Skip to main content Accessibility help
×
Home

Schizophrenia and Substance Abuse

  • Jeanette Smith (a1) and Stephen Hucker (a2)

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.

Copyright

Corresponding author

Dr J. Smith, Fromeside Clinic, Blackberry Hill Hospital, Stapleton, Bristol BS16 1ED

References

Hide All
Abram, K. M. & Teplin, L. A. (1991) Co-occurring disorders among mentally ill jail detainees. American Psychologist, 46, 10361045.
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.
Allebeck, P., Varla, A., Kristjansson, E., et al (1987) Risk factors for suicide among patients with schizophrenia. Acta Psychiatrica Scandinavica, 76, 414419.
Alterman, A. I., Erdlin, F. R., McLellan, A. T., et al (1980) Problem drinking in hospitalised schizophrenic patients. Addictive Behaviours, 5, 273276.
Alterman, A. I., Ayre, F. R. & Williford, W. O. (1984) Diagnostic validation of conjoint schizophrenia and alcoholism. Journal of Clinical Psychiatry, 45, 300303.
Ananth, J., Vandewater, S., Kamal, M., et al (1989) Missed diagnosis of substance abuse in psychiatric patients. Hospital and Community Psychiatry, 40, 297299.
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.
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.
Bartels, S. J., Drake, R. E., Wallach, M. A., et al (1991) Characteristic hostility in schizophrenic outpatients. Schizophrenia Bulletin, 16, 8185.
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.
Bergman, H. C. & Harris, M. (1985) Substance abuse among young adult chronic patients. Psychosocial Rehabilitation Journal, 9, 4954.
Bowers, B. B. (1977) Psychoses precipitating psychomimetic drugs. Archives of General Psychiatry, 34, 832835.
Bowers, B. B., Mazure, C. M., Nelson, J. C., et al (1990) Psychotogenic drug use and neuroleptic response. Schizophrenia Bulletin, 16, 8185.
Brady, K., Anton, R., Ballenger, J. C., et al (1990) Cocaine abuse among schizophrenic patients. American Journal of Psychiatry, 147, 11641167
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.
Breakey, W. R., Goodell, H., Lorenz, P. C., et al (1974) Hallucinogenic drugs as precipitants of schizophrenia. Psychological Medicine, 4, 255261.
Burrows, K. L., Hales, R. E. & Arington, E. (1988) Research on the biological aspects of violence. Psychiatric Clinics of North America, 11, 499509.
Byrne, A., Kirby, B., Zibin, T., et al (1991) Psychiatric and neurological effects of chronic solvent abuse. Canadian Journal of Psychiatry, 36, 735738.
Carey, K. B. (1989) Emerging treatment guidelines for mentally ill chemical abusers. Hospital and Community Psychiatry, 40, 341349.
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.
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.
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.
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.
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.
Dixon, L., Weiden, P., Haas, G., et al (1992) Increased tardive dyskinesia in alcohol abusing schizophrenic patients. Comprehensive Psychiatry, 33, 121122.
Drake, R. E. & Wallach, M. A. (1989) Substance abuse among the chronically mentally ill. Hospital and Community Psychiatry, 40, 10411046.
Drake, R. E., Osher, F. C., Noordsey, D. L., et al (1990) Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin, 16, 5767.
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.
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.
El-Guebaly, N. (1990) Substance abuse and mental disorders: the dual diagnosis concept. Canadian Journal of Psychiatry, 35, 261267.
Fariello, D. & Scheidt, S. (1989) Clinical case management of the dually diagnosed patient. Hospital and Community Psychiatry, 40, 10651067.
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.
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.
Gillies, H. (1976) Homicide in the west of Scotland. British Journal of Psychiatry, 128, 105127.
Glass, G. S. & Bowers, M. B. (1970) Chronic psychosis associated with long term psychotomimetic drugs. Archives of General Psychiatry, 23, 97103.
Gottlieb, P. & Gabrielson, G. (1992) Alcohol intoxicated homicides in Copenhagen, 1959–1983. International Journal of Law and Psychiatry, 15, 7787.
Gunn, J. (1992) Personality disorders and forensic psychiatry. Criminal Behaviour and Mental Health, 2, 202211.
Hafner, H. & Boker, W. (1973/1982) Crimes of Violence by Mentally Abnormal Offenders. Cambridge: Cambridge University Press.
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.
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.
Hays, P. & Aidroos, N. (1986) Alcoholism followed by schizophrenia. Acta Psychiatrica Scandinavica, 74, 187189.
Hellerstein, D. J. & Meehan, B. (1987) Outpatient group therapy for schizophrenic substance abusers. American Journal of Psychiatry, 144, 13371339.
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.
Janowsky, D. S. (1976) Methylphenidate, dextroamphetamine and levamfetamine: effects on schizophrenic symptoms. Archives of General Psychiatry, 33, 304308.
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.
Knudsen, P. & Wilmar, R. (1984) Cannabis and neuroleptic agents in schizophrenia. Acta Psychiatrica Scandinavica, 69, 162174.
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.
Krakowski, M., Volavka, J. & Brizer, D. (1986) Psychopathology and violence: a review of literature. Comprehensive Psychiatry, 27, 131148.
Lamb, H. R. (1982) Young adult chronic patients: the new drifters. Hospital and Community Psychiatry, 33, 465468.
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.
Liebbrman, J. A., Kinon, B. J. & Loebel, A. D. (1990) Dopaminergic mechanisms in idiopathic and drug induced psychoses. Schizophrenia Bulletin, 16, 97110.
Liebbrman, J. A., Kinon, B. J. & Bowers, M. B. (1990) Substance abuse comorbidity in schizophrenia: Editor's introduction. Schizophrenia Bulletin, 16, 2930.
Lindqvist, P. & Allebeck, P. (1989) Schizophrenia and assaultive behaviour: the role of alcohol and drug abuse. Acta Psychiatrica Scandinavica, 82, 191195.
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.
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.
Miller, F. T., Busch, F. & Tanenbaum, J. H. (1989) Substance abuse in schizophrenia. Hospital and Community Psychiatry, 40, 847849.
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.
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.
Minkoff, K. (1989) An integrated treatment model for dual diagnosis of psychosis and addiction. Hospital and Community Psychiatry, 40, 10311036.
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.
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.
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.
Noreik, G. (1975) Attempted suicide and suicide in functional psychoses. Acta Psychiatrica Scandinavica, 52, 81106.
Osher, F. C. & Kofoed, L. L. (1989) Treatment of patients with psychiatric and psychoactive substance abuse disorders. Hospital and Community Psychiatry, 40, 10251030.
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799812.
Pristach, C. A. & Smith, C. M. (1990) Medication compliance and substance abuse among schizophrenic patients. Hospital and Community Psychiatry, 41, 13451348.
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.
Richard, M. L., Liskow, B. I. & Perry, P. J. (1985) Recent psychostimulant use in hospitalised schizophrenics. Journal of Clinical Psychiatry, 46, 7983.
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.
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.
Robins, L. N., Helzer, J. E., Croughan, J., et al (1981) NIMH Diagnostic Interview Schedule: Version III. Rockville, Md: National Institute of Mental Health.
Safer, D. J. (1987) Substance abuse by young adult chronic patients. Hospital and Community Psychiatry, 38, 511514.
Satel, S. L. & Edell, W. S. (1991) Cocaine induced paranoia and psychosis proneness. American Journal of Psychiatry, 148, 17081711.
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.
Shaner, A., Khalsa, M. E., Roberts, L., et al (1993) Unrecognised cocaine use among schizophrenic patients. American Journal of Psychiatry, 150, 758762.
Sheard, M. H. (1988) Clinical pharmacology of aggressive behaviour. Clinical Neuropharmacology, 11, 483492.
Siris, S. G. (1990) Pharmacological treatment of substance abusing schizophrenic patients. Schizophrenia Bulletin, 16, 111122.
Smith, J. E., Frazer, S., Boer, H., et al (1994) Dangerous dual diagnosis patients. Hospital and Community Psychiatry, 3, 280281.
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.
Taylor, P. J. (1985) Motives for offending among violent and psychotic men. British Journal of Psychiatry, 147, 491498.
Taylor, P. J. (1987) Social implications of psychosis. British Medical Bulletin, 43, 718740.
Taylor, P. J. & Gunn, J. (1984a) Violence and psychosis: I – risk of violence among psychotic men. British Medical Journal, 288, 19451949.
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.
Test, M. A., Wallisch, L. S., Allness, D. J., et al (1989) Substance abuse in young adults with schizophrenia. Schizophrenia Bulletin, 15, 465476.
Thornicroft, G. (1990) Cannabis and psychosis: is there epidemiological evidence for an association? British Journal of Psychiatry, 157, 2533.
Toner, B. B., Shugar, G., Campbell, B., et al (1991) Pattern of substance abuse in psychiatric inpatients. Canadian Journal of Psychiatry, 36, 381383.
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.
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.
Tsuang, M. T., Simpson, J. C. & Kronfol, Z. (1982) Subtypes of drug abuse with psychosis. Archives of General Psychiatry, 39, 141147.
Tyrer, P. & Ferguson, B. (1987) Problems in the classification of personality disorder. Psychological Medicine, 1, 1520.
Yesavage, J. A. & Zarcone, V. (1983) History of drug abuse and dangerous behaviour in inpatient schizophrenics. Journal of Clinical Psychiatry, 44, 259261.
Zistook, S., Heaton, R., Moranville, J., et al (1992) Past substance abuse and clinical course of schizophrenia. American Journal of Psychiatry, 149, 552553.
Zitrin, A., Hardesty, A. S., Burdock, E. I., et al (1976) Crime and violence among mental patients. American Journal of Psychiatry, 133, 142149.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Schizophrenia and Substance Abuse

  • Jeanette Smith (a1) and Stephen Hucker (a2)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *