Prevalence of dual diagnosis and clinical-epidemiological profile of patients followed at a specialized psychoactive substance outpatient clinic at FMABC

Abstract

INTRODUCTION: Substance Use Disorders (SUD) are a major public health challenge with high morbidity and mortality. Diagnostic complexity increases with the coexistence of additional mental disorders, known as Dual Diagnosis (DD). DD is often underdiagnosed, compromising prognosis and increasing relapse rates. The FMABC Psychoactive Substance Didactic Outpatient Clinic (FMABC-PSDOC) provides specialized psychiatric care for individuals at the Desafio Jovem Therapeutic Community (TC), integrating clinical care with psychosocial rehabilitation. This study aims to identify the clinical profile and DD prevalence among patients at FMABC-PSDOC over 43 months. METHODS: A 3 retrospective observational study analyzed 135 medical records of male patients. Data included sociodemographic variables, SUD diagnoses (ICD-10 F10-F19), and comorbid psychiatric disorders. Analysis was performed using descriptive statistics (absolute and relative frequencies). RESULTS: DD prevalence was 26%, predominantly mood disorders (96%): Depressive (50%), Bipolar (25%), and Anxiety (19%). Regarding consumption, 60% exhibited polysubstance use (ICD-10 F19). The median age of onset was 14.5 years; alcohol (44%) and cannabis (18%) were the primary gateway drugs. Notably, 52% of those who started with alcohol transitioned to cocaine, which became the primary drug of choice at admission (66%), followed by alcohol (28%). DISCUSSION: The 26% DD prevalence reinforces that specialized psychiatric support is essential for diagnosing underlying pathologies in SUD. This integrated approach allows treatment to transcend isolated abstinence, which is critical for effective rehabilitation in TCs. Early onset and the transition to illicit substances suggest that easy access to alcohol makes it a significant entry point. CONCLUSION: By quantifying DD prevalence and characterizing the clinical profile of 135 patients, this study demonstrates that integrated psychiatric support is vital for individualized management and treatment efficacy for SUD patients in therapeutic communities.