Substance abuse comorbidity in schizophrenia: editors' introduction

Substance abuse is a pervasive problem in American society that extends to persons with mental illness. Despite the fact that substance abuse in the mentally ill is a major clinical problem, there have been very few systematic investigations of the dimensions, nature, and treatment of this problem. This issue of the Schizophrenia Bulletin attempts to examine the problem of substance abuse in schizophrenia from various perspectives by reviewing the published literature, presenting original data, and identifying areas and approaches for future scientific investigation.     

Substance abuse among American Indians in an urban treatment program

Chart reviews were used to describe demographic and clinical characteristics of 68 urban American Indian people attending an Indian-oriented outpatient substance-abuse treatment program in Denver, Colorado, and to describe program staff's assessment of client's response to treatment. Alcohol and marijuana were the drugs abused most frequently. The program admitted about equal numbers of males and females; age averaged 24 years. Although Colorado has only Ute reservations, 49% of clients were Sioux, while none were Ute. Moreover, 87% of clients were not active in Indian religion and culture. Clients had low educational achievement and very low income. Few were in stable marriages. In comparison to counselors, clients underestimated the severity of their problems. By counselors' assessment, 78% of clients did not finish the program, and only two fully achieved the treatment goals. Areas for further clinical research are suggested.     

Substance abuse treatment for high-risk adolescents

Adolescent substance abuse is rising dramatically in the United States. This observation is especially troubling given the association between substance use and HIV, as well as other sexually transmitted diseases. Surprisingly, there have been few carefully constructed, controlled studies examining different treatment approaches with adolescent substance abusers. In our review of the literature, we note that family therapy and, to a lesser extent, cognitive behavioral therapy, received the most attention as intervention strategies with adolescents. Both approaches appear to have some success, although further research is necessary. In addition, developing and assessing strategies to improve family involvement in treatment requires additional investigation.     

Substance abuse differences among students receiving special education school services

Social fragility is used as a context for explaining reported substance abuse differences between disabled children and youth receiving special education school services. Characteristics of severely behaviorally handicapped, specific learning disabled and developmentally handicapped are summarized. Reported use of cigarettes and other drugs are summarized for elementary, junior high and high school students. Differences in patterns of use between special education populations at each level of schooling and regular education students are identified and explored. Differences are interpreted in terms of social attachment and cognitive functioning issues.     

Substance abuse day treatment and managed health care

Day treatment for substance abusers has been viewed by many as a viable treatment modality, particularly in light of the success of psychiatric day treatment programs. The available research also supports the efficacy of day treatment versus inpatient treatment for substance abusers. Nevertheless, day treatment programs for substance abusers have had difficulty gaining acceptance with treatment providers and patients alike. This paper offers several explanations for this lack of acceptance and proposes that managed care settings are ideally suited to pioneer substance abuse day treatment programs. Practical suggestions will also be offered to help market this treatment modality and minimize patient resistance.     

Adolescent substance abuse treatment: evidence-based practice in outpatient services

Adolescent substance use disorder (SUD) is a serious public health concern. The majority of youth with SUD receive outpatient treatment. There is a pressing need to improve treatment outcome due to high rates of both premature treatment termination and relapse during and after treatment completion. Reviews of the latest innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials examining singular and integrative treatment modalities have established empiric support for the efficacy of adolescent treatment. Despite some prominent differences in treatment modalities, design, and methodology, recent studies have reported remarkably similar short-term outcomes. Taken together, the findings represent significant developments in treatment outcome research, and lay the foundation for continued future research addressing important challenges. Potential directions include improving short- and long-term outcomes, enhancing motivation for treatment, improving engagement strategies, identifying challenges associated with psychiatric comorbidity, addressing patient-treatment matching, and developing aftercare programs.     

Substance abuse and psychopathology

This report evaluates, using DSM III, the psychopathological profile of 226 heroin users taken in at the clinical centre of "Cascina Verde" Therapeutic Community (Milan, Italy) and admitted to a psychotherapeutic, retraining, integrated, both out-and-in-patient treatment. The outcome shows that 30% of subjects are to be diagnosed according to Axis I while 61% are to be considered among Axis II personality disorders. A portion of 16% is to be referred to the "schizophrenic spectrum", 25% has histrionic, narcissistic, antisocial and borderline personality disorders and the remaining are to be referred to an extremely heterogeneous category. The report shows also data concerning Axes IV and V, always according DSM III.     

Substance abuse and criminality

Substance abuse issues and the law have become intricately linked over the years. This article reviews the current research underlying the association between substance abuse and crime, and provides an overview of the pertinent issues in conducting a substance abuse evaluation in the forensic context. The epidemiology of substance abuse and crime is reviewed, exploring the association between crime and specific psychoactive substances. Clinical considerations underlying the association are discussed, with specific attention paid to the pharmacological effects of psychoactive substances and to the role of substance use in individuals with serious associated psychopathology. Diagnostic and etiological issues that are important in differentiating substance abuse from criminality are considered in the context of conducting forensic evaluations. Finally, key components of a forensic substance abuse evaluation are presented.     

Substance abuse in bipolar disorder

Background: High rates of substance abuse have been reported in the general population, with males more often affected than females. Although high rates of substance abuse have also been reported in bipolar patients, the relationship between substance abuse and bipolar disorder has not been well characterized.

Methods: Substance abuse histories were obtained in 392 patients hospitalized for manic or mixed episodes of bipolar disorder and rates of current and lifetime abuse calculated. Analyses comparing sex, subtype (manic vs. mixed) and clinical history variables were conducted.

Results: Rates of lifetime substance abuse were high for both alcohol (48.5%) and drugs (43.9%). Nearly 60% of the cohort had a history of some lifetime substance abuse. Males had higher rates of abuse than females, but no differences in substance abuse were observed between subjects in manic and mixed bipolar states. Rates of active substance abuse were lower in older age cohorts. Subjects with a comorbid diagnosis of lifetime substance abuse had more psychiatric hospitalizations.

Conclusions: Substance abuse is a major comorbidity in bipolar patients. Although rates decrease in older age groups, substance abuse is still present at clinically important rates in the elderly. Bipolar patients with comorbid substance abuse may have a more severe course. These data underscore the significance of recognition and treatment of substance abuse in bipolar disorder patients.     

Substance abuse and movement disorders

An array of movement disorders is associated with ethanol, illicit drugs, and tobacco. Heavy ethanol users experience withdrawal tremor and, less often, withdrawal parkinsonism, chorea, and myoclonus. Asterixis is a feature of hepatic failure. On the other hand, ethanol can ameliorate essential tremor and myoclonus‐dystonia. Among opioid drugs, meperidine can precipitate myoclonus. Severe parkinsonism affected users of a synthetic meperidine analog contaminated with 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine. Spongiform leukoencephalopathy, sometimes with chorea and myoclonus, occurred in inhalers of heroin vapor (chasing the dragon). Psychostimulants including cocaine acutely cause stereotypies and dyskinesias. Phencyclidine toxicity causes myoclonus. Tobacco use, on the other hand, protects against Parkinson's disease. Clinicians need to consider substance abuse in patients with unexplained movement disorders. © 2010 Movement Disorder Society.     

Substance abuse prevalence and treatment utilization among American Indians residing on-reservation

American Indians residing on-reservation were interviewed regarding their substance use and treatment utilization. One-third had a current substance abuse problem. Predictors included gender, tribe, age, employment status, household income, and educational attainment. Almost two-thirds of those with substance abuse problems had received no treatment within the past year. A combination of formal and informal treatment was the most common approach. Treatment utilization was predicted by gender, age, and insurance coverage.     

Substance abuse and HIV infection

This chapter reviews the associations between substance use, comorbid psychiatric disorders, and HIV risk behaviors; the prevalence of substance use disorders among HIV-positive individuals in treatment settings; the medical, psychiatric, and substance abuse treatment of individuals with substance use disorders and HIV infection; and finally, HIV risk reduction among substance abusers.     

Substance abuse increases the risk of neuropathy in an HIV-infected cohort

Introduction: Human immunodeficiency virus (HIV)‐infected patients commonly develop distal symmetric polyneuropathy (DSP). Age, ethnicity, and toxic exposures may influence the risk. In this study we examined the association between substance use, antiretrovirals, ethnicity, and incident neuropathy in an HIV‐infected cohort. Methods: Data were obtained from the National NeuroAIDS Tissue Consortium (NNTC), an ongoing, prospective cohort started in 1998. Cox proportional hazards models were used to examine the association of substance use, demographics, neurotoxic antiretrovirals, and laboratory parameters with incident neuropathy in 636 participants who were neuropathy‐free at baseline. Results: The cumulative incidence of DSP was 41%. Substance use (P = 0.04), number of substances used (P = 0.04), and longer duration of HIV infection (P = 0.05) were associated with incident DSP, but demographic factors, use of neurotoxic antiretrovirals, and laboratory parameters were not. Conclusions: Substance use and longer duration of HIV infection are risk factors for DSP in HIV‐infected patients. Use of multiple substances may be particularly risky. Muscle Nerve, 2012