A study led by researchers from the group of Psychiatry, Mental Health and Addictions of Vall d'Hebron Research Institute (VHIR) and from the department of Addictions and Dual Pathology of the Psychiatric Service of the University Hospital Vall d'Hebron has revealed that 7 out 10 (67%) of patients treated in health centres in the country for heroin addiction, suffer at least one psychiatric disorder associated. The study analysed data from 621 patients treated for addiction, provided by 74 centres in the country. This figure makes it the first of its kind carried out, providing a very detailed picture of psychiatric problems arising from the use of heroin, as explained its coordinator, Dr. Carlos Roncero, head of the Department of Addictions and Dual Pathology of the Psychiatric Service of Vall d'Hebron and principal investigator of the research group. The study was recently published in the Psychiatry Research journal in its September issue.84% of patients who participated in the study were men, with an average of less than 40 years old. 47% are unemployed and 19% have legal problems. Almost all, 94%, are being treated with methadone, the majority, 82%, have other types of addictions (especially snuff, alcohol and cannabis), and 59% also suffers at least an infectious disease, such as hepatitis C or HIV infection. Psychiatric comorbidity67% of the analyzed cases are cases of dual pathology, presenting more than one psychiatric disorder at a time. The most common is anxiety, present in 53% of study participants, followed by alterations in mood (48%), sleep disturbances (41%), disturbances related to substance use disorders (36%) and personality disorders (27%). Schizophrenia and other psychotic disorders, severe problems that are not usually diagnosed, affecting 12% of patients, and are more common in those who also abuse cocaine. The proportion of patients with at least one psychiatric comorbidity is significantly increased with the methadone dose received, according to the study authors. These problems are, according to Dr. Roncero, "markers of possible relapse'', which must be taken into account. This forces to evaluate "all addicted patients, especially to heroin dependent'' to search ''if there are other disorders, especially those receiving high doses of methadone.''Another notable factor is the difference between the detected disorders in men and women, who have more disorders in sexuality and gender identity. An ''expected'' finding, according to Dr. Roncero, but he believes that analysis must take into account the low number of women participating in the study. A problem of underdiagnosisFor Dr. Carlos Roncero, the study shows that psychiatric comorbidity in drug abusers is underdiagnosed. 12% receive no specific drug treatment to treat them or receives only partially. This data does not indicate, he says, the 'malpractice' of professionals who follow it, but it forces more preparation to detect them, improve the diagnostic process to get treatment and management. The problem is that "the symptoms are hidden," according to the study coordinator, "because of heroin dependence, which is very serious.'' It is about "very complicated patients, who need more evaluation time to find all the problems arising from their dependence'', says the study coordinator, who explains that this kind of patient needs more treatment and more intensive therapies to their problem.When dealing with these cases, it is important to bear in mind that patients have a worse level of occupation and serious problems health, work, family, legal, alcoholism and psychological than those without associated psychiatric disorders.This fact, coupled with the differences between men and women leads to adopt a gender perspective in treatment, "seek disorders'' following this criterion, and, at the same time, "apply treatment depending on the disorder or disorders'' each patient is suffering.