C OMORBIDITY

W HAT IS COMORBIDITY ? When two disorders or illnesses occur concurrently in the same person, they are called comorbid Drug abuse and other psychiatric disorders (mental illnesses) are often comorbid Infectious conditions such as hepatitis C, B and tuberculosis are common among injecting drug users Non-infectious conditions such as malnutrition, anemia are prevalent amongst people who inject drugs

R ELATIONSHIP BETWEEN DRUG USE AND PSYCHIATRIC DISORDER Six out of ten people with a drug use disorder also suffer from another form of psychiatric disorder (mental illness) Drug use can cause a psychiatric disorder Psychiatric disorder can lead to drug use Drug use and psychiatric disorders are both caused by some common risk factors

W HY DO DRUG USE DISORDERS AND PSYCHIATRIC DISORDERS CO - OCCUR ? Overlapping genetic vulnerabilities Overlapping environmental triggers Involvement of similar brain regions drug use disorders and psychiatric disorders are developmental disorders

P REVALENCE OF PSYCHIATRIC COMORBIDITY Compared with general population Patients with mood or anxiety disorders are 2 times at great risk to develop drug use disorder Patients with drug use disorders are twice as likely to be diagnosed with mood or anxiety disorders Comparison between males and females Antisocial personality disorder is more common in substance using men Substance using women have higher rates of major depression, posttraumatic stress disorder, and other anxiety disorders

N EED FOR DIAGNOSIS AND TREATMENT Comorbidity is relatively common Comorbid patients exhibit more severe symptoms Need to differentiate symptoms related to intoxication and withdrawal from psychiatric disorders Greater stigma attached to people with comorbid disorders

N EED FOR DIAGNOSIS AND TREATMENT Diagnosis and treatment of one disorder will likely reduce risk for the other Integrated treatment to treat both conditions is important There should not be any bias in providing necessary treatment with medications for people with comorbid psychiatric disorder Concurrent therapy with pharmacological and behavioural treatment is ideal

C O - INFECTIONS AMONGST IDU S Hepatitis C Hepatitis B HIV Tuberculosis Sexually transmitted infections (STIs)

C OMMON PHYSICAL DISORDERS AMONG IDU S Anaemia Malnutrition

P OLY -D RUG U SERS Many injecting drug users in the country use multiple drugs Withdrawals from alcohol, benzodiazepines have to be managed effectively Opioid withdrawals can be effectively addressed using evidence based approaches