Psychiatric disorders in opioid-dependent patients.

An examination of substance abusers in contemporary practice reveals a high frequency of psychiatric disorders. In some cases, these probably represent preexisting conditions, but in others the disorder may be initiated or aggravated by the biologic and social consequences of substance abuse. The severity of a patient's psychiatric disorder is predictive of response to substance abuse treatment. A high proportion of affective disorders has been found among opioid-dependent patients; these are responsive to psychotherapy and to antidepressant treatment with doxepin. Careful psychiatric diagnosis in the management of substance abuse can discriminate those patients who are likely to require psychotherapy or psychoactive medication from those who may do well with standard drug counseling alone.