Substance misuse: a primary risk and a major problem of comorbidity

Abstract

The misuse of drugs or alcohol has long been regarded as a major risk factor for violence. This is confirmed by findings from the Epidemiological Catchment Area (ECA) surveys which also show that comorbidity for substance misuse and mental illness further increases the risk. In preliminary findings from the MacArthur Violence Risk Assessment study, it was found that over 40% of patients with a major mental disorder were comorbid for a substance misuse disorder and these individuals were three to four times more at risk of showing violent behaviour. Reviewing the ways in which taking drugs or alcohol may be associated with violence shows that pharmacological, psychological and sociological factors may modify the expression of intoxicated or aggressive behaviour. It is suggested that these findings should lead to a greater awareness of substance misuse issues in risk assessment and management. The implications of this for the delivery of psychiatric care and the organization of services are discussed.