Substance use and symptoms of mental health disorders: a prospective cohort of patients with severe substance use disorders in Norway

Christer F Aas*, Jørn Henrik Vold, Rolf Gjestad, Svetlana Skurtveit, Aaron G Lim, Kristian Varden Gjerde, Else Marie Løberg, Kjell Arne Johansson, Lars Thore Fadnes

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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There is high co-occurrence of substance use disorders (SUD) and mental health disorders. We aimed to assess impact of substance use patterns and sociodemographic factors on mental health distress using the ten-item Hopkins Symptom Checklist (SCL-10) over time.

Nested prospective cohort study of 707 participants with severe SUD across nine opioid-agonist-therapy outpatient clinics and low-threshold municipality clinics in Norway, during 2017–2020. Descriptive statistics were derived at baseline and reported by means and standard deviation (SD). A linear mixed model analysis was used to assess the impact of substance use patterns and sociodemographic factors on SCL-10 sum score with beta coefficients with 95% confidence intervals (CI).

Mean (SD) SCL-10 score was 2.2 (0.8) at baseline with large variations across patients. We observed more symptoms of mental health disorders among people with frequent use of benzodiazepines (beta 3.6, CI:2.4;4.8), cannabis (1.3, CI:0.2;2.5), opioids (2.7, CI:1.1;4.2), and less symptoms among people using frequent stimulant use (− 2.7, CI:-4.1;-1.4) compared to no or less frequent use. Females (1.8, CI:0.7;3.0) and participants with debt worries (2.2, CI:1.1;3.3) and unstable living conditions (1.7, CI:0.0;3.3) had also higher burden of mental health symptoms. There were large individual variations in SCL-10 score from baseline to follow-up, but no consistent time trends indicating change over time for the whole group. 65% of the cohort had a mean score > 1.85, the standard reference score.

People with SUD have a considerable burden of mental health symptoms. We found no association between substance use patterns and change in mental health symptoms over time. This could suggest that the differences observed were indicating flattening of effects or self-medication to a larger degree than medication-related decline in mental health. This call for better individualized mental health assessment and patient care.
Original languageEnglish
Article number20
Number of pages10
JournalSubstance Abuse Treatment, Prevention and Policy
Issue number1
Early online date27 Feb 2021
Publication statusE-pub ahead of print - 27 Feb 2021

Bibliographical note

Funding Information:
This study is part of the main INTRO-HCV study, which was funded by The Norwegian Research Council (no. 269855) and the Western Norway Regional Health Authority (“Åpen prosjektstøtte) with Department of Addiction Medicine, Haukeland University Hospital as responsible institution. The funders had no role in the study design, data collection and analyzes, decision to publish, nor preparation of any content in the manuscript. Two of the authors, CFA and JHV, are funded from the above research grant, whereas the other authors are funded by their respective affiliations.

Funding Information:
Christer Kleppe, data protecting officer, Helse Bergen for his valuable contribution and guidance in data management. We also thank Nina Elisabeth Eltvik for valuable help and input during the planning and preparation phases. INTRO-HCV Study Group participating investigators: Bergen: Christer Frode Aas, Vibeke Br?then Buljovcic, Fatemeh Chalabianloo, Jan Tore Daltveit, Silvia Eiken Alpers, Lars T. Fadnes (principal investigator), Trude Fondenes Eriksen, Per Gundersen, Velinda Hille, Kristin Holmelid H?berg, Kjell Arne Johansson, Rafael Alexander Leiva, Siv-Elin Leirv?g Carlsen, Martine Leps?y Bonnier, Lennart Lor?s, Else-Marie L?berg, Mette Hegland Nordbotn, Cathrine Nyg?rd, Maria Olsvold, Christian Ohldieck, Lillian Sivertsen, Hugo Torjussen, J?rn Henrik Vold, Jan-Magnus ?kland. Stavanger: Tone Lise Eielsen, Nancy Laura Ortega Maldonado, Ewa Joanna Wilk. proLAR: Ronny Bj?rnestad, Ole J?rgen Lygren, Marianne Cook Pierron. Oslo: Olav Dalgard, H?vard Midgard, Svetlana Skurtveit. Bristol: Peter Vickerman. (In alphabetical order of surname) The study was approved by the Regional committee for medical and health research ethics (no. 2017/51/REK vest). It was conducted in accordance with the Helsinki Declaration and STROBE guidelines All included participants signed a written consent to partake in the study.

Publisher Copyright:
© 2021, The Author(s).


  • Substance use disorder
  • substance abuse
  • mental disorder
  • psychological distress
  • mental health problems
  • opioid substitution treatment
  • opioid dependence


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