Background: Substance users’ quality of life (QoL) is influenced by several variables, including psychiatric comorbidity and addiction severity. Thus far, the impact of the type of dependence (alcohol, drug or dual dependence) remains unclear. Therefore, the objectives of the study were to evaluate QoL in a clinical sample of alcohol-, drug- and dual-dependent patients and to assess the independent impact of psychiatric comorbidity, addiction severity and type of dependence on QoL. Methods: Face-to-face interviews with 274 patients admitted to residential substance abuse treatment were conducted using the European Addiction Severity Index (EuropASI), the Mini-International Neuropsychiatric Interview and the Assessment of Personality Disorders self-report questionnaire. Results: Multivariate analyses showed that anxiety, mood or personality disorder, employment status and the severity rating on the EuropASI domain alcohol use were associated with overall QoL. Gender, anxiety disorder and the severity ratings on the EuropASI domains alcohol use, drug use, physical health and emotional and psychological health were associated with overall perception of health. Conclusion: Addiction severity and psychiatric comorbidity explained the greatest amount of QoL variance, whereas the type of dependence did not play a central role.

1.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text rev. Washington, American Psychiatric Association, 2000.
2.
McLellan AT, Lewis DC, O’Brien CP, Kleber HD: Drug dependence, a chronic medical illness – implications for treatment, insurance, and outcomes evaluation. JAMA 2000;284:1689–1695.
3.
Koob GF, Volkow ND: Neurocircuitry of addiction. Neuropsychopharmacology 2010;35:217–238.
4.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA): 2008 Annual Report on the State of the Drugs Problem in Europe. Luxembourg, Office for Official Publications of the European Communities, 2008.
5.
European Monitoring Centre on Drugs and Drug Addiction (EMCDDA): 2009 Annual Report on the State of the Drugs Problem in Europe. Luxembourg, Office for Official Publications of the European Communities, 2009.
6.
Colpaert K, Vanderplasschen W, Van Hal G, Broekaert E: Dual substance abusers seeking treatment: demographic, substance-related, and treatment utilization characteristics. J Drug Issues 2008;38:559–583.
7.
Gossop M, Marsden J, Stewart D: Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems. Addiction 2002;97:169–178.
8.
Gossop M, Marsden J, Stewart D, Rolfe A: Patterns of drinking and drinking outcomes among drug misusers. 1-year follow-up results. J Subst Abuse Treat 2000;19:45–50.
9.
Smart RG, Ogborne AC, Newton-Taylor B: Drug abuse and alcohol problems among cocaine abusers in an assessment referral service. Br J Addict 1990;85:1595–1598.
10.
Stinson FS, Grant BE, Dawson DA, Ruan WJ, Huang B, Saha T: Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Drug Alcohol Depend 2005;80:105–116.
11.
Falk D, Yi HY, Hiller-Sturmhofel S: An epidemiologic analysis of co-occurring alcohol and drug use and disorders. Alcohol Res Health 2008;31:100–110.
12.
Foster JH, Powell JE, Marshall EJ, Peters TJ: Quality of life in alcohol-dependent subjects – a review. Qual Life Res 1999;8:255–261.
13.
Foster JH, Peters TJ, Marshall EJ: Quality of life measures and outcome in alcohol-dependent men and women. Alcohol 2000;22:45–52.
14.
Donovan D, Mattson ME, Cisler RA, Longabaugh R, Zweben A: Quality of life as an outcome measure in alcoholism treatment research. J Stud Alcohol 2005;15:119–139.
15.
Rapley M: Quality of Life Research: A Critical Introduction. London, Sage Publications, 2003.
16.
Schalock RL, Brown I, Brown R, Cummins RA, Felce D, Matikka L, Keith KD, Parmenter T: Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: report of an international panel of experts. Ment Retard 2002;40:457–470.
17.
Zubaran C, Foresti K: Quality of life and substance use: concepts and recent tendencies. Curr Opin Psychiatr 2009;22:281–286.
18.
Foster JH, Marshall EJ, Hooper R, Peters TJ: Quality of life measures in alcohol dependent subjects and changes with abstinence and continued heavy drinking. Addict Biol 1998;3:321–332.
19.
Günther O, Roick C, Angermeyer MC, König HH: The EQ-5D in alcohol dependent patients: relationships among health-related quality of life, psychopathology and social functioning. Drug Alcohol Depend 2007;86:253–264.
20.
Barros da Silva Lima AF, Fleck M, Pechansky F, de Boni R, Sukop P: Psychometric properties of the World Health Organization Quality of Life instrument (WHOQoL-BREF) in alcoholic males: a pilot study. Qual Life Res 2005;14:473–478.
21.
Costenbader EC, Zule WA, Coomes CM: The impact of illicit drug use and harmful drinking on quality of life among injection drug users at high risk for hepatitis C infection. Drug Alcohol Depend 2007;89:251–258.
22.
De Maeyer J, Vanderplasschen W, Lammertyn J, van Nieuwenhuizen C, Broekaert E: Exploratory study on domain-specific determinants of opiate-dependent individuals’ quality of life. Eur Addict Res 2011;17:198–210.
23.
Senbanjo R, Wolff K, Marshall J: Excessive alcohol consumption is associated with reduced quality of life among methadone patients. Addiction 2006;102:257–263.
24.
Foster JH, Peters TJ, Kind P: Quality of life, sleep, mood and alcohol consumption: a complex interaction. Addict Biol 2002;7:55–65.
25.
Smith KW, Larson MJ: Quality of life assessments by adult substance abusers receiving publicly funded treatment in Massachusetts. Am J Drug Alcohol Abuse 2003;29:323–335.
26.
Akvardar Y, Akdede BB, Özerdem A, Eser E, Topkaya S, Alptekin K: Assessment of quality of life with the WHOQOL-BREF in a group of Turkish psychiatric patients compared with diabetic and health subjects. Psychiatry Clin Neurosci 2006;60:693–699.
27.
De Maeyer J, Vanderplasschen W, Broekaert E: Quality of life among opiate-dependent individuals: a review of the literature. Int J Drug Policy 2010;21:364–380.
28.
Braucht GN, Reichardt CS, Geissler LJ, Bormann CA, Kwiatkowski CF, Kirby MW: Effective services for homeless substance abusers. J Addict Dis 1995;14:87–109.
29.
Ginieri-Coccossis M, Liappas IA, Tzavellas E, Triantafillou E, Soldatos C: Detecting changes in quality of life and psychiatric symptomatology following an in-patient detoxification programme for alcohol-dependent individuals: the use of WHOQOL-100. In Vivo 2007;21:99–106.
30.
Rather BC, Sherman MF: Relationship between alcohol expectancies and length of abstinence among alcoholics anonymous members. Addict Behav 1989;14:531–536.
31.
Gillet P, Paille F, Wahl D, Aubin HJ, Pirollet P, Prime T: Outcome of treatment in alcoholic women. Drug Alcohol Depend 1991;29:189–194.
32.
Volk RJ, Cantor SB, Steinbauer JR, Cass AR: Alcohol use disorders, consumption patterns, and health-related quality of life of primary care patients. Alcohol Clin Exp Res 1997;21:899–905.
33.
Daeppen JB, Krieg MA, Burnand B, Yersin B: MOS-SF-36 in evaluating health-related duality of life in alcohol-dependent patients. Am J Drug Alcohol Abuse 1998;24:685–694.
34.
Evren C, Dalbudak E, Durkaya M, Cetin R, Evren B, Celik S: Relationship of life quality with severity of alcohol related problems in male alcohol dependent inpatients. Arch Neuropsychiatry 2010;47:64–68.
35.
Lahmek P, Berlin I, Michel L, Berghout C, Meunier N, Aubin HJ: Determinants of improvement in quality of life of alcohol-dependent patients during an inpatient withdrawal programme. Int J Med Sci 2009;6:160–167.
36.
Lozano OM, Domingo-Salvany A, Martinez-Alonso M, Brugal MT, Alonso J, de la Fuente L: Health-related quality of life in young cocaine users and associated factors. Qual Life Res 2008;17:977–985.
37.
Romeis JC, Waterman B, Scherrer JF, Goldberg J, Eisen SA, Heath AC, Bucholz KK, Slutske WS, Lyons MJ, Tsuang MT, True WR: The impact of sociodemographics, comorbidity and symptom recency on health-related quality of life in alcoholics. J Stud Alcohol 1999;60:653–662.
38.
Hambley J, Arbour S, Sivagnanasundaram L: Comparing outcomes for alcohol and drug abuse clients. J Subst Use 2010;15:184–200.
39.
Garg N, Yates WR, Jones R, Zhou M, Williams S: Effect of gender, treatment site and psychiatric comorbidity on quality of life outcome in substance dependence. Am J Addict 1999;8:44–54.
40.
Bizzarri J, Rucci P, Vallotta A, Girelli M, Scandolari A, Zerbetto E, Sbrana A, Iagher C, Dellantonio E: Dual diagnosis and quality of life in patients in treatment for opioid dependence. Subst Use Misuse 2005;40:1765–1776.
41.
Colpaert K, De Maeyer J, Vanderplasschen W, Broekaert E, De Fruyt F: Prevalence and determinants of personality disorders in a clinical sample of alcohol-, drug-, and dual-dependent patients. Subst Use Misuse, DOI: 10.3109/10826084.2011.653427.
42.
Grant BF, Stinson FS, Dawson DA, Chou SP, Ruan J, Pickering RP: Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States – results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2004;61:361–368.
43.
Fassino S, Daga GA, Delsedime N, Rogna L, Boggio S: Quality of life and personality disorders in heroin abusers. Drug Alcohol Depend 2004;76:73–80.
44.
Karow A, Verthein U, Krausz M, Schäfer I: Association of personality disorders, family conflicts and treatment with quality of life in opiate addiction. Eur Addict Res 2008;14:38–46.
45.
Evren C, Sar V, Dalbudak E, Cetin R, Durkaya M, Evren B, Celik S: Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse and dissociation. Psychiatry Res 2011;186:85–90.
46.
Saatcioglu O, Yapici A, Cakmak D: Quality of life, depression and anxiety in alcohol dependence. Drug Alcohol Rev 2008;27:83–90.
47.
Kokkevi A, Hartgers C: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. Eur Addict Res 1995;1:208–210.
48.
McLellan AT, Luborsky L, Woody GE, O’Brien CP: An improved diagnostic evaluation instrument for substance abuse patients, the Addiction Severity Index. J Nerv Ment Dis 1980;168:26–33.
49.
McLellan AT, Cacciola JC, Alterman AI, Rikoon SH, Carise D: The Addiction Severity Index at 25: origins, contributions and transitions. Am J Addict 2006;15:113–124.
50.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini- International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:22–33.
51.
Jones JE, Hermann BP, Barry JJ, Gilliam F, Kanner AM, Meador KJ: Clinical assessment of axis I psychiatric morbidity in chronic epilepsy: a multicenter investigation. J Neuropsychiatry Clin Neurosci 2005;17:172–179.
52.
Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, Schinka J, Knapp E, Sheehan MF, Dunbar GC: The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry 1997;12:232–241.
53.
Schotte CKW, de Doncker D, Vankerckhoven C, Vertommen H, Cosyns P: Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV. Psychol Med 1998;28:1179–1188.
54.
Schotte CKW, de Doncker D, Courjaret J: De ADP-IV: Vragenlijst voor DSM-IV én gedragstherapeutische diagnostiek. Gedragstherapie 2007;40:113–125.
55.
Schotte CKW: New instruments for diagnosing personality disorders. Curr Opin Psychiatr 2000;13:605–609.
56.
Skevington SM, Lofty M, O’Connell KA: The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Qual Life Res 2004;13:299–310.
57.
The WHOQOL Group: Development of the WHOQOL-BREF Quality of Life Assessment. Psychol Med 1998;28:551–558.
58.
Gonzales R, Ang A, Glik DC, Rawson RA, Lee S, Iguchi MY: Quality of life among treatment seeking methamphetamine-dependent individuals. Am J Addict 2011;20:366–372.
59.
Mendlowicz MV, Stein MB: Quality of life in individuals with anxiety disorders. Am J Psychiatry 2000;157:669–682.
60.
Miller PR, Dasher R, Collins R: Inpatient diagnostic assessments. 1. Accuracy of structured versus unstructured interviews. Psychiatry Res 2001;105:255–264.
61.
McGovern MP, Xie H, Segal SR, Siembab L, Drake RE: Addiction treatment services and co-occurring disorders: prevalence estimates, treatment practices, and barriers. J Subst Abuse Treat 2006;31:267–275.
62.
Baillie AJ, Stapinski L, Crome E, Morley K, Sannibale C, Haber P, Teesson M: Some new directions for research on psychological interventions for comorbid anxiety and substance use disorders. Drug Alcohol Rev 2010;29:518–524.
63.
Moggi F, Hirsbrunner HP, Brodbeck J, Bachmann KM: One-year outcome of an integrative inpatient treatment for dual diagnosis patients. Addict Behav 1999;24:589–592.
64.
Zimmer Höfler D, Dobler-Mikola D, Uchtenhagen A, Christen S: Therapeutic communities and methadone treatment in follow-up research. Documentation of the First European Conference on Rehabilitation and Drug Policy. Stockholm, European Federation of Therapeutic Communities, 1993, pp 62–74.
65.
Johnson ME, Brems C, Fisher DG: Self-reported levels of psychopathology of drug abusers not currently in treatment. J Psychopathol Behav 1996;18:21–34.
66.
Schwartz RP, Kelly SM, O’Grady KE, Mitchell SG, Brown BS: Antecedents and correlates of methadone treatment entry: a comparison of out-of-treatment and in-treatment cohorts. Drug Alcohol Depend 2011;115:23–29.
67.
Millson P, Challacombe L, Villeneuve PJ, Strike CJ, Fischer B, Myers T, Shore R, Hopkins S: Determinants of health-related quality of life of opiate users at entry to low-threshold methadone programs. Eur Addict Res 2006;12:74–82.
68.
Carpentier PJ, van Gogh MT, Knapen LJM, Buitelaar JK, De Jong CAJ: Influence of attention deficit hyperactivity disorder and conduct disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients. Eur Addict Res 2011;17:10–20.
69.
Carr AJ, Higginson IJ: Measuring quality of life: are quality of life measures patient centred? BMJ 2001;322:1357–1360.
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