Swedish Agency for Health Technology Assessment and Assessment of Social Services
Treatment and social support for adults with co-occurring addictive and psychiatric disorders
Part I: Pharmacological interventions, a preliminary report*
* This is a preliminary report that covers only pharmacological interventions. The full report is expected to be published in 2025. The final report will replace this one when it is published.
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Popular science summary
Main message
The scientific evidence is insufficient to determine whether most pharmaceutical treatments are more effective than placebo for reducing symptoms of addiction or of the co-occurring psychiatric disorder, in adults with dual diagnoses.
Conclusions
After reviewing the scientific literature, SBU has drawn the following conclusions:
- More and better research is needed to determine the effects of medications used to treat adults with co-occurring addictive and psychiatric disorders. In particular, studies are need that evaluate:
- effects of drug combinations for both addiction and psychiatric outcomes
- effects of drug treatments for people with ADHD in combination with different types of addiction
- For adults with both alcohol dependence and a psychiatric disorder, Naltrexone may reduce consumption and does not appear to have any negative effects on the person’s mental health.
What does this mean?
The lack of reliable evidence on the effects of pharmacological treatments does not necessarily mean that the treatment has no effect, but rather that evidence to judge whether it is effective or not is insufficient.
In most of the studies analysed, psychiatric symptoms and substance-use generally improved during the course of the study regardless of whether participants received the active drug or placebo. This could reflect the importance of initiating some form of treatment and continuous care contact.
As long as the scientific evidence is incomplete, some guidance for pharmacological treatment of adults with both addictive and psychiatric disorders can be found in the evidence-based recommendations for either condition alone, as well as clinical experience and patient preferences.
What is this report about?
National recommendations for the pharmacological treatment of adults with dual diagnoses are largely lacking. In Sweden guidelines for the support and care of people with substance abuse or dependence were last updated by the National Board of Health and Welfare in 2015, with respect to the population with dual diagnoses.
The aim of this report has therefore been to evaluate the effects of pharmacological treatments for people who have been diagnosed with a co-occurring addictive and psychiatric disorders. This type of co-morbidity is common; international studies have shown that up to 70 percent of patients in health care who have an addictive disorder also have at least one other mental illness. This co-morbidity often leads to significantly worse health and quality of life, worse treatment prognosis, and an increased risk of premature death compared to either conditions alone.
What studies are the results based on?
The latest literature search was carried out in March and April 2023. A total of 48 studies were included and described in 51 articles. The studies evaluated the effect of various drug treatments on substance use, psychiatric symptoms, retention to treatment and quality of life. The reliability of the study results was generally very low, partly because many of the studies lost a large proportion of their study participants over the course of the study. Another reason was the significant uncertainty in the final effect estimate, likely due to the heterogeneous trial conditions.
