Institute of Psychiatry : Events : DoDSept09 : Speaker Information

This talk will focus on prevalence, etiologic relationships and treatment of co-occurring mood and anxiety disorders and substance use disorders. Evidence from a number of sources converge to indicate that mood, anxiety and substance use disorders co-occur more commonly than would be expected by chance alone. Several large epidemiologic surveys conducted over the last 15 years have indicated that individuals with anxiety and mood disorders are at least twice as likely to have a substance use disorder when compared to individuals without mood or anxiety disorders. Individuals with bipolar disorder appear to be at particular risk. Recent studies have shown that more than 50% of individual with bipolar disorder have a lifetime substance use disorder. Individuals with bipolar disorder are 6-8 times more likely to have a lifetime substance use disorder when compared to individuals without bipolar disorder.

The reasons for the high rate of comorbidity are multiple and complex. There are some common risk factors, such as childhood abuse, which appear to predispose to the development of both mood/anxiety disorders and substance use disorders. The same neurobiologic systems are involved in substance use, mood and anxiety disorders. It appears that the relationship between these disorders is likely bidirectional. Mood and anxiety disorders may predispose to the development of substance use through self-medication or other mechanisms. Through dysregulation of important neural pathways, substance use may predispose to the development of mood or anxiety disorders and worsen the course and prognosis of existing disorders.

Diagnosis of co-occurring disorders can be difficult. Substances of abuse can cause symptoms that are indistinguishable from mood and anxiety disorders. It is best to have a period of abstinence before making the diagnosis of a mood and anxiety disorder although this can be difficult to achieve. Treatment of mood and anxiety disorders is important to maximizing outcomes. If an individual has mood/anxiety symptoms that pre-dated the substance use or persisted during a period of abstinence in the past, a diagnosis can be made. If there is a family history, or the symptoms are very severe with minimal change or prominent symptoms that do not overlap with substance use or withdrawal, a provisional diagnosis can be made for treatment purposes. It is important to follow individuals carefully during treatment.

Optimal treatment for co-occurring mood, anxiety and substance use disorders is likely to be a combination of psychotherapy and medications. Relapse prevention techniques have demonstrated efficacy in the treatment of substance use disorders. Patients can learn new coping skills and gain a sense of mastery. In choosing a medication, abuse potential and risk of interaction with drugs of abuse must be considered.   

1. Discuss the prevalence of co-occurring mood, anxiety and substance use disorder

2. Describe the pharmacotherapeutic treatment of co-occurring mood, anxiety and substance use disorder

3. Describe the psychotherapeutic treatment of co-occurring mood, anxiety and substance use disorder

Kathleen T. Brady, M.D., Ph.D., is a board-certified psychiatrist specializing in addiction psychiatry. A professor of psychiatry at the Medical University of South Carolina (MUSC), Dr. Brady is Director of the Clinical Neuroscience Division, Director of the Women’s Research Center, Associate Dean of Clinical and Translational Research, Director of the South Carolina Clinical and Translational Research Institute and Director of the Clinical and Translational Research Center. She is also Director of the Southern Consortium of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. She received her Ph.D. in pharmacology from Virginia Commonwealth University and her M.D. degree from MUSC, where she completed a residency in psychiatry, served as chief resident, and completed an addiction psychiatry fellowship. 

Dr. Brady’s research is devoted to the study of drug and alcohol abuse/addiction and comorbid conditions such as post-traumatic stress disorder and other anxiety disorders. Her areas of specialty also include gender and women’s issues related to addiction, stress, and hypothalamic-pituitary-adrenal axis functioning in substance-dependent individuals. Dr. Brady’s recent research has focused on the interface between basic and clinical science, investigating the mechanistic connection between stress and substance use disorders, and on the translation of empirically based treatments from academic medical centers to front-line treatment settings. She has served as principal investigator, co-principal investigator, and mentor on numerous research projects and is author of dozens of peer-reviewed publications. She is currently in the seventh year of a NIDA-sponsored K24 Mid-Career Investigator Award in Patient-Oriented Research. 

Dr. Brady has received many awards for her research, teaching, and clinical work. She has been listed in "Best Doctors in America" since 1998. She has been active in many national organizations addressing the concerns of psychiatry and addictions. She is Past President of the Association for Medical Education and Research in Substance Abuse and Past President of the American Academy of Addiction Psychiatry. She has served on the Scientific Advisory Council of the NIDA, the Committee on Community-Based Treatment of the Institute of Medicine of the National Academies, and the Board of Directors of the College of Problems of Drug Dependence.

This speaker has no financial relationships to disclose.

This presentation will not include discussion of unapproved or investigational uses of products or devices.