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Drug and Alcohol Problems among Individuals with Severe Mental Illnesses in South London

Published online by Cambridge University Press:  02 January 2018

Paulo R. Menezes*
Affiliation:
Institute of Psychiatry, London
Sonia Johnson
Affiliation:
Institute of Psychiatry, London
Graham Thornicroft
Affiliation:
Institute of Psychiatry, London
Jane Marshall
Affiliation:
Maudsley Hospital and National Addiction Centre, London
David Prosser
Affiliation:
Behavioural Psychotherapy Unit, Bethlem Royal Hospital, London
Paul Bebbington
Affiliation:
Social and Epidemiological Psychiatry Unit, Institute of Psychiatry, London
Elizabeth Kuipers
Affiliation:
Department of Psychology, Institute of Psychiatry, London
*
Paulo Menezes, Maudsley Continuing Care Study, Institute of Psychiatry, De Crespigny Park, London SE5 8AF. Fax: (0171) 277 1462

Abstract

Background

High rates of comorbid alcohol and drug disorders have previously been found among individuals with severe mental illnesses such as schizophrenia and bipolar affective disorders. Clinical and social outcomes have been reported to be worse in this group and service costs greater than in individuals with severe mental illness only. These ‘dual diagnosis’ patients have mainly been investigated in the USA, and there has been very little research in Europe, where patterns of substance abuse may be different.

Method

All patients with psychotic illnesses who had any contact with the mental health services in a geographically defined sector in South London over a specified period were studied. Individuals with problems related to alcohol or drugs were identified using standardised interviews with subjects and their keyworkers. Data on psychiatric service use during the previous 2 years were also obtained.

Results

One hundred and seventy-one subjects with psychotic illnesses were interviewed (response rate: 78.4%). The one-year prevalence rate for any substance problem was 36.3% (95% CI=29.1–43.5), for alcohol problems it was 31.6% (95% CI=24.6–38.5), and for drug problems 15.8% (95% CI=10.3–21.3). Young male subjects were at higher risk of having substance problems. Patients with substance problems had spent almost twice as many days in hospital as those without such problems over the previous two years (difference=26.3 days, 95% CI=3.8–48.7).

Conclusions

The prevalence of substance problems among people suffering from severe mental disorders is high, and seems to be associated with greater use of in-patient services. This is a significant clinical problem, with cost implications. Further investigation is needed for adequate service provision.

Type
Papers
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Bachrach, L. L. (1986) The context of care for the chronic mental patient with substance abuse problems. Psychiatric Quarterly, 58, 314.CrossRefGoogle ScholarPubMed
Barbee, J. G., Clarck, 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., Teague, G. B., Drake, R. E., et al (1993) Service utilization and costs associated with substance use disorder among severely mentally ill patients. Journal of Nervous and Mental Disease, 181, 227232.Google Scholar
Bernadt, M. W. & Murray, R. M. (1986) Psychiatric disorder, drinking and alcoholism: what are the links? British Journal of Psychiatry, 148, 393400.Google Scholar
Drake, R. E., Osher, F. C. & Wallach, M. A. (1989) Alcohol use and abuse in schizophrenia. A prospective community study. Journal of Nervous and Mental Disease, 177, 408414.Google Scholar
Drake, R. E., & Wallach, M. A. (1989) Substance abuse among the chronic mentally ill. Hospital and Community Psychiatry, 40, 10411046.Google Scholar
Drake, R. E., McHugo, G. J. & Noordsy, D. L. (1993) Treatment of alcoholism among schizophrenic outpatients: 4-year outcomes. American Journal of Psychiatry, 150, 328329.Google ScholarPubMed
Drake, R. E., & McHugo, G. J. (1993) Moderate drinking among people with severe mental illness. Hospital and Community Psychiatry, 44, 780782.Google Scholar
Duke, P., Pantelis, C. & Barnes, T. R. E. (1994) South Westminster Schizophrenia Survey: Alcohol use and its relationship to symptoms, tardive dyskinesia and illness onset. British Journal of Psychiatry, 164, 630636.CrossRefGoogle ScholarPubMed
El-Guebaly, N. (1990) Substance abuse and mental disorders: the dual diagnoses concept. Canadian Journal of Psychiatry, 35, 261267.Google Scholar
Lehman, A. F., Myers, C. P., Thompson, J. W., et al (1993) Implications of mental and substance use disorders: a comparison of single and dual diagnosis patients. Journal of Nervous and Mental Disease, 181, 365370.CrossRefGoogle ScholarPubMed
Regier, D. A., Farmer, M. E., Rae, D. S., et al (1990) Comorbidity of mental disorders with alcohol and other substances: results from the Epidemiological Catchment Area. Journal of the American Medical Association, 264, 25112518.Google Scholar
Searles, J. A., Alterman, A. I. & Purtill, J. J. (1990) The detection of alcoholism in hospitalized schizophrenics: a comparison of the MAST and the MAC. Alcoholism: Clinical and Experimental Research, 14, 557560.Google Scholar
Selzer, M. L. (1971) The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument. American Journal of Psychiatry, 127, 16531658.CrossRefGoogle ScholarPubMed
Skinner, H. A. (1982) The Drug Abuse Screening Test. Addictive Behaviors, 7, 363371.CrossRefGoogle ScholarPubMed
Soyka, M., Albus, M., Kathmann, N., et al (1993) Prevalence of alcohol and drug abuse in schizophrenic inpatients. European Archives of Psychiatry and Clinical Neuroscience, 242, 362372.CrossRefGoogle ScholarPubMed
Staley, D. & El-Guebaly, N. (1990) Psychometric properties of the Drug Abuse Screening Test in a psychiatric patient population. Addictive Behaviors, 15, 257264.Google Scholar
Tessler, R. C. & Dennis, D. L. (1989) A Synthesis of NIMH-Funded Research Concerning Persons who are Homeless and Mentally Ill. Washington, DC: NIMH Division of Education and Service System Liaison.Google Scholar
Thom, B. (1993) Social factors and alcohol abuse. In Principles of Social Psychiatry (eds Bhugra, D. & Leff, J.), pp. 162179. Oxford: Blackwell Scientific.Google Scholar
Yesavage, J. A. & Zarcone, V. (1983) History of drug abuse and dangerous behaviour in inpatient schizophrenics. Journal of Clinical Psychiatry, 44, 259261.Google Scholar
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