Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-17T19:12:17.190Z Has data issue: false hasContentIssue false

Schizophrenia and Substance Abuse

Published online by Cambridge University Press:  02 January 2018

Jeanette Smith*
Affiliation:
Fromeside Clinic, Bristol
Stephen Hucker
Affiliation:
Clarke Institute of Psychiatry, University of Toronto, Canada
*
Dr J. Smith, Fromeside Clinic, Blackberry Hill Hospital, Stapleton, Bristol BS16 1ED

Extract

Background

Recent research from North America has demonstrated higher than expected rates of drug and alcohol abuse among the seriously mentally ill. Schizophrenics appear to be particularly susceptible to the negative effects of substance abuse. These include psychiatric and social complications, with antisocial behaviour, particularly violence emerging as one of the most worrying features. This review examines the strength of the association and explores the possible explanations for the apparent link between schizophrenia, substance abuse and violence.

Method

The literature was searched using Medline, supplemented with a manual literature search.

Results

Very few articles specifically approached the problem of violence among substance abusing schizophrenics, but over 80 papers were identified which were helpful in exploring the link between dangerous behaviour and substance abuse by schizophrenics.

Conclusions

While there is circumstantial evidence to support the hypothesis that schizophrenics who abuse drugs or alcohol are at an increased risk of behaving violently, longitudinal studies are required to facilitate a better understanding of the mediating mechanisms.

Type
Review Article
Copyright
Copyright © Royal College of Psychiatrists, 1994 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abram, K. M. & Teplin, L. A. (1991) Co-occurring disorders among mentally ill jail detainees. American Psychologist, 46, 10361045.CrossRefGoogle ScholarPubMed
Adams, J. J., Meloy, J. R. & Moritz, M. S. (1990) Neuropsychological deficits and violent behaviour in incarcerated schizophrenics. Journal of Nervous and Mental Disease, 178, 253256.CrossRefGoogle ScholarPubMed
Allebeck, P., Varla, A., Kristjansson, E., et al (1987) Risk factors for suicide among patients with schizophrenia. Acta Psychiatrica Scandinavica, 76, 414419.CrossRefGoogle ScholarPubMed
Alterman, A. I., Erdlin, F. R., McLellan, A. T., et al (1980) Problem drinking in hospitalised schizophrenic patients. Addictive Behaviours, 5, 273276.CrossRefGoogle Scholar
Alterman, A. I., Ayre, F. R. & Williford, W. O. (1984) Diagnostic validation of conjoint schizophrenia and alcoholism. Journal of Clinical Psychiatry, 45, 300303.Google ScholarPubMed
Ananth, J., Vandewater, S., Kamal, M., et al (1989) Missed diagnosis of substance abuse in psychiatric patients. Hospital and Community Psychiatry, 40, 297299.Google ScholarPubMed
Arndt, S., Tyrrel, G., Flaum, M., et al (1992) Comorbidity of substance abuse and schizophrenia: the role of pre-morbid adjustment. Psychological Medicine, 22, 379388.CrossRefGoogle ScholarPubMed
Barbee, J. G., Clark, P. D., Crapanzano, M. S., et al (1989) Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service. Journal of Nervous and Mental Disease, 177, 400407.CrossRefGoogle Scholar
Bartels, S. J., Drake, R. E., Wallach, M. A., et al (1991) Characteristic hostility in schizophrenic outpatients. Schizophrenia Bulletin, 16, 8185.Google Scholar
Bartels, S. J., Teague, G., Drake, R. E., et al (1993) Substance abuse in schizophrenia: service utilization and costs. Journal of Nervous and Mental Disease, 181, 227232.CrossRefGoogle ScholarPubMed
Bergman, H. C. & Harris, M. (1985) Substance abuse among young adult chronic patients. Psychosocial Rehabilitation Journal, 9, 4954.CrossRefGoogle Scholar
Bowers, B. B. (1977) Psychoses precipitating psychomimetic drugs. Archives of General Psychiatry, 34, 832835.CrossRefGoogle Scholar
Bowers, B. B., Mazure, C. M., Nelson, J. C., et al (1990) Psychotogenic drug use and neuroleptic response. Schizophrenia Bulletin, 16, 8185.CrossRefGoogle ScholarPubMed
Brady, K., Anton, R., Ballenger, J. C., et al (1990) Cocaine abuse among schizophrenic patients. American Journal of Psychiatry, 147, 11641167 Google ScholarPubMed
Brady, K., Casto, S., Lydiard, R. B., et al (1991) Substance abuse in an inpatient psychiatric sample. American Journal of Drug and Alcohol Abuse, 17, 379389.CrossRefGoogle Scholar
Breakey, W. R., Goodell, H., Lorenz, P. C., et al (1974) Hallucinogenic drugs as precipitants of schizophrenia. Psychological Medicine, 4, 255261.CrossRefGoogle ScholarPubMed
Burrows, K. L., Hales, R. E. & Arington, E. (1988) Research on the biological aspects of violence. Psychiatric Clinics of North America, 11, 499509.CrossRefGoogle Scholar
Byrne, A., Kirby, B., Zibin, T., et al (1991) Psychiatric and neurological effects of chronic solvent abuse. Canadian Journal of Psychiatry, 36, 735738.CrossRefGoogle ScholarPubMed
Carey, K. B. (1989) Emerging treatment guidelines for mentally ill chemical abusers. Hospital and Community Psychiatry, 40, 341349.Google ScholarPubMed
Carey, M. P., Carey, K. B. & Meisler, A. W. (1991) Psychiatric symptoms in mentally ill chemical abusers. Journal of Nervous and Mental Disease, 179, 136138.CrossRefGoogle ScholarPubMed
Chiles, J. A., Von Cleve, E., Jemelka, R. P., et al (1990) Substance abuse and psychiatric disorders in prison inmates. Hospital and Community Psychiatry, 41, 11321134.Google ScholarPubMed
Cuffel, B. J., Heithoff, K. A. & Lawson, W. (1993) Correlates of patterns of substance abuse among patients with schizophrenia. Hospital and Community Psychiatry, 44, 247251.Google ScholarPubMed
Dixon, L., Haas, G., Weiden, P., et al (1990) Acute effects of drug abuse on schizophrenic patients: clinical observations and patients' self reports. Schizophrenia Bulletin, 16, 6979.CrossRefGoogle ScholarPubMed
Dixon, L., Haas, G., Weiden, P., et al (1991) Drug abuse in schizophrenic patients: clinical correlates and reasons for use. American Journal of Psychiatry, 148, 224230.Google ScholarPubMed
Dixon, L., Weiden, P., Haas, G., et al (1992) Increased tardive dyskinesia in alcohol abusing schizophrenic patients. Comprehensive Psychiatry, 33, 121122.CrossRefGoogle ScholarPubMed
Drake, R. E. & Wallach, M. A. (1989) Substance abuse among the chronically mentally ill. Hospital and Community Psychiatry, 40, 10411046.Google Scholar
Drake, R. E., Osher, F. C., Noordsey, D. L., et al (1990) Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin, 16, 5767.CrossRefGoogle ScholarPubMed
Drake, R. E., McHugo, G. J. & Noordsey, D. L. (1993) Treatment of alcoholism among schizophrenic outpatients: 4 year outcomes. American Journal of Psychiatry, 150, 328329.Google ScholarPubMed
Durell, J., Lechtenberg, B., Corse, S., et al (1993) Intensive case management of persons with chronic mental illness who abuse substances. Hospital and Community Psychiatry, 44, 415428.Google ScholarPubMed
El-Guebaly, N. (1990) Substance abuse and mental disorders: the dual diagnosis concept. Canadian Journal of Psychiatry, 35, 261267.CrossRefGoogle Scholar
Fariello, D. & Scheidt, S. (1989) Clinical case management of the dually diagnosed patient. Hospital and Community Psychiatry, 40, 10651067.Google ScholarPubMed
Galanter, M. & Castaneda, R. (1988) Substance abuse among general psychiatric patients: place of presentation, diagnosis and treatment. American Journal of Drug and Alcohol Abuse, 14, 211235.CrossRefGoogle ScholarPubMed
Gelberg, L., Linn, L. S. A. Leake, B. D. (1988) Mental health, alcohol and drug use, and criminal history among homeless adults. American Journal of Psychiatry, 145, 191196.Google ScholarPubMed
Gillies, H. (1976) Homicide in the west of Scotland. British Journal of Psychiatry, 128, 105127.CrossRefGoogle ScholarPubMed
Glass, G. S. & Bowers, M. B. (1970) Chronic psychosis associated with long term psychotomimetic drugs. Archives of General Psychiatry, 23, 97103.CrossRefGoogle Scholar
Gottlieb, P. & Gabrielson, G. (1992) Alcohol intoxicated homicides in Copenhagen, 1959–1983. International Journal of Law and Psychiatry, 15, 7787.CrossRefGoogle ScholarPubMed
Gunn, J. (1992) Personality disorders and forensic psychiatry. Criminal Behaviour and Mental Health, 2, 202211.CrossRefGoogle Scholar
Hafner, H. & Boker, W. (1973/1982) Crimes of Violence by Mentally Abnormal Offenders. Cambridge: Cambridge University Press.Google Scholar
Hall, R. C. W., Popkin, M. K., Stickney, S. K., et al (1978) Covert outpatient drug abuse. Journal of Nervous and Mental Disease, 166, 343348.CrossRefGoogle ScholarPubMed
Hanson, M., Kramer, T. H. & Gross, W. (1990) Outpatient treatment of adults with coexistent substance use and mental disorders. Journal of Substance Abuse Treatment, 7, 109116.CrossRefGoogle ScholarPubMed
Hays, P. & Aidroos, N. (1986) Alcoholism followed by schizophrenia. Acta Psychiatrica Scandinavica, 74, 187189.CrossRefGoogle ScholarPubMed
Hellerstein, D. J. & Meehan, B. (1987) Outpatient group therapy for schizophrenic substance abusers. American Journal of Psychiatry, 144, 13371339.Google ScholarPubMed
Humphreys, M. S., Johnstone, E. C., MacMillan, J. F., et al (1992) Dangerous behaviour preceding first admissions for schizophrenia. British Journal of Psychiatry, 161, 501505.CrossRefGoogle ScholarPubMed
Janowsky, D. S. (1976) Methylphenidate, dextroamphetamine and levamfetamine: effects on schizophrenic symptoms. Archives of General Psychiatry, 33, 304308.CrossRefGoogle ScholarPubMed
Khalsa, H. K., Shaner, A., Anglin, M. D., et al (1991) Prevalence of substance abuse in a psychiatric evaluation unit. Drug and Alcohol Dependence, 28, 215223.CrossRefGoogle Scholar
Knudsen, P. & Wilmar, R. (1984) Cannabis and neuroleptic agents in schizophrenia. Acta Psychiatrica Scandinavica, 69, 162174.CrossRefGoogle ScholarPubMed
Kofoed, L., Kahia, J., Walsh, T., et al (1986) Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders. American Journal of Psychiatry, 143, 867872.Google ScholarPubMed
Krakowski, M., Volavka, J. & Brizer, D. (1986) Psychopathology and violence: a review of literature. Comprehensive Psychiatry, 27, 131148.CrossRefGoogle ScholarPubMed
Lamb, H. R. (1982) Young adult chronic patients: the new drifters. Hospital and Community Psychiatry, 33, 465468.Google Scholar
Lehman, A. F., Herron, J. D., Schwarz, R. P., et al (1993) Rehabilitation for adults with severe mental illness and substance use disorders: a clinical trial. Journal of Nervous and Mental Disease, 181, 8690.CrossRefGoogle ScholarPubMed
Liebbrman, J. A., Kinon, B. J. & Loebel, A. D. (1990) Dopaminergic mechanisms in idiopathic and drug induced psychoses. Schizophrenia Bulletin, 16, 97110.CrossRefGoogle Scholar
Liebbrman, J. A., Kinon, B. J. & Bowers, M. B. (1990) Substance abuse comorbidity in schizophrenia: Editor's introduction. Schizophrenia Bulletin, 16, 2930.CrossRefGoogle Scholar
Lindqvist, P. & Allebeck, P. (1989) Schizophrenia and assaultive behaviour: the role of alcohol and drug abuse. Acta Psychiatrica Scandinavica, 82, 191195.CrossRefGoogle Scholar
McLellan, A. T., Woody, G. E. & O'Brien, C. P. (1979) Development of psychiatric illness in drug abusers: possible role of drug preferences. New England Journal of Medicine, 301, 13101314.CrossRefGoogle Scholar
Miller, F. T., Busch, F. & Tanenbaum, J. H. (1989) Drug abuse in schizophrenic and bipolar disorders. American Journal of Drug and Alcohol Abuse, 15, 291295.CrossRefGoogle Scholar
Miller, F. T., Busch, F. & Tanenbaum, J. H. (1989) Substance abuse in schizophrenia. Hospital and Community Psychiatry, 40, 847849.Google ScholarPubMed
Miller, H. R. & Streiner, D. L. (1990) Using the Millon Clinical Multiaxial Inventory's Scale B and MacAndrew Alcoholism Scale to identify alcoholism with concurrent psychiatric diagnoses. Journal of Personality Assessment, 54, 736746.CrossRefGoogle ScholarPubMed
Miller, N. S., Gold, M. S. & Mahler, J. C. (1991) Violent behaviours associated with cocaine use: possible pharmacological mechanisms. International Journal of the Addictions, 26, 10771088.CrossRefGoogle ScholarPubMed
Minkoff, K. (1989) An integrated treatment model for dual diagnosis of psychosis and addiction. Hospital and Community Psychiatry, 40, 10311036.Google ScholarPubMed
Mueser, K. T., Yarnold, P. R., Levinson, D. F., et al (1990) Prevalence of substance abuse in schizophrenia: demographic and clinical correlates. Schizophrenia Bulletin, 16, 3156.CrossRefGoogle ScholarPubMed
Negrete, J. C., Knapp, W. P., Douglas, D. E., et al (1986) Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey. Psychological Medicine, 16, 515520.CrossRefGoogle ScholarPubMed
Noordsey, D. L., Drake, R. E., Teague, G. B., et al (1991) Subjective experiences related to alcohol use among schizophrenics. Journal of Nervous and Mental Disease, 179, 410414.CrossRefGoogle Scholar
Noreik, G. (1975) Attempted suicide and suicide in functional psychoses. Acta Psychiatrica Scandinavica, 52, 81106.CrossRefGoogle ScholarPubMed
Osher, F. C. & Kofoed, L. L. (1989) Treatment of patients with psychiatric and psychoactive substance abuse disorders. Hospital and Community Psychiatry, 40, 10251030.Google ScholarPubMed
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799812.CrossRefGoogle Scholar
Pristach, C. A. & Smith, C. M. (1990) Medication compliance and substance abuse among schizophrenic patients. Hospital and Community Psychiatry, 41, 13451348.Google ScholarPubMed
Regier, D. A., Farmer, M. E., Rae, D. S., et al (1990) Comorbidity of mental disorders with alcohol and other drugs of abuse: results from the Epidemiologic Catchment Area (EGA) Study. Journal of the American Medical Association, 264, 25112518.CrossRefGoogle Scholar
Richard, M. L., Liskow, B. I. & Perry, P. J. (1985) Recent psychostimulant use in hospitalised schizophrenics. Journal of Clinical Psychiatry, 46, 7983.Google Scholar
Richardson, M. A., Craig, T. J. & Haugland, G. (1985) Treatment patterns of young chronic schizophrenic patients in the era of deinstitutionalisation. Psychiatric Quarterly, 57, 104110.CrossRefGoogle Scholar
Ridgely, M. S., Goldman, H. H. & Willenbring, M. (1990) Barriers to the care of persons with dual diagnosis: organisational and financial issues. Schizophrenia Bulletin, 16, 123132.CrossRefGoogle Scholar
Robins, L. N., Helzer, J. E., Croughan, J., et al (1981) NIMH Diagnostic Interview Schedule: Version III. Rockville, Md: National Institute of Mental Health.Google Scholar
Safer, D. J. (1987) Substance abuse by young adult chronic patients. Hospital and Community Psychiatry, 38, 511514.Google ScholarPubMed
Satel, S. L. & Edell, W. S. (1991) Cocaine induced paranoia and psychosis proneness. American Journal of Psychiatry, 148, 17081711.Google ScholarPubMed
Schneier, F. R. & Siris, S. G. (1987) A review of psychoactive substance use and abuse in schizophrenia: patterns of drug choice. Journal of Nervous and Mental Disease, 175, 641652.CrossRefGoogle ScholarPubMed
Shaner, A., Khalsa, M. E., Roberts, L., et al (1993) Unrecognised cocaine use among schizophrenic patients. American Journal of Psychiatry, 150, 758762.Google Scholar
Sheard, M. H. (1988) Clinical pharmacology of aggressive behaviour. Clinical Neuropharmacology, 11, 483492.CrossRefGoogle Scholar
Siris, S. G. (1990) Pharmacological treatment of substance abusing schizophrenic patients. Schizophrenia Bulletin, 16, 111122.CrossRefGoogle ScholarPubMed
Smith, J. E., Frazer, S., Boer, H., et al (1994) Dangerous dual diagnosis patients. Hospital and Community Psychiatry, 3, 280281.Google Scholar
Swanson, J. W., Holzbr, C. E., Ganju, V. K., et al (1990) Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area Survey. Hospital and Community Psychiatry, 41, 761770.Google Scholar
Taylor, P. J. (1985) Motives for offending among violent and psychotic men. British Journal of Psychiatry, 147, 491498.CrossRefGoogle ScholarPubMed
Taylor, P. J. (1987) Social implications of psychosis. British Medical Bulletin, 43, 718740.CrossRefGoogle ScholarPubMed
Taylor, P. J. & Gunn, J. (1984a) Violence and psychosis: I – risk of violence among psychotic men. British Medical Journal, 288, 19451949.CrossRefGoogle Scholar
Taylor, P. J. & Gunn, J. (1984b) Violence and Psychosis: II – effects of psychiatric diagnosis on conviction and sentencing of offenders. British Medical Journal, 289, 912.CrossRefGoogle Scholar
Test, M. A., Wallisch, L. S., Allness, D. J., et al (1989) Substance abuse in young adults with schizophrenia. Schizophrenia Bulletin, 15, 465476.CrossRefGoogle Scholar
Thornicroft, G. (1990) Cannabis and psychosis: is there epidemiological evidence for an association? British Journal of Psychiatry, 157, 2533.CrossRefGoogle ScholarPubMed
Toner, B. B., Shugar, G., Campbell, B., et al (1991) Pattern of substance abuse in psychiatric inpatients. Canadian Journal of Psychiatry, 36, 381383.CrossRefGoogle ScholarPubMed
Toner, B. B., Gillies, L. A., Prendergast, P., et al (1992) Pattern of substance use disorder in the chronically mentally ill. Hospital and Community Psychiatry, 43, 251254.Google Scholar
Travin, S. & Protter, B. (1982) Mad or bad? Some clinical considerations in the misdiagnosis of schizophrenia as antisocial personality disorder. American Journal of Psychiatry, 139, 13351338.Google ScholarPubMed
Tsuang, M. T., Simpson, J. C. & Kronfol, Z. (1982) Subtypes of drug abuse with psychosis. Archives of General Psychiatry, 39, 141147.CrossRefGoogle ScholarPubMed
Tyrer, P. & Ferguson, B. (1987) Problems in the classification of personality disorder. Psychological Medicine, 1, 1520.CrossRefGoogle Scholar
Yesavage, J. A. & Zarcone, V. (1983) History of drug abuse and dangerous behaviour in inpatient schizophrenics. Journal of Clinical Psychiatry, 44, 259261.Google ScholarPubMed
Zistook, S., Heaton, R., Moranville, J., et al (1992) Past substance abuse and clinical course of schizophrenia. American Journal of Psychiatry, 149, 552553.Google Scholar
Zitrin, A., Hardesty, A. S., Burdock, E. I., et al (1976) Crime and violence among mental patients. American Journal of Psychiatry, 133, 142149.Google ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.