PSYCHIATRY

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Severe Mental Illness Tied to Higher Rates of Substance Use

 

Studies exploring the link between substance use disorders and other mental illnesses have typically not included people with severe psychotic illnesses.

 

According to a study published online in JAMA Psychiatry (01 January 2014), people with severe mental illness such as schizophrenia or bipolar disorder have a higher risk for substance use, especially cigarette smoking.  Protective factors usually associated with lower rates of substance use do not exist in severe mental illness. Protective factors are conditions or attributes in individuals, families, communities or the larger society that help people deal more effectively with stressful events and mitigate or eliminate risk in families and communities.

 

Estimates based on past studies suggest that people diagnosed with mood or anxiety disorders are about twice as likely as the general population to also suffer from a substance use disorder. Statistics from the 2012 National Survey on Drug Use and Health indicate close to 8.4 million adults in the United States have both a mental and substance use disorder. However, only 7.9% of people receive treatment for both conditions, and 53.7% receive no treatment at all, the statistics indicate.

 

In the current study, 9,142 people diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features, and 10,195 controls matched to participants according to geographic region, were selected using the Genomic Psychiatry Cohort program. Mental disorder diagnoses were confirmed using the Diagnostic Interview for Psychosis and Affective Disorder (DI-PAD), and controls were screened to verify the absence of schizophrenia or bipolar disorder in themselves or close family members. The DI-PAD was also used for all participants to determine substance use rates.

 

Results showed that compared to controls, people with severe mental illness were about 4 times more likely to be heavy alcohol users (four or more drinks per day); 3.5 times more likely to use marijuana regularly (21 times per year); and 4.6 times more likely to use other drugs at least 10 times in their lives. The greatest increases were seen with tobacco, with patients with severe mental illness 5.1 times more likely to be daily smokers. This is of concern because smoking is the leading cause of preventable death in the United States.

 

In addition, certain protective factors often associated with belonging to certain racial or ethnic groups — or being female — did not exist in participants with severe mental illness. According to the authors, in the general population, women have lower substance use rates than men, and Asian-Americans have lower substance use rates than white Americans. However, these differences were not seen among people with severe mental illness. The authors added that they also saw that among young people with severe mental illness, the smoking rates were as high as smoking rates in middle-aged adults, despite success in lowering smoking rates for young people in the general population.“

 

Previous research has shown that people with schizophrenia have a shorter life expectancy than the general population, and chronic cigarette smoking has been suggested as a major contributing factor to higher morbidity and mortality from malignancy as well as cardiovascular and respiratory diseases. These new findings indicate that the rates of substance use in people with severe psychosis may be underestimated, highlighting the need to improve the understanding of the association between substance use and psychotic disorders so that both conditions can be treated effectively.

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