-occurring mental health.

Lehman, Myers, Corty, & Thompson, 1994; Hien, Zimberg, Weisman, First, & Ackerman, 1997; Craig, 1994, Milling & Faulkner

This figure is even greater for teens seeking treatment for substance use disorders.

In one survey with over 4,000 teenagers in treatment, it was discovered that approximately 70% of participants had symptoms of depression, while approximately a third had signs of anxiety disorders or conduct disorder.

Hoffmann, Mee-Lee, Arrowood, 1993

Another survey of over 1,400 teenagers found that about a third of patients meet expectations for a potential affective disorder by utilising a more strict definition of depression and conduct disorder.

Bergman, Smith, & Hoffmann, 1995

Adolescents enrolled in addiction treatment services often exhibit personality problems as a function of their involvement in the legal or criminal justice systems.

A recent survey of over 2,300 juvenile substance addicts’ treatment results discovered that more than 75% had any contact with law enforcement and more than half had been arrested. The degree of behavioural and legal disorders or conduct disorder in school was shown to associate with the effects of drug therapy six months after discharge.

Hsieh, Hoffmann, & Hollister, 1998

Depression and activities that place the teenager at risk of coming into touch with the justice system are only a few of the symptoms linked with substance abuse. Suicide risk, anxiety problems, conduct disorder and ADHD (attention-deficit/hyperactivity disorder) are all correlated with substance abuse.

(Bukstein, 2001)

It is important to ascertain which diagnoses are present. It is important to provide standardised medical tests that specifically distinguish people with problems and those that follow medical requirements. Without a thorough and reliable evaluation of symptoms in order to accurately identify illnesses or conduct disorder, adequate and successful treatment strategies cannot be established.

Conduct disorder studies tell diagnostic evaluations should not be viewed as a method of labeling? but as an essential, acceptable, and crucial move toward successful treatment planning.

“Modern diseases” are also affecting our lives in evil ways. We have different research-based medicines to cure these diseases and conduct disorder. These relieving drugs are often also providing a chance to enhance the chances of a person getting addicted to these drugs. People start with curative medications under the supervision of a physician but never leave them. They first get addicted to these drugs as medicines, and after that, they start taking illegal drugs and leads to conduct disorder.

Many drugs alter the hormone levels in the body and hence disturbing the normal functioning of the brain. As a result, when a person gets addicted to these drugs becomes dependent on these drugs. The addicted person feels different types of conduct disorder, mental and physical issues when facing the unavailability of these addictive drugs. The affected person feels the need for such drugs for ordinary working of the brain and body.

Our brain develops until the age of twenty years of age, especially the prefrontal cortex. This mentioned part of the brain makes most of the decisions. So, young people who are under the age of 20 years are most likely to make wrong decisions and have problem of conduct disorder. Drug intake during this early age causes impaired growth of the prefrontal cortex. It will result in a loss of ability to make the right decisions in life. Such people often cannot even perform routine works in proper order.

The use of drugs at an early age may also cause the most severe addiction in later life, and withdrawal becomes very much complicated and even impossible in some cases. Early age drug addiction also causes complex physical health diseases, conduct disorder, including heart disease, high blood pressure, and sleep disorders.

Different studies showed that people suffering one problem, either conduct disorder, drug addiction or some mental health disease, are at a high risk of developing the other problem

Weisman, First, & Ackerman, 1997

It was reported in the National Survey on Drug Use and Health, 2010, that 45% of drug-addicted people also have some mental health disorders, and conduct disorder at the same time. It was also found under different research studies that chances of depression and anxiety increase 70% in drug-using persons than those of non-users.

Hoffmann, Mee-Lee, Arrowood, 1993

People often start drug usage with prescribed medicines, including opium-derived drugs, and tend towards alcohol also. The use of opioids, even heroin, is also found to be increasing in recent years. Intake routes of different drugs also fascinate young adolescents, like vaping has increased use of tobacco and marijuana. Cigarette smoking is becoming part of our routine social habit, either as addiction or as fun. This leads to conduct disorder.

It is also notable that adolescents are more likely to develop co-occurring diseases than adults. Lack of proper counseling, family stress, social competition, and easy availability of abusive drugs lead the young ones towards drug addiction, and conduct disorder. They use some drugs firstly for their mental relaxation and later on become addicted to these drugs.

The use of abusive medicines for a long time will result in a lousy mood, sleeplessness, and malnutrition, which, in the end, make a complex with mental disorders, and conduct disorder. Such adolescents are often found to be involved in illegal activities like robbery and face police actions. Behavioral changes in such adolescents also lead to negative social moralities and suicidal thoughts. Depression, conduct disorder, anxiety, suicidal thoughts, risk of ADHD (attention-deficit/hyperactivity disorder), and other conditions are also observed to associated with excessive and abusive use of drugs.

Bukstein, 2001

Diagnosis is the first step and essential part of proper treatment of conduct disorder. The accuracy of treatment always lies in the accuracy of diagnosis of the problem. Different diagnosis measures and lab tests are always available to check a patient properly. But which diagnostic method and what lab tests are required?

This question’s answer may become difficult and complex when we are talking about a dual disorder person with a problem of conduct disorder. It depends on several factors and facts about the patients.

The Following Points Must Be Noted when We Are Going to Diagnose a Co-Occurring Disorder and Conduct Disorder Person:

1. What type of drug he/she is taking?
2. Period of drug addiction
3. Amount of drug used
4. Check if the patient is taking multiple drugs
5. Which disease(s) is present with drug addiction?
6. Duration of disease and conduct disorder
7. Any other physical problems, if prevailing
8. The social condition of the patient

These points will allow a physician to determine a best suited diagnostic method and lab tests to confirm problems. Along with these, all the physical and mental symptoms of the conduct disorder patients must also be noted. All of these will make a set to diagnose the issue and exact level of disease properly.

An accurate diagnosis will lead us to find effective and suitable treatment programs, and helps to cater conduct disorder. These conditions require a lot of concentration, time, care, and medication to cure correctly, so all the above steps should be followed with great concern.

Detection in a pragmatic manner Two of the scientists, Drs. Estroff and Hoffmann, created the PADDI (Practical Adolescent Dual Diagnostic Interview) to accomplish this goal. The PADDI is a standardised diagnostic interview that is consistent with DSM-IV diagnostic guidelines. They have made guidelines to treat conduct disorder.

APA, 1994

Medical scientists are working for the well-being of humanity. As a result, they developed several diagnostic models for conduct disorder, and co-occurring disorders. PADDI is one of the most used diagnostic techniques developed by Dr. Estroff and Dr.Hoffmann. PADDI is an abbreviated term of Practical Adolescent Dual Diagnostic Interview. It is an interview, compatible with DSM-IV diagnostic criteria, structured for the diagnosis of conduct disorder, and co-occurring disorders.

This diagnostic model was developed for the ease of both physicians and patients. It requires no specific expertise, easy to conduct, easy to understand results, and adaptable to different settings and applications. It also helps qualified and expert physicians to reach up an accurate diagnosis of conduct disorder.

This diagnostic model has proven a great assistant to Para-medical professionals, drug addiction counselors, conduct disorder, and psychologists when it comes to an accurate diagnosis. It is a fully structured interview plan, and one can easily use the instrument involved and make the summary of results on a score page.

The Development Scale for The Instrument Related to Conduct Disorder Is as Following:

• The instrument had to be safe to use
• Not include experience in both mental health and substance abuse
• Adaptable to a number of contexts and applications
• Simple to score
• Should be used as a foundation for diagnosis by a trained specialist

The goal was to provide a method that conduct disorder, substance abuse counselling and mental health providers could utilise effectively and efficiently. The completely organised interview style was selected to make the instrument easy to perform and summarise answers on the score page for technicians, criminal justice officials, and paraprofessionals. Medical interpretations and confirmation of diagnosis, on the other hand, may be reserved to trained practitioners.

The Practical Adolescent Dual Diagnostic Interview (also well known by the abbreviation PADDI) collects information regarding the used conduct disorder, abusive drugs and the mental health of the patient. It addresses the patient’s complete physical and psychological condition in every aspect, and thus a user can make results very easily by scoring.

The Following Key Areas Are Included in This conduct disorderModel, and They Show Similarities of This Model with DSM-Iv Diagnostic Criteria (estroff and Hoffmann, 2001):

• Depression
• Mania
• Psychotic problems
• Anxiety
• Panic disorders
• Phobia, if prevails
• Posttraumatic stress disorder (PTSD)
• Conduct disorder
• Disorder of Oppositional defiant
• Drug intake responses

The above part belongs to Axis I diagnostic areas.

Axis II diagnosis covers the signs and symptoms of persons with conduct disorder and paranoid conditions. It also includes indications by personality-dependent people. Some terrible and dangerous are also addressed in this interview, like the patient’s physical, sexual, and emotional behavior. It takes on 20 to 40 minutes to complete The Practical Adolescent Dual Diagnostic Interview. Time was taken during the interview varies depending upon the severity of problems faced by a specific conduct disorder patient.

Trial Statistics of PADDI

The Practical Adolescent Dual Diagnostic Interview was 1st tested with 111 people (adolescents) who were taking treatment for conduct disorder and abusive drugs. The male patients 65% (72 patients) among observed total patients. The ages of these observed adolescents were between 14 to 18 years. Among these, 80% were of age between 15 to 17 years. These patients were of different areas, including America, Africa, and Hispania, etc.

Although all of the patients under observation were school students, their academic record was abysmal compared to their healthy fellows. During PADDI interviews, it was also noted that almost 33% of these patients were getting treatment for some conduct disorder and mental disorder.

Caucasians made up more than 75% of the sample, while African-Americans made up the biggest group (13%). The remaining sample members were Hispanic, Native American, or of mixed racial origin. Although the overwhelming majority of non-incarcerated youth were still enrolled in education, their academic performance tended to be modest, as shown by their highest grade passed compared to their age. The majority of juveniles in the criminal justice system is expected to complete schoolwork or enrol in a GED programme. At the time of the assessment, about a third of the youth were taking medication for either conduct disorder or mental disorder.

Conduct disorder studies tellstThe internal accuracy efficacy coefficients for the different diagnosis scales vary from approximately 70 for behaviour disorders to greater than 90 for affective disorders. The index for substance dependency is greater than 80. According to these numbers, medical elements characterise largely homogeneous syndromes. This is compatible with the assumption that the DSM-IV descriptions describe well-defined situations with consistent presentation.

Around 90% of teenagers meet the requirements for substance abuse and nearly as many met the criteria for behaviour disorder. A third of the study fulfilled expectations for a present or previous diagnosis of major conduct disorder, depressive episode or manic episode. Mixed states, in which depression and mania coexist, were indicated in about 15% of the study. About a fourth of patients required a current diagnosis of major depressive disorder, while less than a third required a current diagnosis of mania. These rates do not include incidents in which the depression or mania tended to be caused by a substance. The PADDI listed substance dependency, behaviour disorder, major depressive event, mania, and PTSD as the five most prevalent diagnoses in this study. While co-occurring substance dependency, conduct disorder and behaviour disorder was the most prevalent combination, 55% of teenagers exhibited at least three of these five disorders. About a quarter (26%) happen to follow at least four of the five requirements. Adolescents in these residential facilities do also have a variety of problems.

Profiles of Symptoms with Selected Conditions N=1

Situation (Lifetime) Minimum Requirements Exceeds Criteria Exceeds All Expectations Major Depressive Episode 35% 25% 15% Manic Episode 36% 24% 15% Disorders with Posttraumatic Stress 25% 22% 11% Frightened 17% 11% 5% Anxiety/phobias** 22% 12 % 4 % 86 percent 63 percent 38 percent Oppositional Defiant Disorder* 63% 48% 31% Substance Abuse*** 92.5% 87.5% 78.5% This section contains information on oppositional defiant disorder (ODD) signs regardless of what behavioural disorder requirements are fulfilled. According to the DSM-IV, this diagnosis is not made until the conditions for behaviour disorder or conduct disorder are fulfilled. The instances matching criteria for ODD have matched criteria for behaviour disorder in this group.

**Although items in this list do not explain a particular conduct disorder, and anxiety diagnosis, they still indicate the severity of symptoms.

***In the absence of substance usage in the preceding 12 months reports, the zero is maintained by the symptom count.

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