Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa

Abstract

Background. There is a lack of studies addressing the frequency and correlates of comorbidities among heroin users admitted for treatment in South Africa (SA). Objective. To assess the frequency and correlates of psychiatric comorbidity among patients with heroin use disorder admitted to the Opioid Detoxification Unit at Stikland Hospital in the Western Cape, SA.

Method. Participants (N=141) were assessed for psychiatric illness (Mini International Neuropsychiatric Interview), comorbid substance use disorders (World Health Organization’s Alcohol Smoking Substance Involvement Screening Tool), and legal and social problems (Maudsley Addiction Profile). Demographic, personal, psychiatric and substance-use history, in addition to mental state examination on admission, were collected from the case notes.

Results. The largest group of patients (n=56, 40%) had not been abstinent from heroin use since drug debut, and most had been arrested for drug-related activities (n=117, 83%) and had family conflicts related to use (n=135, 96%). Nicotine was the most common comorbid substance of dependence (n=137, 97%) and methamphetamine was the most common comorbid substance abused (n=73, 52%). The most common comorbid psychiatric illness was previous substance-induced psychosis (n=42, 30%) and current major depressive disorder (n=37, 26%). Current major depressive disorder was significantly associated with females (p=0.03), intravenous drug use (p=0.03), alcohol use (p=0.02), and a higher number of previous rehabilitation attempts (p=0.008).

Conclusion. Patients with heroin use disorders present with high rates of psychiatric comorbidities, which underscores the need for substance treatment services with the capacity to diagnose and manage these comorbidities.