Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment

Aim We examined the association of substance abuse treatment with uptake, adherence and virological response to highly active antiretroviral therapy (HAART) among HIV‐infected people with a history of alcohol problems. Design Prospective cohort study. Methods A standardized questionnaire was administered to 349 HIV‐infected participants with a history of alcohol problems regarding demographics, substance use, use of substance abuse treatment and uptake of and adherence to HAART. These subjects were followed every 6 months for up to seven occasions. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half‐way house or residential facility; 12 visits to a substance abuse counselor or mental health professional; or participation in any methadone maintenance program. Our outcome variables were uptake of antiretroviral therapy, 30‐day self‐reported adherence and HIV viral load suppression. Findings At baseline, 59% (205/349) of subjects were receiving HAART. Engagement in substance abuse treatment was independently associated with receiving antiretroviral therapy (adjusted OR; 95% CI: 1.70; 1.03–2.83). Substance abuse treatment was not associated with 30‐day adherence or HIV viral load suppression. More depressive symptoms (0.48; 0.32–0.78) and use of drugs or alcohol in the previous 30 days (0.17; 0.11–0.28) were associated with worse 30‐day adherence. HIV viral load suppression was positively associated with higher doses of antiretroviral medication (1.29; 1.15–1.45) and older age (1.04; 1.00–1.07) and negatively associated with use of drugs or alcohol in the previous 30 days (0.51; 0.33–0.78). Conclusion Substance abuse treatment was associated with receipt of HAART; however, it was not associated with adherence or HIV viral load suppression. Substance abuse treatment programs may provide an opportunity for HIV‐infected people with alcohol or drug problems to openly address issues of HIV care including enhancing adherence to HAART.     

Changing provider practices, program environment, and improving outcomes by transporting multidimensional family therapy to an adolescent drug treatment setting

Effective interventions for drug abusing adolescents are underutilized. Using an interrupted time series design, this study tested a multicomponent, multi-level technology transfer intervention developed to train clinical staff within an existing day treatment program to implement multidimensional family therapy (MDFT), an evidence-based adolescent substance abuse treatment. The sample included 10 program staff and 104 clients. MDFT was incorporated into the program and changes were noted in the program environment, therapist behavior, and in most (e.g., drug abstinence, and out of home placements) but not all (e.g., drug use frequency) client outcomes. These changes remained after MDFT supervision was withdrawn.     

The added risk of opioid problem use among treatment‐seeking youth with marijuana and/or alcohol problem use

Objectives To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU). Methods A total of 475 youth (ages 14–21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment‐funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated. Results The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex‐related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15–17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services. Conclusions These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment‐seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth.     

Multidimensional family therapy for adolescent drug abuse: results of a randomized clinical trial.

Random assignment was made of 182 clinically referred marijuana- and alcohol-abusing adolescents to one of three treatments: multidimensional family therapy (MDFT), adolescent group therapy (AGT), and multifamily educational intervention (MEI). Each treatment represented a different theory base and treatment format. All treatments were based on a manual and were delivered on a once-a-week outpatient basis. The therapists were experienced community clinicians trained to model-specific competence prior to the study and then supervised throughout the clinical trial. A theory-based multimodal assessment strategy measured symptom changes and prosocial functioning at intake, termination, and 6 and 12 months following termination. Results indicate improvement among youths in all three treatments, with MDFT showing superior improvement overall. MDFT participants also demonstrated change at the 1-year follow-up period in the important prosocial factors of school/academic performance and family functioning as measured by behavioral ratings. Results support the efficacy of MDFT, a relatively short-term, multicomponent, multitarget, family-based intervention in significantly reducing adolescent drug abuse and facilitating adaptive and protective developmental processes.     

Is there a progression from abuse disorders to dependence disorders?

Background Recent studies suggest that a progression occurs from alcohol abuse to alcohol dependence. Although DSM‐IV criteria for all substance use‐related diagnoses are based largely on the alcohol dependence syndrome, progression from abuse to dependence might not generalize to other substances. Aims This study tested whether a progression from DSM‐IV abuse to dependence occurs related to the use of cannabis, cocaine and opiates. Design Retrospective data from the DSM‐IV Substance Use Disorders Work Group (n = 1226) were reanalysed using McNemar's χ², configural frequency analyses and survival analyses. Participants were men and women who were primarily African‐Americans or Caucasians. Settings Participants were recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview–Substance Abuse Module. Findings For all substances, life‐time dependence in the absence of life‐time abuse was rare. Results were consistent with a progression occurring for alcohol and cannabis, but not for cocaine and opiates. Abuse and dependence occurred in the same year for 66% of the cocaine users who experienced both disorders (57% of users with any cocaine disorder) and 65% of the opiate users who experienced both disorders (46% of users with any opiate disorder). Because cocaine and opiate dependence in the absence of abuse were rare, it is possible that progressions in cocaine and opiate disorders occur more rapidly than cannabis and alcohol. Conclusions Research is needed to clarify the mechanisms that influence progressions of substance use disorders. Potential factors leading to between‐drug variation in rate of progression of disorders are discussed.     

Seeking Safety treatment for male veterans with a substance use disorder and post-traumatic stress disorder symptomatology

Aims To determine whether substituting Seeking Safety (SS), a manualized therapy for comorbid substance use disorders (SUD) and post‐traumatic stress disorder (PTSD) for part of treatment‐as‐usual (TAU) improves substance use outcomes. Design Randomized controlled effectiveness trial. Settings Out‐patient Veterans Administration Health Care System SUD clinic. Participants Ninety‐eight male military Veterans with a SUD and co‐occurring PTSD symptomatology. Measurements Drug and alcohol use and PTSD severity, measured on the first day of treatment, and 3 (i.e. the planned end of SS sessions) and 6 months following the baseline assessment. Treatment attendance and patient satisfaction were measured following treatment (3‐month follow‐up). Active coping was measured at treatment intake and following treatment. Findings SS compared to TAU was associated with better drug use outcomes (P < 0.05), but alcohol use and PTSD severity decreased equally under both treatments (P's < 0.01). SS versus TAU was associated with increased treatment attendance, client satisfaction and active coping (all P's < 0.01). However, neither these factors nor decreases in PTSD severity mediated the effect of treatment on drug use. Conclusions The manualized treatment approach for substance use disorder, Seeking Safety, is well received and associated with better drug use outcomes than ‘treatment as usual’ in male veterans with post‐traumatic stress disorder. However, the mechanism of its effect is unclear.     

Substance abuse in an inpatient psychiatric sample.

The relationship between psychoactive drug abuse and psychopathology is complex. There have been few systematic explorations of substance abuse in psychiatric populations since the recent epidemic of cocaine abuse. To update and further explore the relationship between psychiatric illness and substance abuse, 100 consecutively admitted patients to an inpatient psychiatry unit were administered a drug and alcohol use/abuse questionnaire. Sixty-four percent endorsed current or past problems with substance abuse and 29% met DSM-III-R criteria for substance abuse in the 30 days prior to admission. For the major diagnostic categories, there were no significant differences between groups in percentages of patients with substance abuse disorders. There was a trend (p less than or equal to .2) toward an increased number of lifetime psychiatric hospitalizations in the substance-abusing group. Alcohol was the most common drug of choice followed by stimulants, cannabis, and sedative hypnotics. Differences in drug choices between diagnostic categories are discussed. Forty-three percent of urine drug screens obtained were positive, and of those with positive urine drug screens, 42% denied drug use upon admission. Only 40% of patients with current or past substance abuse problems had received treatment for their chemical dependency. In our sample, while substance abuse was very prevalent, it was underreported and undertreated.     

Level of current and past adolescent cigarette smoking as predictors of future substance use disorders in young adulthood

Aims. This study examined the impact of adolescent cigarette smoking (life-time use, recency, frequency and age of onset) on the occurrence of substance use disorders during young adulthood. Design. Participants were assessed while in high school (T1), approximately 1 year later (T2) and then after they had turned 24 years of age (T3). Setting. Adolescents were randomly selected at T1 from nine senior high schools in western Oregon. Participants. A subset (n=684) of 1709 adolescents who had been assessed regarding cigarette smoking during high school were evaluated for alcohol, cannabis and other drug abuse/dependence up to age 24. Measurements. Semi-structured interviews provided information regarding life-time use of cigarettes and chewing tobacco, age of smoking onset, frequency and quantity of cigarette smoking and quit efforts in adolescence. Diagnoses of substance abuse and dependence in young adulthood were made as per DSM-IV. Findings. Life-time smoking among older adolescents significantly increased the probability of future alcohol, cannabis, hard drug and multiple drug use disorders during young adulthood. Having been a former smoker did not reduce the risk of future substance use disorder, although having maintained smoking cessation for more than 12 months was associated with significantly lower rates of future alcohol use disorder. Daily smoking was associated with increased risk of future cannabis, hard drug and multiple drug use disorders. Among daily smokers, earlier smoking onset age predicted future substance use disorders. Conclusions. The results extend knowledge about relationships between cigarette smoking during adolescence and the development of substance use disorders during young adulthood, illustrating additional risks associated with early cigarette smoking. Future research is needed to examine potential causal associations.     

Linking substance use with symptoms of subclinical psychosis in a community cohort over 30 years

Aims The aim of the study was to examine the temporal associations between substance use and subclinical psychosis symptoms. Design Data from a prospective community study sampled within a single cohort over 30 years (1978–2008) were analysed with discrete‐time hazard models. Setting General population‐based sample. Participants At initial sampling in 1978 males (n = 292) were 19 and females (n = 299) were 20 years old. Measurements Two psychosis syndromes representing ‘schizotypal signs’ and ‘schizophrenia nuclear symptoms’ and various substance use variables including cannabis, alcohol, tobacco and multiple‐drug use (i.e. cannabis combined with other drugs). Findings In bivariate analyses, schizotypal signs were predominantly associated with regular cannabis use in adolescence (OR = 2.29, 95% CI 1.32–3.97). Schizophrenia nuclear symptoms were mainly related to alcohol (OR = 1.84, 95% CI 1.00–3.38) and multiple‐drug use (OR = 2.35, 95% CI 1.38–4.02) during adolescence. Multivariate analyses showed that, in particular, regular cannabis use during adolescence was associated with the occurrence of subsequent schizotypal symptoms over a 30‐year period (OR = 2.60, 95% CI; 1.59–4.23), whereas multiple‐drug use in adolescence was associated predominantly with schizophrenia nuclear symptoms (OR = 1.75, 95% CI 1.01–3.03). Alcohol misuse was only slightly associated with the onset of such symptoms. Conclusions A significant portion of the occurrence of subclinical psychosis symptoms in adulthood can be attributed to excessive cannabis and multiple‐drug use during adolescence. This is in line with the hypothesis that long‐term sensitization of dopaminergic brain receptors plays a role in developing psychotic symptoms.     

Assessment of Alcohol and Other Drug Use by Runaway Youths: A Test-Retest Study of the Form 90

While excellent adolescent alcohol and drug screening tools are available, there are relatively few, if any, psychometrically validated measures to use in the assessment of adolescent treatment outcome. This study conducted a test-retest exercise of the Form 90 Drug and Alcohol (Form 90 DnA) to determine the stability of adolescent responses when administering the day-by-day calendar/grid approach. Homeless youth (N = 37) with alcohol, drug, or alcohol and drug abuse/dependence combined were recruited to participate in the test-retest study. High pre-post stability in means was obtained on measures of frequency of substance use in general, and on specific measures of alcohol, cocaine, marijuana use. The findings from this paper provide support for the reliability and validity of the Form 90 for use with adolescent runaways with a substance abuse or dependence diagnosis.     

Smoking Cessation Treatment among Patients in Community-Based Substance Abuse Rehabilitation Programs: Exploring Predictors of Outcome as Clues Toward Treatment Improvement

Background: Predictors of smoking cessation (SC) treatment outcome were explored in a multisite clinical trial of SC treatment at community-based, outpatient, substance abuse rehabilitation programs affiliated with the National Drug Abuse Treatment Clinical Trials Network. Objectives: To explore baseline demographic and clinical predictors of abstinence during treatment. Methods: Cigarette smokers from five methadone maintenance programs and two drug and alcohol dependence treatment programs were randomly assigned to SC treatment as an adjunct to substance abuse treatment as usual or to substance abuse treatment as usual. SC treatment consisted of group counseling (weeks 1–8) plus transdermal nicotine patch treatment (21 mg/day, weeks 1–6; 14 mg/day, weeks 7–8). Demographic and clinical predictors of smoking abstinence were evaluated among those patients assigned to the active SC condition (N = 153) using logistic regression. Results: Abstinence during treatment was positively associated with younger age, Hispanic or Caucasian (as opposed to African American) ethnicity/race, employment or student status, fewer cigarettes per day at baseline, lower severity of the primary substance problem at baseline, and higher methadone doses (among the subsample in methadone treatment). Conclusions and Scientific Significance: During future efforts to improve SC treatments among drug- and alcohol-dependent patients, consideration should be given to adequate treatment to reduce the severity of the primary drug or alcohol problem, tailoring treatments for patients with greater severity of smoking and of the primary substance problem, and culturally sensitive interventions. Analysis of predictors of outcome may be a useful tool for treatment development.     

Driving Behavior of Alcohol,Cannabis, and Cocaine Abuse Treatment Clients and Population Controls

Background/Introduction: A paucity of research exists on driving after use of cannabis or cocaine among clients in substance abuse treatment and changes in this behavior after treatment. Objectives: The objectives of this research are to compare treatment clients and population controls before and after treatment in terms of: 1) amount of driving; 2) alcohol, cannabis, and cocaine consumption; 3) driving after use of alcohol, cannabis, and cocaine; and 4) driving infractions. Method: Telephone interviews were conducted with a sample of 110 clients who received treatment in 1995 for a primary problem of alcohol (n = 44), cannabis (n = 37), or cocaine (n = 29) abuse. A random sample of 104 drivers from the general population, frequency matched by age and sex was also interviewed. Participants were asked to describe their driving habits and driving infractions before and after 1995. Results: Both treatment and control groups reported about the same amount of driving. The treatment group reported significantly more consumption of alcohol, cannabis, and cocaine than did the control group before treatment. Significant declines in use for each substance were found for the treatment group after treatment, but use for the control group remained stable over the two time periods. Similarly significant declines in driving after use of alcohol, cannabis, and cocaine were found for the treatment group but the control group remained stable. Finally driving infractions, including speeding tickets, collisions, and license suspensions, significantly declined for the treatment group but not the control group. Discussion: The results confirm that before treatment, the treatment subjects drove more frequently after consuming alcohol, cannabis, or cocaine than the control group. Declines in substance use and driving after treatment were accompanied by reductions in some types of driving infractions. Differences between groups, and over time in terms of driving while under the influence of psychoactive substances better explain the results than differences between groups in impulsivity/risk‐taking or sleep problems.     

Driving behavior of alcohol, cannabis, and cocaine abuse treatment clients and population controls

BACKGROUND/INTRODUCTION: A paucity of research exists on driving after use of cannabis or cocaine among clients in substance abuse treatment and changes in this behavior after treatment. OBJECTIVES: The objectives of this research are to compare treatment clients and population controls before and after treatment in terms of: 1) amount of driving; 2) alcohol, cannabis, and cocaine consumption; 3) driving after use of alcohol, cannabis, and cocaine; and 4) driving infractions. METHOD: Telephone interviews were conducted with a sample of 110 clients who received treatment in 1995 for a primary problem of alcohol (n = 44), cannabis (n = 37), or cocaine (n = 29) abuse. A random sample of 104 drivers from the general population, frequency matched by age and sex was also interviewed. Participants were asked to describe their driving habits and driving infractions before and after 1995. RESULTS: Both treatment and control groups reported about the same amount of driving. The treatment group reported significantly more consumption of alcohol, cannabis, and cocaine than did the control group before treatment. Significant declines in use for each substance were found for the treatment group after treatment, but use for the control group remained stable over the two time periods. Similarly significant declines in driving after use of alcohol, cannabis, and cocaine were found for the treatment group but the control group remained stable. Finally driving infractions, including speeding tickets, collisions, and license suspensions, significantly declined for the treatment group but not the control group. DISCUSSION: The results confirm that before treatment, the treatment subjects drove more frequently after consuming alcohol, cannabis, or cocaine than the control group. Declines in substance use and driving after treatment were accompanied by reductions in some types of driving infractions. Differences between groups, and over time in terms of driving while under the influence of psychoactive substances better explain the results than differences between groups in impulsivity/risk-taking or sleep problems.     

Exploring the nature of the relationship between child sexual abuse and substance use among women

Aims. This study investigated whether child sexual abuse (CSA) was associated with earlier substance use and greater severity of substance dependence and what aspects of CSA might predict substance abuse. Design. The study compared (a) drug and alcohol treatment clients with and without a history of CSA and (b) CSA survivors outside drug and alcohol treatment who did or did not have current substance abuse. Settings. Semi-structured interviews took place at participants' homes, treatment agencies or the research centre. Participants. Volunteer participants included 100 women recruited from drug and alcohol treatment programmes and 80 CSA survivors recruited through CSA counselling services and media advertising. Measurements. The results focus on data from the Opiate Treatment Index, Severity of Alcohol Dependence Questionnaire, Substance Dependence Scale, Self-Esteem Inventory and self-reported histories of CSA. Findings. There were no differences between CSA survivors and other drug and alcohol treatment clients in their severity of dependence. Women with a history of CSA more frequently identified stimulants as their main problem drug and reported an earlier age of first intoxication and earlier use of inhalants. Among CSA survivors outside drug and alcohol treatment, women with current substance abuse had typically been abused during adolescence by someone outside the family, whereas those without current substance abuse were typically abused by family members before adolescence. Conclusions. The results suggest that adolescence is a crucial time for the influence of CSA experiences on substance abuse.     

Common Genetic Contributions to Alcohol and Cannabis Use and Dependence Symptomatology

Background: Despite mounting evidence that use of and dependence on alcohol and cannabis are influenced by heritable factors, the extent to which heritable influences on these phenotypes overlap across the 2 substances has only rarely been explored. In the current study, we quantified cross‐substance overlap in sources of variance and estimated the degree to which within‐substance associations between use and dependence measures are attributable to common genetic and environmental factors for alcohol and cannabis. Methods: The sample was comprised of 6,257 individuals (2,761 complete twin pairs and 735 singletons) from the Australian Twin Registry, aged 24 to 36 years. Alcohol and cannabis use histories were collected via telephone diagnostic interviews and used to derive an alcohol consumption factor, a frequency measure for cannabis use, and DSM‐IV alcohol and cannabis dependence symptom counts. Standard genetic analyses were conducted to produce a quadrivariate model that provided estimates of overlap in genetic and environmental influences across the 4 phenotypes. Results: Over 60% of variance in alcohol consumption, cannabis use, and cannabis dependence symptoms, and just under 50% of variance in alcohol dependence (AD) symptoms were attributable to genetic sources. Shared environmental factors did not contribute significantly to the 4 phenotypes. Nearly complete overlap in heritable influences was observed for within‐substance measures of use and dependence symptoms. Genetic correlations across substances were 0.68 and 0.62 for use and dependence symptoms, respectively. Conclusions: Common heritable influences were evident for alcohol and cannabis use and for AD and cannabis dependence symptomatology, but findings indicate that substance‐specific influences account for the majority of the genetic variance in the cannabis use and dependence phenotypes. By contrast, the substantial correlations between alcohol use and AD symptoms and between cannabis use and cannabis dependence symptoms suggest that measures of heaviness of use capture much of the same genetic liability to alcohol‐ and cannabis‐related problems as dependence symptomatology.     

Anhedonia and Social Adaptation Predict Substance Abuse Evolution in Dual Diagnosis Schizophrenia

The current study sought to identify the variables, derived from the self-medication hypothesis, which predicted substance abuse evolution during a homogeneous 3-month antipsychotic treatment. Twenty-four patients were diagnosed with schizophrenia and substance abuse (mainly cannabis and alcohol). Substance abuse, psychiatric symptoms, anhedonia, and social adjustment were assessed at baseline and study endpoint. Linear regression analyses were performed. Better social adaptation and worse anhedonia predicted substance abuse improvements. Conversely, greater psychoactive substance (PAS) use predicted endpoint positive and depressive symptoms. These results suggest that: (i) substance abuse interferes with psychiatric prognosis in schizophrenia; and (ii) dual diagnosis treatments leading patients to engage in alternative social activities may render substance abuse less appealing. Further studies are warranted to dissociate the causes and consequences of substance abuse in schizophrenia.     

Chapter 10: Substance Abuse Prevention for High-Risk Youth

SUMMARY

This pilot study explores issues of culture and alcohol and other drug use in relation to substance abuse prevention with high-risk youth, with a particular interest in Latinos/as and acculturation. Many of the prominent prevention studies are school based, missing some of the youth at very highest risk for alcohol and drug use and abuse. Consequently, this study was conducted in community settings with youth from high-risk neighborhoods and environmental conditions including a homeless youth shelter, an alternative learning setting, and a low-income community program. The data indicated a high lifetime prevalence of drug use (over 80% for Whites and Latinos for beer, wine, liquor, and marijuana), with consistently lower prevalence rates observed among African-Americans. In addition, the study found significant ethnic differences in substance use (last 30 days) in the sample (median age = 16), with African-Americans reporting significantly lower incidence of marijuana and cocaine use (p < .05) than other youth. Implications for prevention, intervention and future research are discussed.     

Course, severity, and treatment of substance abuse among women versus men

OBJECTIVE: To assess the course and severity of substance-related disorder (SRD) in relation to gender. DESIGN: Retrospective data on course were obtained for several indices of substance use, abuse, and related morbidity. SETTING: Two university medical centers with alcohol-drug programs located in departments of psychiatry. SUBJECTS: A total of 642 patients were assessed, of whom 365 (57%) were men and 277 (43%) were women. METHODS: Data on course included demographic characteristics, family history of substance abuse, lifetime use, age at first use, years of use, use in the last year, periods of abstinence, and current diagnosis. Data on severity included two measures of SRD-associated problems (one patient rated and one interviewer rated), substance abuse versus dependence, self-help activities, and previous treatment. RESULTS: Women were more apt to be homemakers; to have a sibling or, if married, a spouse who abused substances; to be less apt to have ever used hallucinogens or inhalants; to have used substances for fewer years; to have used cannabis and inhalants for fewer days in the last year; to have a lower rate of current cannabis abuse/dependence; to have fewer legal problems related to substances (especially driving while intoxicated [DWI] charges); to have fewer outpatient admissions to treatment; to have fewer admissions to substance abuse treatment (all categories together), fewer lifetime days in treatment, and lower overall treatment cost (for all categories of treatment together). CONCLUSIONS: These data confirm earlier reports of a shorter course, less deviant drug usage, and--if married--a substance-abusing spouse. In addition, we found higher rates of familial substance abuse and lower rates of lifetime admissions, treatment days, and total cost of substance abuse treatment. Homemaking responsibilities, a substance-abusing spouse, a male-oriented treatment system, and/or a more rapid course may reduce substance abuse treatment for women.     

Anhedonia and social adaptation predict substance abuse evolution in dual diagnosis schizophrenia

The current study sought to identify the variables, derived from the self-medication hypothesis, which predicted substance abuse evolution during a homogeneous 3-month antipsychotic treatment. Twenty-four patients were diagnosed with schizophrenia and substance abuse (mainly cannabis and alcohol). Substance abuse, psychiatric symptoms, anhedonia, and social adjustment were assessed at baseline and study endpoint. Linear regression analyses were performed. Better social adaptation and worse anhedonia predicted substance abuse improvements. Conversely, greater psychoactive substance (PAS) use predicted endpoint positive and depressive symptoms. These results suggest that: (i) substance abuse interferes with psychiatric prognosis in schizophrenia; and (ii) dual diagnosis treatments leading patients to engage in alternative social activities may render substance abuse less appealing. Further studies are warranted to dissociate the causes and consequences of substance abuse in schizophrenia.