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Comorbidity of substance abuse and schizophrenia: the role of pre-morbid adjustment

Published online by Cambridge University Press:  09 July 2009

Stephan Arndt ,
Gary Tyrrell ,
Michael Flaum  and
Nancy C. Andreasen
Stephan Arndt*
Affiliation:
Department of Preventive Medicine and Environmental Health; Department of Psychiatry, University of Iowa, Iowa City, USA
Gary Tyrrell
Affiliation:
Department of Preventive Medicine and Environmental Health; Department of Psychiatry, University of Iowa, Iowa City, USA
Michael Flaum
Affiliation:
Department of Preventive Medicine and Environmental Health; Department of Psychiatry, University of Iowa, Iowa City, USA
Nancy C. Andreasen
Affiliation:
Department of Preventive Medicine and Environmental Health; Department of Psychiatry, University of Iowa, Iowa City, USA
*
1Address for correspondence: Dr S. Arndt, 1–305 PH MH-CRC, 500 Newton Road, University of Iowa, Iowa City, Iowa 52242, USA.
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Synopsis

Co-morbid substance use and abuse is common in schizophrenic patients, and the role of substance abuse in initiating and maintaining psychosis has important definitional and aetiological implications. We investigated the issue in a cohort of 131 schizophrenic patients. We found non-users (N = 67) were similar to pathological users (N = 64) in current symptomatology and clinical history. The pathological users did, however, have better pre-morbid adjustment levels. Only alcohol use and to some extent cannabis use contributed to this effect; use of stimulants or hallucinogens did not. These results indicate the importance of evaluating the various types of substance used when attempting to explore the significance of co-morbidity. The results also suggest that co-morbidity of substance abuse and schizophrenia may be explained by a common factor antecedent to both: better pre-morbid adjustment. A two-stage model is proposed to explain these findings: increased sociability increases exposure to opportunities of substance use in a subset of patients; subsequent onset of psychotic illness accelerates the use to a pathological level as the individual attempts to cope with the stress of the developing mental illness.

Type
Original Articles
Information
Psychological Medicine , Volume 22 , Issue 2 , May 1992 , pp. 379 - 388
Copyright
Copyright © Cambridge University Press 1992

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References

American Psychiatric Association, Committee on Nomenclature and Statisitcs. (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn.American Psychiatric Association: Washington, DC.Google Scholar
Andreasen, N. C. (1983). The Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City, IA.Google Scholar
Andreasen, N. C. (1984). The Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City, IA.Google Scholar
Andreasen, N. C. (1985). Comprehensive Assessment of Symptoms and History (CASH). University of Iowa: Iowa City, IA.Google Scholar
Andreasson, S., Allebeck, P., Engstrom, A. & Rydberg, U. (1987). Cannabis and schizophrenia: a longitudinal study of Swedish conscripts. Lancet. ii, 1483–1486.CrossRefGoogle Scholar
Bowers, M. B., Mazure, C. M., Nelson, J. C. & Jatlow, P. I. (1990). Psychotogenic drug use and neuroleptic response. Schizophrenia Bulletin 16, 81–85.CrossRefGoogle ScholarPubMed
Brady, K., Anton, R., Ballenger, J. C., Lydiard, B., Adinoff, B. & Selander, J. (1990). Cocaine abuse among schizophrenic patients. American Journal of Psychiatry 147, 1164–1167.Google ScholarPubMed
Breakey, W. R., Goodell, H., Lorenz, P. C. & McHugh, P. R. (1974). Hallucinogenic drugs as precipitants of schizophrenia. Psychological Medicine 4, 255–261.CrossRefGoogle ScholarPubMed
Cooper, M. L., Russell, M. & George, W. H. (1988). Coping, expectancies and alcohol abuse: a test of social learning formulations. Journal of Abnormal Psychology 97, 218–230.CrossRefGoogle ScholarPubMed
Craig, T. J., Lin, S. P., El-Defrawi, Mh. H. & Goodman, A. B. (1985). Clinical correlates of readmission in a schizophrenic cohort. Psychiatric Quarterly 57, 5–10.CrossRefGoogle Scholar
Dixon, L., Haas, G., Weiden, P., Sweeney, J. & Frances, A. (1990). Acute effects of drug abuse in schizophrenic patients: clinical observations and patients' self-reports. Schizophrenia Bulletin 16, 69–79.CrossRefGoogle ScholarPubMed
Dixon, L., Haas, G., Weiden, P. J., Sweeney, J. & Frances, A. (1991). Drug abuse in schizophrenic patients: clinical correlates and reasons for use. American Journal of Psychiatry 148, 224–230.Google ScholarPubMed
Drake, R. E., Osher, F. C., Noordsy, D. L., Hurlbut, S. C., Teague, G. B. & Beaudett, M. S. (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin 16, 57–68.CrossRefGoogle ScholarPubMed
Endicott, J., Spitzer, R. L., Fleiss, J. L. & Cohen, J. (1976). The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbances. Archives of General Psychiatry 33, 766–771.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. (1975). ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Fox, J. (1984). Linear Statistical Models & Related Methods. John Wiley & Sons: New York.Google Scholar
Gittelman-Klein, R. & Klein, D. F. (1969). Premorbid asocial adjustment and prognosis in schizophrenia. Journal of Psychiatric Research 7, 35–53.CrossRefGoogle ScholarPubMed
Goldfinch, C. (1990). Reefer madness. Health 22, 21–23.Google Scholar
Kandel, D. (1973). Adolescent marihuana use: role of parents and peers. Science 181, 1067–1070.CrossRefGoogle ScholarPubMed
Kandel, D. (1975). Stages in adolescent involvement in drug use. Science 190, 912–914.CrossRefGoogle ScholarPubMed
Kandel, D. & Faust, R. (1975). Sequence and stages in patterns of adolescent drug use. Archives of General Psychiatry 32, 923–932.CrossRefGoogle ScholarPubMed
Kandel, D. B., Kessler, R. C. & Margulies, R. Z. (1978). Antecedents of adolescent initiation into stages of drug use: a developmental analysis. Journal of Youth and Adolescence 7, 13–39.CrossRefGoogle ScholarPubMed
Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on Heroin and cocaine dependence. American Journal of Psychiatry 142, 1259–1264.Google ScholarPubMed
Kirk, R. E. (1968). Experimental Design: Procedures for the Behavior Sciences. Brooks/Cole Publishing Co.: Belmont, California.Google Scholar
Lieberman, J. A., Kinon, B. J. & Loebel, A. D. (1990). Dopaminergic mechanisms in idiopathic and drug-induced psychoses. Schizophrenia Bulletin 16, 97–110.CrossRefGoogle ScholarPubMed
McLellan, A. T. & Druley, K. A. (1977). Non-random relation between drugs of abuse and psychiatric diagnosis. Journal of Psychiatry Research 13, 179–184.CrossRefGoogle ScholarPubMed
Meyer, R. E. (1989). Prospects for a rational pharmacotherapy of alcoholism. Journal of Clinical Psychiatry 50, 403–412.Google ScholarPubMed
Mueser, K. T., Yarnold, P. R., Levinson, D. R., Singh, H., Bellack, A. S., Kee, K., Morrison, R. L. & Yadalam, D. G. (1990). Prevalence of substance abuse in schizophrenia: demographic and clinical correlates. Schizophrenia Bulletin 16, 31–56.CrossRefGoogle ScholarPubMed
Negrete, J. C., Knapp, W. P., Douglas, D. E. & Smith, W. B. (1986). Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey. Psychological Medicine 16, 515–520.CrossRefGoogle ScholarPubMed
Pedhazur, E. J. (1982). Multiple Regression in Behavioral Research. Holt, Reinehart and Winston: New York.Google Scholar
Penick, E. C., Powell, B. J., Liskow, B. I., Jackson, H. O. & Nickel, E. J. (1988). The stability of coexisting psychiatric symptoms in alcoholic men after one year. Journal of Studies on Alcohol 49, 395–405.CrossRefGoogle ScholarPubMed
Phillips, L. (1953). Case history and prognosis in 117 schizophrenia patients. Journal of Nervous & Mental Disease 117, 515–525.CrossRefGoogle Scholar
Richard, M. L., Liskow, B. I. & Perry, P. J. (1985). Recent psychostimulant use in hospitalized schizophrenics. Journal of Clinical Psychiatry 46, 79–83.Google ScholarPubMed
Ridgely, M. S., Goldman, H. H. & Willenbring, M. (1990). Barriers to the care of persons with dual diagnosis: organizational and financing issues. Schizophrenia Bulletin 16, 123–132.CrossRefGoogle Scholar
Ritzler, B. A., Strauss, J. S., Vanord, A. & Kokes, R. F. (1977). Prognostic implications of various drinking patterns in psychiatric patients. American Journal of Psychiatry 134, 546–549.Google ScholarPubMed
Robins, L. N., Helzer, J. E. & Davis, D. H. (1975). Narcotic use in Southeast Asia and afterward. Archives of General Psychiatry 32, 995–961.CrossRefGoogle ScholarPubMed
Rounsaville, B. J., Anton, S. F., Carroll, K., Budde, D., PrusofT, B. A. & Gawin, F. (1991). Psychiatric diagnoses of treatment-seeking cocaine abusers. Archives of General Psychiatry 48, 43–51.CrossRefGoogle ScholarPubMed
Schneier, F. R. & Siris, S. G. (1987). A review of psychoactive substance use and abuse in schizophrenia patterns of drug choice. Journal of Nervous and Mental Disease 175, 641–652.CrossRefGoogle ScholarPubMed
Shedler, J. & Block, J. (1990). Adolescent drug use and psychological health. American Psychologist 45, 612–630.CrossRefGoogle ScholarPubMed
Steele, C. M. & Josephs, R. A. (1988). Drinking your troubles away. II. An attention-allocation model of alcohol's effect on psychological stress. Journal of Abnormal Psychology 97, 196–205.CrossRefGoogle Scholar
Steele, C. M. & Josephs, R. A. (1990). Alcohol myopia: Its prized and dangerous effects. American Psychologist 45, 921–933.CrossRefGoogle ScholarPubMed
Stevens, J. (1987). Storming Heaven: LSD and the American Dream. The Atlantic Monthly Press: New York.Google Scholar
Taylor, G. J., James, D. A., Parker, M. A. & Bagby, R. M. (1990). A preliminary investigation of alexithymia in men with psychoactive substance dependence. American Journal of Psychiatry 147, 1228–1230.Google ScholarPubMed
Test, M.A., Wallisch, L. S., Allness, D. J. & Ripp, K. (1989). Substance use in young adults with schizophrenic disorders. Schizophrenia Bulletin 15, 465–476.CrossRefGoogle ScholarPubMed
Timmer, S. G., Veroff, J. & Colten, M. E. (1985). Life stress, helplessness, and the use of alcohol and drugs to cope: an analysis of national survey data. In Coping and Substance Use (ed. Shiftman, S. and Wills, T. A.), pp. 171–198. Academic Press: New York.Google Scholar
Tsuang, M. T., Simpson, J. C. & Kronfol, Z. (1982). Subtypes of drug with psychosis. Archives of General Psychiatry 39, 141–147.CrossRefGoogle ScholarPubMed
Wills, T. A. (1985). Stress, coping, and tobacco and alcohol use in early adolescence. In Coping and Substance Use (ed. Shiffman, S. and Wills, T. A.), pp. 67–94. Academic Press: New York.Google Scholar
Wills, T. A. & Shiffman, S. (1985). Coping and substance use: a conceptual framework. In Coping and Substance Use (ed. Shiffman, S. and Wills, T. A.), pp. 1–24. Academic Press: New York.Google Scholar
Wise, R. A. (1988). Neurobiology of craving. Journal of Abnormal Psychology 97, 118–132.CrossRefGoogle ScholarPubMed