I believe that substance abuse services need to be integrated in secondary care. I’m quite aware this causes significant distress to both psychiatric patients (who stigmatize the user) and to substance patients (who stigmatize the mad). But ofen these are the same people
Substance abuse worsens the course of schizophrenia, but it is not known whether or not there are differences between specific substances concerning their association with the hospitalizations of patients with schizophrenia. Aims: The primary aims of this study were to examine the possible associations between amphetamine, cannabis, and opioid abuse, and the risk of hospitalizations among patients with schizophrenia. Methods: The study population consisted of 146 patients with ICD-defined schizophrenia from two different geographical sites in Finland, and it included both inpatients and outpatients. Data were collected retrospectively from the patients’ medical files. Substance abuse was defined as either harmful use or dependence according to ICD-10. Results: The cumulative prevalence of substance abuse was 10.9% (16/146) for cannabis, 8.9% (13/146) for amphetamine, and 4.1% (6/146) for opioids. Among patients with schizophrenia and abuse of any substance, the number of hospitalizations was about 1.5-fold when compared to those without substance abuse. The incidence rate ratio for hospitalizations was 2.9 (95% CI 2.47–3.63) for opioids, 2.0 (1.71–2.41) for amphetamine, and 1.6 (1.33–1.84) for cannabis, when compared with no abuse of each substance. The risk of hospitalizations was significantly higher for opioids when compared with amphetamine (p < 0.001) or cannabis (p < 0.001).
There are some logistic issues here. The management of opiate dependancy is challenging and needs sub-specailists: there is frequently divisions between these clinicians and their ways of working with clients and mental health, which is not scared to coerce[1].
And correlation is not causation, but a correlation close to three suggests that there is an issue. Read the paper, it is in the public domain.
Now for some research into whether drug users do so because of underlying mental problems or whether people who otherwise have no problems develop them after drug use…..not entirely an academic question for me, as I’ve got a few relatives who have had depression, bipolar disorder, and ADHD.
And for that matter, have a few former colleagues from a company where we openly joked about drinking away our troubles–and when they left, they didn’t seem to find new jobs. Not sure if that’s the company or the economy or something else, but I can’t discard the idea that they were unable to “bounce back” after their treatment there.
Lots and lots of clinical reports. Some data from cohort studies. A lot from case control stufies. But almost all this work occurs either in Scandinavia or the Antipodes. And is not read in the USA, for they invented it not.
Would love to hear your take on what those reports and studies say…my nickel bet is that it’s complicated, but with a certain portion of mental illness attributable to drug use.