Differences in Psychopathology among Patients with Dual Diagnosis that are Entering Mental Health Services in Cyprus in Correlation with Alcohol Dependence

Introduction: Dual diagnosis is undoubtedly one of the most important problems that mental health services are currently facing. The common problem of all patients is that they resort to psychiatric services due to complications caused by the use or abuse of legal and illegal substances and at the same time due to the presence of another psychiatric disorder. The literature supports the hypothesis that psychiatric disorders and substance abuse disorders coexist more frequently than initially estimated. Aim: The aim of this study is to examine, assess and compare the characteristics and the psychopathology between patients with dual diagnosis receiving treatment for mental disorders and those receiving treatment for substance abuse disorders within the framework of the substance abuse treatment programs provided by the Mental Health Services of Cyprus. Furthermore, this study examines the differences in psychopathology in correlation with alcohol dependence, duration of treatment and the number of hospitalizations in relation with dual diagnosis. Methods: In this study three hundred patients were used: 150 of them were dually diagnosed and admitted to drug addiction therapeutic and rehabilitation centers for legal and illegal substances and 150 were dually diagnosed and admitted to psychiatric units in the Mental Health Center in Cyprus. The EuropASI the AUDIT, and the PDQ4 were administered individually to each participant. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis. Results: The results revealed that the dually diagnosed patients who were admitted to psychiatric units had higher figures of diagnosis (mhuM=3.03, duM=2.55, pvalue), higher figures of hospitalization in Mental Health Services (mhuM=12.25, duM=7.73) and significantly more psychological problems (mhuM=63.02, duM=18.78), as well as longer prison time (mhuM=5.55, duM=2.10), compared to those that entered substance abuse treatment programs. The mean age of first use for men was 17.88 for psychiatric patients and 17.52 for patients entering substance abuse treatment programs (p value=0.001). For women, the mean starting age was 17.50 in psychiatric units and 17.60 in substance abuse treatment programs (p value=0.01).In most cases, the main substance of dependence was cannabis, followed by cocaine, in both study groups (57.5% the case of cannabis, 20% for cocaine in psychiatric units and 30% for cannabis, 20% for cocaine in substance abuse treatment programs). A total of 53.4% of the patients admitted to substance abuse treatment programs had a family history of alcoholism, while the corresponding figure for those in psychiatric units was 46.6%; 50% of both groups had a family history of drug addiction. The patients with anti-social disorder according to the PDQ-4 questionnaire had a higher incidence of alcohol dependence than patients without anti-social disorder. The use of alcohol over the last 30 days was associated with an increase in the frequency of alcohol dependency. Implications for Mental Health Nursing: The results indicate that the lack of a specialized treatment center creates a significant gap for treatment, which leads to Mental Health Services overuse and misuse, and to continuous hospitalizations and relapses, leading dual diagnosis patients to disorganization and isolation. Mental health specialists should learn and be educated in new therapeutic approaches in order to treat dually diagnosed patients holistically.