The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68585

Josh Wilk, PhD, American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209, 703-907-8618, jwilk@psych.org

We will present findings on the relationship of comorbid psychiatric and substance use disorders (SUD) to patterns of work disability in a representative sample of patients treated in routine psychiatric practice in the U.S. This analysis used cross-sectional, nationally representative data from the 1999 American Psychiatric Institute for Research and Education’s Practice Research Network Study of Psychiatric Patients and Treatments. Each psychiatrist was asked to provide detailed clinical data on three randomly selected patients. 1,843 patients of 615 psychiatrists were included. Psychiatrists practicing in a full range of treatment settings participated. Patients represented a range of diagnoses and demographic characteristics. Although work disability rates were high for individuals with one Axis I disorder (27.2%), the rates increased with the addition of a comorbid SUD (40.8%). For example, the rates of work disability for individuals with a diagnosis of bipolar disorder alone were 37.2%. However, individuals with bipolar disorder and a comorbid alcohol use disorder, had disability rates of 47.2%. Similarly, the rates of work disability for individuals with a diagnosis of depression alone were 24.5%. In individuals with depression and a comorbid alcohol use disorder, the rate of disability rose to 29.4%. Comorbid psychiatric and substance abuse disorders have a relatively high prevalence in routine psychiatric practice, with significant implications for patient work functioning. The increase in patient work disability related to an additional SUD diagnosis suggests that with increased diagnostic complexity further services related to functional disabilities should be considered by policymakers and providers alike.

Learning Objectives:

At the conclusion of this session, the participant (learner) in this session will be able to: (
• Describe the characteristics of clients treated in psychiatric practice and the range of diagnoses of these clients. (
• Articulate how co-occurring substance use disorders among clients with primary psychiatric disorders affect rates and patterns of work disability. (
• Discuss the implications for psychiatric practice of encountering clients with comorbid Axis I disorders.

Keywords: Mental Health, Substance Abuse

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Center for Substance Abuse Treatment (CSAT), American Psychiatric Association (APA)
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employee of APA