Severe Substance Use Research Articles

Unrecognized cocaine use among schizophrenic patients.

Unrecognized stimulant use could lead to the misdiagnosis of schizophrenia or the misunderstanding of its course and prognosis. This study was conducted to determine the prevalence of unrecognized stimulant use among patients with a clinical diagnosis of schizophrenia. The subjects were 108 schizophrenic patients admitted consecutively to a Veterans Affairs psychiatric hospital. Admitting psychiatrists supplemented routine clinical evaluations with a semistructured interview regarding recent and lifetime use of alcohol, cocaine, amphetamine, marijuana, and opiates. A urine specimen was assayed for the four illicit drugs. Of the 103 patients who provided a urine specimen, 37 (36%) used cocaine during the 6 months before admission, including 31 who used the drug in the week before admission. Because of the poor reliability of negative self-reports of recent cocaine use, clinicians failed to recognize cocaine use in one-third of the patients with a urine toxicology positive for cocaine metabolites. Two other groups of patients were identified; schizophrenic patients without substance abuse (including alcohol) and schizophrenic patients with substance abuse other than stimulants. Both substance-abusing groups were younger than the nonabusing group, but the three groups had similarly high rates of recent psychotic symptoms, homelessness, and unemployment. Among schizophrenic patients who require hospitalization, clinicians should not rely solely on self-reported stimulant use. Recognition of stimulant use could be improved through routine urine toxicologies for all psychotic patients. The authors suggest that recognition of stimulant use among schizophrenic patients may identify a population with a better prognosis for schizophrenia and different treatment needs.

History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers

Thirty-five percent of 298 treatment-seeking cocaine abusers met DSM-III-R criteria for childhood attention deficit hyperactivity disorder (ADHD). Subjects with childhood ADHD were likely to be male (78%), meet Research Diagnostic Criteria (RDC) for conduct disorder (93%) and antisocial personality disorder (47%), and report a history of conduct disorder in first-degree relatives. With respect to those without the disorder and regardless of co-occurrence with sociopathy, cocaine abusers with childhood ADHD were younger at presentation for treatment and reported more severe substance use, earlier onset of cocaine abuse, more frequent and intense cocaine use, intranasal rather than freebase or intravenous use of cocaine, higher rates of alcoholism, and more previous treatment. This pattern of cocaine use is consistent with clinical descriptions of self-medication of residual symptoms of ADHD in cocaine abusers. Data from this study suggest that there may be more cocaine abusers with a history of ADHD than previously recognized in clinical samples of cocaine users, and that these individuals may differ in clinically meaningful ways from those without childhood ADHD. Moreover, the poorer outcome of subjects with ADHD in this sample underlines the importance of identifying and treating residual symptoms of ADHD in cocaine abusers.

Treatment of alcoholism among schizophrenic outpatients: 4-year outcomes

In this pilot study, the authors assessed 4-year outcomes for 18 schizophrenic outpatients with alcoholism who were treated in an innovative dual-diagnosis program. Over half (61.1%) achieved stable remissions from alcoholism. The mean duration of remission was 26.5 months.

HIV Seroprevalence and Clinical Characteristics of Severe Inpatient Mentally III Homeless

Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a chart review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical, and psychiatric services. Assertive community outreach programs are necessary to assure delivery of services to this population.

Lessons from a pilot residential treatment program for people with dual diagnoses of severe mental illness and substance use disorder.

Lessons from a pilot residential treatment program for people with dual diagnoses of severe mental illness and substance use disorder.

HIV seroprevalence among patients admitted to two psychiatric hospitals

The authors determined the seroprevalence of HIV-1 among patients admitted to two psychiatric hospitals in New York City. Patients consecutively admitted to an acute psychiatric unit in Manhattan and a large state hospital in Queens were anonymously tested for HIV-1 antibodies from December 1989 through July 1990. Test results were linked to age, gender, ethnicity, and two risk behaviors: male homosexual activity and injection drug use. Blood was obtained from 83.0% of the eligible patients. The prevalence of HIV was 5.5% (25 of 451). Black patients accounted for 38.0% of the patients tested and 76.0% of positive results (N = 19), a rate of 11.1% for this group. The rate of seropositivity was comparable in women and men. Clinicians had charted risk behavior for nine (36.0%) of the 25 HIV-positive patients. Infection control records suggested that clinicians were aware of seven (28.0%) of the positive cases. One in every 18 patients admitted to two public psychiatric hospitals in New York City was HIV positive. Clinical staff largely failed to identify HIV-positive patients. Ethnicity and a history of homosexual activity among men or use of injected drugs were strongly associated with seropositivity. This pattern of infection may be linked to needle sharing and/or sexual activity with partners who have shared needles. Future research should clarify how psychiatric illness affects risk-taking behavior, focus on improving detection by clinicians, and identify effective prevention strategies in this population.

Homelessness and dual diagnosis.

People who are dually diagnosed with severe mental illness and substance use disorders constitute 10%-20% of homeless persons. They are a heterogeneous and extremely vulnerable subgroup with complex, poorly understood needs. In this article recent research on the epidemiology, subject characteristics, and service needs of the dually diagnosed homeless population is reviewed. Also, the range of evolving approaches to providing social services, housing, and mental health and substance-abuse treatments; the relevant system issues and legal issues; and problems with current research, as well as future research directions, are discussed. The importance of the distinction between providing appropriate living environments and mental health treatments emerges throughout.

Evaluation of Services for Young Adults With Severe Mental Illness and Substance Use Disorders—by Gregory B. Teague, Ph.D., Brenda Schwab, Ph.D., and Robert E. Drake, M.D., Ph.D.; National Association of State Mental Health Program Directors, 1990, 63 pages plus appendixes. Available from the association's Young Adult Project, 1101 King Street, Suite 160, Alexandria, Virginia 22303; $25 for state agencies on

<b>Evaluation of Services for Young Adults With Severe Mental Illness and Substance Use Disorders</b>—by Gregory B. Teague, Ph.D., Brenda Schwab, Ph.D., and Robert E. Drake, M.D., Ph.D.; National Association of State Mental Health Program Directors, 1990, 63 pages plus appendixes. Available from the association's Young Adult Project, 1101 King Street, Suite 160, Alexandria, Virginia 22303; $25 for state agencies on

Alcohol and the Writer

Back to table of contents Previous article Next article ArticleNo AccessAlcohol and the WriterJOHN PAUL BRADYJOHN PAUL BRADYSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.147.1.115AboutSections ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Alcohol and the Writer." American Journal of Psychiatry, 147(1), pp. 115–116 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. 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FiguresReferencesCited byDetailsCited ByComorbid Psychiatric and Physical Disorders6 February 2020Substance Use in Adolescent Psychiatric Outpatients: Self-Report, Health Care Providers' Clinical Impressions, and Urine Screening28 October 2013 | Journal of Child & Adolescent Substance Abuse, Vol. 23, No. 1Journal of Social Work Practice in the Addictions, Vol. 12, No. 4The Potential Role of Long-Acting Injectable Antipsychotics in People With Schizophrenia and Comorbid Substance Use13 February 2012 | Journal of Dual Diagnosis, Vol. 8, No. 1An open label study of quetiapine in patients with schizophrenia and alcohol disordersMental Health and Substance Use, Vol. 2, No. 3Journal of Dual Diagnosis, Vol. 4, No. 4Mental Health and Substance Use, Vol. 1, No. 3Acta Psychiatrica Scandinavica, Vol. 104, No. 5Journal of Dual Diagnosis, Vol. 3, No. 2Journal of Psychiatric Practice, Vol. 12, No. 3Current Medical Research and Opinion, Vol. 22, No. 7Hepatitis C virus and HIV co-infection in people with severe mental illness and substance use disordersAIDS, Vol. 19, No. Suppl 3Co-Occurring Mental and Substance Use Disorders: The Neurobiological Effects of Chronic StressKathleen T. Brady, M.D., Ph.D., and Rajita Sinha, Ph.D.1 August 2005 | American Journal of Psychiatry, Vol. 162, No. 8Cocaine Abuse in Schizophrenic Patients Treated With Olanzapine Versus HaloperidolJournal of Nervous & Mental Disease, Vol. 193, No. 6Journal of Dual Diagnosis, Vol. 1, No. 2International Clinical Psychopharmacology, Vol. 18, No. 3Addictive Disorders & Their Treatment, Vol. 2, No. 4International Clinical Psychopharmacology, Vol. 18, No. 3Substance Abuse, Vol. 23, No. sup1Journal of Psychiatric Practice, Vol. 8, No. 2Treatment of the special patient with schizophrenia1 April 2022 | Dialogues in Clinical Neuroscience, Vol. 3, No. 2Journal of Clinical Psychology, Vol. 57, No. 1A haplotype at the DBH locus, associated with low plasma dopamine β-hydroxylase activity, also associates with cocaine-induced paranoia28 January 2000 | Molecular Psychiatry, Vol. 5, No. 1Journal of Clinical Psychopharmacology, Vol. 20, No. 1Synapse, Vol. 32, No. 1Synapse, Vol. 33, No. 3Substance Abuse, Vol. 19, No. 4Flupenthixol Treatment for Cocaine Abusers with Schizophrenia: A Pilot Study7 July 2009 | The American Journal of Drug and Alcohol Abuse, Vol. 24, No. 3Comorbidity of drug abuse treatmentJournal of Psychopathology and Behavioral Assessment, Vol. 19, No. 2The Journal of Nervous &amp Mental Disease, Vol. 185, No. 1New Directions for Mental Health Services, Vol. 1996, No. 2Clinical effects of recent cocaine use on patients with acute schizophrenia1 April 2006 | American Journal of Psychiatry, Vol. 152, No. 10Psychopharmacology, Vol. 121, No. 4Molecular Neurobiology, Vol. 11, No. 1-3New England Journal of Medicine, Vol. 333, No. 12Decreased substance use in chronically psychotic patients treated with clozapine1 April 2006 | American Journal of Psychiatry, Vol. 151, No. 5Bleeding attributed to the intake of paroxetine1 April 2006 | American Journal of Psychiatry, Vol. 151, No. 5Substance abuse among patients with treatment-resistant schizophrenia: characteristics and implications for clozapine therapy1 April 2006 | American Journal of Psychiatry, Vol. 151, No. 3The American Journal of Drug and Alcohol Abuse, Vol. 20, No. 4Depression in alcoholic schizophrenic patients1 April 2006 | American Journal of Psychiatry, Vol. 150, No. 8Unrecognized cocaine use among schizophrenic patients1 April 2006 | American Journal of Psychiatry, Vol. 150, No. 5Community Mental Health Journal, Vol. 29, No. 2Past substance abuse and clinical course of schizophrenia1 April 2006 | American Journal of Psychiatry, Vol. 149, No. 4New Directions for Mental Health Services, Vol. 1992, No. 53, Vol. 10Acta Psychiatrica Scandinavica, Vol. 85, No. 1Journal of Addictions Nursing, Vol. 4, No. 1Cocaine-induced paranoia and psychosis proneness1 April 2006 | American Journal of Psychiatry, Vol. 148, No. 12 Volume 147Issue 1 January 1990Pages 115-116 Metrics History Published online 1 April 2006 Published in print 1 January 1990

The criminality of the mentally ill: a dangerous misconception.

A longstanding controversy is the relative dangerousness and criminality of the mentally ill. The author presents observational data from 1,072 police-citizen encounters in an urban area. The data show that persons exhibiting signs of serious mental disorder were not suspected of serious crimes at a rate disproportionate to their numbers in the population. The patterns of crime for mentally disordered persons and for non-mentally-disordered persons were substantially similar. These data help dispel the myth that the mentally ill constitute a dangerous group prone to violent crime.