Several clinical and public health implications arise from these findings. Most simply, those with greater substance use and dependence are more at risk for mental health disorders, personality disorders, suicide and overdose. However even those with no other dependence diagnoses had relatively high rates of these problems. Although a lack of other substance dependence does not preclude these problems, there may be a rationale for more intensive interventions for those with a greater number of dependence diagnoses. There is also a case for shifting the emphasis when assessing and addressing risks for males and females: males may be more at risk of criminal reoffending and other substance dependence, particularly alcohol dependence which has implications for liver disease given the high prevalence of the Hepatitis C virus amongst injecting drug users (Day & Dolan, 2006). Females in this population appear to be more at risk of problems related to sex work, adult violence and sexual assault, childhood trauma, internalising disorders and suicidality. Additionally, the prevalence of these problems for women with multiple substance dependence diagnoses is exceptionally high.
