Elsevier

Addictive Behaviors

Volume 26, Issue 1, January–February 2001, Pages 51-61
Addictive Behaviors

Original article
Drug-use behavior and correlates in people with schizophrenia

https://doi.org/10.1016/S0306-4603(00)00084-8Get rights and content

Abstract

This study examined how illicit drugs were accessed, reasons for drug use, prevalence of emotional, physical, and sexual abuse, psychiatric symptomatology, level of functioning, and the relationship of these factors to substance use in 25 schizophrenia outpatients. To identify unique substance-use behaviors or correlates, this information was compared to 25 substance-abusing outpatients with major affective disorders, and 30 people with schizophrenia alone. Patients largely financed their drug habits with money given by immediate family members, and reported using drugs primarily for social reasons. While all three groups reported high levels of physical, sexual, and emotional abuse, a relationship between emotional abuse and substance use was observed only for people with schizophrenia. There were no differences between the two schizophrenia groups in psychiatric symptoms or level of functioning. The treatment implications of these findings are discussed.

Section snippets

Participants

Participants were 80 psychiatric outpatients attending an inner city community mental health center: (1) 25 patients with schizophrenia or schizoaffective disorder and co-occurring drug abuse or dependence (SZsub); (2) 25 patients with a major affective disorder and co-occurring drug abuse or dependence (MADsub); and (3) 30 individuals with schizophrenia or schizoaffective disorder and no history of substance abuse or dependence (SZonly). Written informed consent was obtained from all

Results

To control for Type I error, alpha was set at 0.01 for all analyses. All tests were two-tailed and prior to conducting any analyses, distributions were examined for violations of the assumptions necessary to conduct parametric tests. As many of the variables from the ASI had skewed distributions, these data were standardized prior to the creation of the composites and then rank ordered (Alterman et al., in press).

Discussion

The purpose of this study was twofold. The first goal was to increase the understanding of substance use in schizophrenia by addressing three important questions: (1) How do people with schizophrenia access their drugs, maintain their habits, and who are their drug partners?, (2) Why do people with schizophrenia use drugs?, and (3) Are emotional, physical, and sexual abuse prevalent in people with schizophrenia and co-occurring substance-use disorders? The second purpose of the study was to

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Cited by (38)

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    We also controlled for substance using motives (social enhancement, personal enhancement, and coping) given that they have also been shown to vary positively with substance use and related problems in people with severe mental illness in ways similar to reasons given by non-SMI groups (Gearon, Bellack, Rachbeisel, & Dixon, 2001; Gregg et al., 2009; O'Hare & Shen, 2012). One consistent finding has shown that coping motives appear to be associated with more problematic substance use overall, particularly in people with major mood disorders (Bolton, Robinson, & Sareen, 2009; Gearon et al., 2001; O'Hare, Shen, & Sherrer, 2010). Having used regression to control for psychiatric symptoms in a sample of people with SMI (which overlaps with the current sample), O'Hare and Shen found that coping motives varied positively and significantly with alcohol use and substance use problems, but personal enhancement motives varied with drug use.

  • Development and validation of a scale for assessing reasons for substance use in schizophrenia: The ReSUS scale

    2009, Addictive Behaviors
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    There is less consensus about whether people use substances for reasons directly related to schizophrenia however (as suggested by Khantzian, 1985, 1997), either in terms of psychotic symptoms, the distress associated with those symptoms or the side effects of neuroleptic medication. Only a handful of studies have reported that people experiencing psychosis report using substances to self medicate (Addington & Duchak, 1997; Gearon, Bellack, Rachbeisel, & Dixon, 2001; Goswami, Mattoo, Basu, & Singh, 2004; Spencer, Castle, & Michie, 2002) but because of sampling and methodological differences (in the way that dual diagnosis was defined; the diagnostic criteria used for substance use and the variety of measures to assess reasons for use) it is difficult to draw firm conclusions about these results. In an attempt to address some of the methodological limitations of the earlier self report studies Gregg, Haddock and Barrowclough (2009) used Q methodology (Stephenson, 1953) to examine reasons for use by people with a diagnosis of schizophrenia and current comorbid substance use.

  • Application of the Transtheoretical Model of change: Psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness

    2008, Addictive Behaviors
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    Most of the “pros” assessed on the Decisional Balance Scale focus on using drugs to cope with unpleasant emotions or regulate affect; it is possible these items were more frequently endorsed in the affective disorder group because of the frequent experience of negative affect among people with affective disorders. Studies of people with different forms of SMI have found that while people with schizophrenia generally report relief of boredom and peer pressure and main reasons for their drug use, people with affect disorders are more likely to report drug use to lessen negative emotions (Gearon, Bellack, Rachbeisel, & Dixon, 2001). However, individuals with schizophrenia have also reported that a primary reason for using drugs is to reduce depression (Addington & Duchak, 1997; Dixon, Haas, Weiden, Sweeney & Frances, 1991).

  • Reasons for increased substance use in psychosis

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Preparation of this manuscript was supported in part by NIH grants DA11199-01 (JSG) and DA09406 (ASB) from NIDA, and the VA Capital Network MIRECC (ASB).

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