Dual diagnosis in Spain

Our aim is to describe the current situation regarding the diagnosis and treatment of addiction in a variety of settings in Spain. Four-hundred and twenty-seven physicians known to treat addicted patients in non-private settings were recruited and agreed to participate. Each physician provided clinical and anonymous information on the first 6 consecutive patients who attended on a scheduled day. A total of 2361 patients were interviewed (92.1%) and data were obtained concerning gender, age, work, educational level, civil status, addiction diagnosis, type of treatment and psychiatric comorbidity. Seven-hundred and ninety-eight out of 2361 addicts (33.8%) presented with a dual diagnosis. Depression was the most prevalent disorder (21.6%), followed by anxiety disorders (11.7%). Comorbidity was found to be related to age, female gender, divorce and widowhood, and higher educational levels. Alcoholics who abused other drugs showed the highest rates of comorbidity (48.5%), while opiate addicts were at the lower end of the spectrum (27.4%). No differences were found related to the treatment setting, the doctor's medical specialty, or the geographical area. Finally, doctors tended to perceive that dual diagnosis was related to a worse psychiatric prognosis but not to higher relapse rates. Antidepressants were the most commonly prescribed drugs (62.4% of co-morbid patients) and anticraving agents were prescribed equally to comorbid and non-comorbid patients. Within the limitations of a descriptive study, our data show that comorbidity is a common clinical problem in patients who access addiction treatment. Affective and anxiety disorders are the most common comorbid diseases, and comorbidity rates seem to be unrelated to regional differences, medical settings or doctor's professional background. Dual diagnosis patients thus account for one third of the clinical workload of addiction specialists in Spain.