Cocaine use disorder, mental health diagnoses, and serious mental illness characteristics in mental health treatment

Over half of treatment-seeking individuals with a cocaine use disorder have a co-occurring mental health disorder. Mental health disorder symptoms may impact an individual's functioning so severely that they are classified as a serious mental illness (SMI). However, there is variability in defining SMI, including the duration of symptoms, functional impairment, or specific diagnoses such as schizophrenia. This study answered the following questions among a national sample of adults with cocaine use disorder who received services from mental health treatment facilities from 2013 to 2021 (N = 359,500): [1] what are most diagnosed mental health disorders, [2] what is the percentage of SMI, and [3] are some mental health diagnoses associated with the designation of SMI? Binary logistic regression identified mental health diagnoses associated with SMI. The sample was primarily male (n = 184,312; 51.3%) and the largest racial group was Black or African American (n = 149,080; 41.5%). The most endorsed mental health disorder diagnoses in the sample include depressive disorders (n = 115,347; 32.1%), bipolar disorders (n = 94,591; 26.3%), and schizophrenia or other psychotic disorders (n = 86,298; 24.0%). Anxiety disorders, bipolar disorders, conduct disorders, dementia/delirium, depressive disorders, personality disorders, pervasive developmental disorders, schizophrenia or other psychotic disorders, trauma-or stressor-related disorders, and other mental health disorders were associated with SMI. Diagnoses most associated with SMI were schizophrenia or other psychotic disorders (Adjusted odds ratio = 20.188; 95% Confidence Interval = 19.533, 20.865), bipolar disorders (Adjusted odds ratio = 7.257; 95% Confidence Interval = 7.085, 7.433), and depressive disorders (Adjusted odds ratio = 4.855; 95% Confidence Interval = 4.754, 4.957). This study provides a snapshot of the recent landscape of mental health disorders and SMI among individuals with a cocaine use disorder who received treatment from mental health facilities from 2013 to 2021. Significant comorbidity was identified, including multiple diagnoses and SMI.