Network Analysis of DSM Symptoms of Substance Use Disorders and Frequently Co-Occurring Mental Disorders in Patients with Substance Use Disorder Who Seek Treatment

Edith López-Toro; Casper J H Wolf; Rafael A González; Wim van den Brink; Arnt Schellekens; María C Vélez-Pastrana; On Behalf Of The Afp Working Collaborative Group

doi:10.3390/jcm11102883

Network Analysis of DSM Symptoms of Substance Use Disorders and Frequently Co-Occurring Mental Disorders in Patients with Substance Use Disorder Who Seek Treatment

J Clin Med. 2022 May 19;11(10):2883. doi: 10.3390/jcm11102883.

Authors

Edith López-Toro¹, Casper J H Wolf^{2

3

4}, Rafael A González^{5

6}, Wim van den Brink⁷, Arnt Schellekens^{2

4}, María C Vélez-Pastrana¹, On Behalf Of The Afp Working Collaborative Group

Affiliations

¹ PhD Program in Clinical Psychology, Universidad Carlos Albizu, P.O. Box 9023711, San Juan, PR 00902-3711, USA.
² Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
³ Department of Cognitive Neuroscience, Donders Institute for Brain Cognition and Behaviour, Radboud University, 6525 EN Nijmegen, The Netherlands.
⁴ Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands.
⁵ National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
⁶ Centre for Psychiatry, Imperial College London, London W12 0NN, UK.
⁷ Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.

Abstract

Background: Substance use disorders (SUD) often co-occur with other psychiatric conditions. Research on SUD and comorbid disorders generally flows from a categorical diagnostic or dimensional latent variable perspective, where symptoms are viewed as independent indicators of an underlying disorder. In contrast, the current study took a network analysis perspective to examine the relationships between DSM symptoms of SUD, ADHD, conduct disorder (CD), depression (MDD), and borderline personality disorder (BPD). In addition, we explored possible gender differences in the network structures of these symptoms.

Method: In a sample of 722 adult treatment-seeking patients with SUD from the International ADHD in Substance Use Disorders Prevalence Study (IASP) we estimated the network structure for 41 symptoms of SUD, ADHD, CD, MDD, and BPD. We described the structure of symptom networks and their characteristics for the total sample, and we compared the symptom networks for males and females.

Results: Network analyses identified seven clusters of symptoms, largely corresponding with the DSM diagnostic categories. There were some connections between clusters, mainly between some hyperactivity symptoms and CD and depressive symptoms. ADHD hyperactivity was most central in the symptom network. Invariance tests revealed no significant gender differences in the structure of symptom networks.

Conclusions: The current findings support the categorical DSM classification of mental disorders in treatment-seeking patients with SUD. Future network analyses should include a broader range of symptoms and prospectively explore changes in the symptoms network of patients during treatment.

Keywords: ADHD; borderline personality; comorbidity; conduct disorder; gender differences; network analysis; personality disorders; substance use disorders.

Grants and funding

Data collection for the IASP studies was performed with in-kind support from all participating addiction treatment centers. In some centers, financial support was obtained from regional or national scientific funding agencies (for details see: [25,27]). The present research received no additional external funding.