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Paper text:
substance use disorders ( suds ) are a global health problem which present in a variety of clinical settings .
substance use may complicate an underlying medical or psychiatric disorder and can also lead to medical or psychological morbidity in its own right .
high rates of substance use have been reported in patients with psychiatric syndromes such as schizophrenia , mood disorders [ 2 , 3 ] , and anxiety disorders .
patients , have been found to have more severe symptoms and poorer outcomes [ 1 , 4 ] .
psychosexual disorders , also termed psychogenic sexual disorders , are dysfunctions of the sexual response cycle that cause impaired sexual performance and distress to affected patients and their partners .
the commonest sexual disorders seen in male patients are premature ejaculation   and erectile dysfunction .
earlier studies have reported significant rates of problematic substance use in men with sexual disorders [ 79 ] , but this association has been less well studied than in patients with other mental disorders , and its causal significance is unclear . a consistent association between erectile dysfunction and tobacco use has been found [ 7 , 9 ] , but the effects of alcohol use on sexual dysfunction are less clear .
however , this association has not been systematically examined in the indian context . in the current study
, we retrospectively examined the rates of substance use , abuse , and dependence in young and middle - aged south indian men presenting to an outpatient clinic for psychosexual disorders .
the case records of 105 male patients who attended the marital and psychosexual disorders ( maps ) clinic at the jawaharlal institute of postgraduate medical education and research ( jipmer ) between january 2011 and october 2013 were reviewed .
alcohol use disorders are a significant problem in pondicherry , which was a further motivation for conducting this study .
patients are referred to the clinic either by self - referral or from other departments in jipmer , particularly general surgery and urology . at initial presentation ,
a brief assessment is made by a trained psychiatrist , and an appointment is given for a detailed evaluation in the maps clinic .
on the day of this appointment , patients are evaluated using a semistructured interview to elicit a sexual history as well as details of medical and psychiatric comorbidity , family history of mental illness , and early childhood experiences .
all interviews are conducted by psychiatry residents , and diagnoses are made according to icd-10 clinical guidelines after review by a consultant . following diagnosis , patients received psychological interventions , including education and behaviour therapy .
pharmacotherapy in the form of antidepressants and anxiolytics was used for the management of comorbid anxiety and depression , and the short - acting serotonin uptake inhibitor dapoxetine was used in selected patients with premature ejaculation .
all tests were two - tailed and a significance level of 0.05 was considered statistically significant .
the sample consisted of 105 men . of these , 25 ( 23.8% ) had a lifetime diagnosis of a substance use disorder ; a further 7 ( 6.7% ) had used alcohol or nicotine but were not dependent on them .
of the 25 with an identified substance use disorder , 3 only had a harmful use pattern without dependence ; all of these three men were using alcohol .
the remaining 22 ( 21% ) fulfilled criteria for substance dependence : 21 had nicotine dependence , and 6 had alcohol dependence .
one patient had harmful use of benzodiazepines , and one reported harmful use of cannabis . among those men with a history of alcoholism (
n = 6 ) , the mean age at onset of dependence was 22.8  3.11 years ; three of these men ( 50% ) had an early ( < 25 years ) onset
. only one of the men with alcohol dependence had a family history of alcoholism . of these 25 men , 19 ( 18.1% ) fulfilled icd-10 criteria for current harmful use or dependence : 17 with nicotine dependence and two with alcohol dependence , one with harmful use of alcohol and one with harmful use of benzodiazepines .
the remaining six had discontinued substance use prior to receiving a diagnosis of sexual dysfunction . when patients with comorbid substance use were compared with those without , the two groups were comparable on most variables , including age , duration of illness , types of sexual dysfunction , comorbid conditions , and early childhood adversity .
however , men with comorbid substance use were more likely to have a family history of substance dependence ( alcohol or nicotine ) in a first - degree relative ( 14/25 versus 23/80 ;  = 6.198 , p = 0.013 ) .
this association held good even when only family histories of alcoholism were considered ( 11/25 versus 18/80 ;  = 4.404 , p = 0.036 ) .
anxious - avoidant personality was more common in men without substance use disorders ( 15% versus 4% ) , but this difference was not statistically significant ( table 1 ) .  
when the subgroup with active substance use alone ( n = 19 ) was compared with the group without substance use disorders , they were also significantly more likely to have a family history of substance dependence ( 12/19 versus 23/80 ;  = 7.953 , p = 0.005 ) or alcoholism in particular ( 9/19 versus 18/80 ;  = 4.787 , p = 0.029 ) .
however , they did not differ on any other clinical or demographic variable , including the type of sexual dysfunction experienced .
separate analyses were then conducted to compare the profiles of single and married men with and without substance use disorders . among single men , patients with comorbid substance use disorders were more likely to suffer from a comorbid mood disorder ( 5/15 versus 4/51 ;  = 6.395 , p = 0.011 ) and were more likely to have a family history of alcoholism ( 9/15 versus 11/51 ;  = 8.106 , p = 0.004 ) than those without substance use disorders ; the two groups were comparable in other respects . among married men , patients with comorbid substance use disorders
were less likely to report infertility as a precipitating or aggravating factor for their sexual dysfunction ( none out of 10 versus 9/29 ;  = 4.034 , p = 0.045 ) ; however , they did not differ from married men without substance use disorder on any other clinical or demographic variable .
nonsubstance users were numerically more likely to report marital disharmony ( 55.16% against 30% of married substance users ) , but this difference did not reach statistical significance .
the rate of comorbid substance use disorders in men with psychosexual disorders was 23.8% ; in 21% , this amounted to dependence . these rates are slightly higher than those reported for mood or anxiety disorders in general   but lower than those reported for schizophrenia   or bipolar disorder , and they are comparable to the rates of regular smoking ( 27.2% ) reported in australian men with erectile dysfunction .
this suggests that substance use disorders may be an important comorbidity in men with sexual dysfunction and should be screened for and addressed in its own right . in this sample ,
nicotine and alcohol were the most common substances abused . as these substances are licit and freely available , they are commonly used by young men in india .
in contrast , the use of other drugs such as benzodiazepines and cannabis was infrequent in our patients .
this pattern is consistent with epidemiological research on the relative frequencies of various substance use disorders in india .
the rates reported in our patients are somewhat lower than those reported from deaddiction centres in india , though they are higher than those documented in the general population .
the most significant difference noted between men with and without substance use disorders in this study was the presence of a family history of substance dependence , particularly alcoholism , in the former group .
this is in line with current evidence on the genetics of alcoholism and nicotine dependence .
further research is needed to examine the possibility that substance use disorders and psychosexual disorders may arise from a shared genetic liability .
single men with substance use and psychosexual disorders were more likely to suffer from mood disorders in our study .
this may reflect the well - documented association between depression and substance use [ 13 , 14 ] .
caution is required in managing depression in this population , as antidepressants can themselves worsen sexual dysfunction in some patients . as this study was retrospective ,
a causal association between substance use disorders and sexual dysfunction could not be established . moreover ,
group consisted of men with a primary diagnosis of sexual dysfunction , making meaningful comparisons difficult .
current evidence suggests that smoking cessation can improve sexual dysfunction in men . though a meta - analytic review found that the association between alcohol use and erectile dysfunction was inconsistent , an indian study found a significant link between alcohol dependence and sexual disorders .
managing the comorbid substance use disorder in these patients may therefore lead to resolution of the patient 's sexual dysfunction .
diagnoses were made using the icd-10 clinical guidelines and depended on clinical skill rather than the use of a structured diagnostic interview .
finally , the study sample , which was drawn from a clinic for psychosexual disorders , may not accurately represent the young and middle - aged male population .
substance use disorders are a common comorbid diagnosis in men with psychosexual disorders . in these patients ,
substance use disorders tend to run in families and may be associated with higher rates of mood disorder in single men .
further prospective hospital and community - based studies are needed to obtain a better estimate of the magnitude and correlates of this problem .
introduction . substance use disorders ( suds ) are commonly associated with a variety of psychiatric disorders . 
 community - based studies have found a significant association between suds and sexual dysfunction in men , with a possible causal relation in the case of nicotine . 
 methods . 
 the case records of 105 men presenting to a clinic for patients with psychosexual disorders were reviewed . 
 men with and without comorbid suds were compared in terms of demographic , clinical , and familial variables . 
 results . 
 25 of the 105 men ( 23.8% ) had a lifetime diagnosis of sud , and 19 ( 18.1% ) had a current sud . 
 the commonest substances involved were nicotine ( n = 21 , 20% ) and alcohol ( n = 9 , 9.5% ) . 
 men with comorbid suds were more likely to report a family history of substance dependence , particularly alcoholism . 
 single men with suds were more likely to have a comorbid mood disorder . 
 conclusion . 
 suds , particularly nicotine and alcohol use disorders , are common comorbidities in patients with psychosexual disorders . identifying and treating these disorders in this population are important aspects of management .