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Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK

A systematic review

  • ORIGINAL PAPER
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Abstract

Background

Comorbid substance misuse in psychosis is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for such ‘dual diagnosis’. Evidence has now been accumulating in the UK since the early 1990s, and allows a relatively comprehensive comparison of rates between service settings, geographical areas and social contexts in terms of ethnic background.

Methods

A literature search was carried out with the aim of investigating: (a) comorbid alcohol and drug misuse rates in people with established psychosis in different mental health and addiction settings in the UK, (b) variations in such rates between different population groups.

Results

There are wide variations in reported drug and alcohol misuse rates in psychosis. Most recent UK studies report rates between 20 and 37% in mental health settings, while figures in addiction settings are less clear (6–15%). Rates are generally not as high as in US studies, but appear to be especially high in inpatient and crisis team settings (38–50%) and forensic settings. In terms of geography, rates appear highest in inner city areas. Some ethnic groups are over-represented among clinical populations of people with dual diagnosis.

Conclusions

Rates of substance misuse in psychosis are likely to be influenced by service setting, population composition and geography. Acute and forensic settings are especially appropriate for the development of targeted interventions.

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Acknowledgments

The authors are grateful for information about their studies obtained from Tim Weaver from the Division of Neurosciences and Mental Health, Imperial College, London, and from Hermine Graham and Ruth Clutterbuck from the COMPASS Programme, Birmingham.

Author information

Authors and Affiliations

  1. Dept. of Mental Health Sciences, Royal Free and University College Medical School, Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK

    Giuseppe Carrà & Sonia Johnson

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  1. Giuseppe Carrà
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  2. Sonia Johnson
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Corresponding author

Correspondence to Giuseppe Carrà.

Appendices

Appendix 1

Databases were searched using the Schizophrenia search phrase (“Mentally Ill Persons”[MeSH] OR “Schizophrenia”[MeSH] OR “Psychotic Disorders”[MeSH] OR “Mental Disorders”[MeSH]), modified from the Cochrane Schizophrenia Group’s term for schizophrenia [1], and combined with the phrases:

[and (DRUG* or POLYDRUG* or SUBSTANCE* or ALCOHOL* or TRANQUIL* or CHEMICAL* or NARCOTIC* or OPIAT* or STREET DRUG* or SOLVENT* or INHALANT* or PSYCHOTROPIC* or INTOXICA*) and (ABUS* or USE* or MISUS* or USIN* or UTILIZ* or UTILIS* or DEPEND* or ADDICT* or ILLEGAL* or ILLICIT* or HABIT* or WITHDRAW* or BEHAVI* or ABSTINENCE* or ABSTAIN* or REHAB* or INTOXICA* or NON-PRESCRI*) or DUAL* near DIAGNOS*) or explode \SUBSTANCE-ABUSE”/ all subheadings or explode \DRUGDEPENDENCE”/ all subheadings or explode \ALCOHOLABUSE”/ all subheadings or explode \ALCOHOLISM”/ all subheadings] [14]

  • AND Europe (for Medline, but eventually including in the review only studies conducted in the UK)

  • AND ((LO:PSYI = ENGLAND) or (LO:PSYI = GREAT-BRITAIN) or (LO:PSYI = SCOTLAND) or (LO:PSYI = UNITED-KINGDOM) or (LO:PSYI = WALES)) (for Psych Info)

  • AND (SB: NU = UK) (for CINHAHL)

An internet search was also conducted.

Appendix 2

Alcohol

Abuse§ [25]

Abuse [37]

Problem drinking, dependence§ [5]

DSM–IV abuse or dependence [6]

Substance use [102]

Misuse** [11]

Alcohol and/or other drugs with impairment or dependence* [40]

Harmful use, dependence^ [65]

Drug misuse [34]

Abuse§* [68]

Harmful use** [99]

Any substance misuse^ [13]

Drinking more than 8 measures per day [8]

Substances abuse, Alcohol dependence [17]

High alcohol problems** [29]

Using substances with impairment/dependence* [40]

Alcohol dependence§ [30]

Misuse§* [107]

Abuse/dependency* [96]

Alcohol Misuse or dependence* [81]

Substance abuse* [28]

Misuse, Dependence§ [11]

Misuse§ [100]

Substance misuse or dependence* [70]

Substance misuse [43]

Substance misuse or dependence* [53, 54]

DSM-IV any substance use [86]

Hazardous use and dependence** [4]

Alcohol or other drugs substance misuse or dependence* [80]

Substance misuse§ [93]

Harmful use^^ [49]

Alcohol or drug abuse§ [16]

Alcohol misuse* [59]

Drugs

Abuse§ [26]

Misuse§* [107]

Abuse [37]

Use§ [5]

Cannabis abuse or dependence [6]

Substance misuse** [4]

Cannabis misuse (Urinalysis) [48]

Substance use [102]

Misuse, Dependence§ [11]

Using substances with impairment/dependence* [40]

Harmful use, dependence^ [65]

Drug misuse [34]

Abuse§* [68]

Problem drug use, dependency** [99]

Any substance misuse^ [13]

Substances abuse, Alcohol dependence [17]

Severe dependence on stimulant, heroin/non pre scribed methadone, Cannabis, amphetamines and cocaine/crack§ [29]

Using substances with impairment/dependence* [40]

Drugs misuse§ [30]

Misuse§* [107]

Abuse/dependency* [96]

Drug Misuse or dependence* [81]

Substance abuse* [28]

Misuse, Dependence§ [11]

Substance misuse** [4]

Misuse§ [100]

Substance misuse or dependence* [70]

Substance misuse [43]

Substance misuse or dependence* [53, 54]

Cannabis use [41]

DSM-IV any substance use [86]

Drug use [62]

Alcohol or other drugs substance misuse or dependence* [80]

Substance misuse§ [93]

Present or past drug use, daily use of stimulants, opiates^^ [49]

Alcohol or drug abuse§ [16]

Drug misuse * [59]

Legend

§Questionnaires matching DSM Abuse and/or Dependence

^Using SCAN, matching Harmful use and Dependence, ICD equivalent for DSM Abuse

^^Harmful use ICD equivalent for DSM Abuse

*Using AUS and DUS, mapping into DSM Alcohol or Drugs Abuse and Dependence

**Using AUDIT, mapping into DSM Alcohol Abuse and Dependence

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Carrà, G., Johnson, S. Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK. Soc Psychiat Epidemiol 44, 429–447 (2009). https://doi.org/10.1007/s00127-008-0458-2

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  • DOI: https://doi.org/10.1007/s00127-008-0458-2

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