Skip to main content

Advertisement

SpringerLink
Log in

The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC)

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Relatively little is known about rates of comorbid drug and alcohol problems in people with schizophrenia outside the USA. Most studies have recruited from single countries. Newly available data provided an unmatched opportunity to investigate the prevalence of comorbid dependence on alcohol and other psychoactive substances in people with schizophrenia in France, Germany and the UK at the same time. The European Schizophrenia Cohort study data set used semi-structured clinical interviews to establish DSM-IV diagnoses. 1,208 patients were interviewed in nine centres. The lifetime rate for comorbid dependence on any substance was highest in the UK (35 %), but considerably lower in Germany (21 %) and in France (19 %), and generally more than double the past-year rates. Dependence on alcohol and on other psychoactive substances showed similar variations (comorbid alcohol dependence: UK 26 %; Germany 18 %; France 14 %; comorbid drug dependence: UK 18 %; Germany 8 %; France 7 %). Differences within countries persisted after controlling for individual characteristics. The relative odds of dependence were higher than in the general population, but varied between countries and centres. Dependence disorders are a common problem in people with schizophrenia in Western Europe, although effective service configurations have yet to be developed. Overall, these European rates are less than those reported from the USA. Research comparing people with current comorbidity with those who are no longer dependent is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Crawford V, Crome IB, Clancy C (2003) Co-existing problems of mental health and substance misuse (Dual Diagnosis): a literature review. Drugs 10:1–74

    Google Scholar 

  2. Regier DA, Farmer ME, Rae DS (1990) Co-morbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiological Catchment Area (ECA) study. JAMA 264:2511–2518

    Article  PubMed  CAS  Google Scholar 

  3. Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ (1996) The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatr 66:17–31

    Article  CAS  Google Scholar 

  4. Swartz MS, Wagner HR, Swanson JW, Stroup TS, McEvoy JP, Canive JM, Miller DD, Reimherr F, McGee M, Khan A, Van Dorn R, Rosenheck RA, Lieberman JA (2006) Substance use in persons with schizophrenia: baseline prevalence and correlates from the NIMH CATIE study. J Nerv Ment Dis 194:164–172

    Article  PubMed  Google Scholar 

  5. Mueser KT, Essock SM, Drake RE, Wolfe R, Frisman L (2001) Rural and urban differences in patients with a dual diagnosis. Schizophr Res 48:93–107

    Article  PubMed  CAS  Google Scholar 

  6. Carrà G, Johnson S (2009) Variations in rates of comorbid substance use in psychosis between geographical areas and mental health settings in the UK. Soc Psychiatr Psychiatr Epidemiol 44:429–447

    Article  Google Scholar 

  7. Soyka M, Albus M, Kathmann N, Finelli A, Hofstetter S, Holzbach R, Immler B, Sand P (2003) Prevalence of alcohol and drug abuse in schizophrenic inpatients. Eur Arch Psychiatr Clin Neurosci 242:362–372

    Google Scholar 

  8. Dervaux A, Laqueille X, Bourdel MC (2003) Cannabis and schizophrenia: demographic and clinical correlates. Encephale 29:11–17

    PubMed  CAS  Google Scholar 

  9. Corcoran CM, Kimhy D, Stanford A, Khan S, Walsh J, Thompson J, Schobel S, Harkavy-Friedman J, Goetz R, Colibazzi T, Cressman V, Malaspina D (2008) Temporal association of cannabis use with symptoms in individuals at clinical high risk for psychosis. Schizophr Res 106:286–293

    Article  PubMed  Google Scholar 

  10. Foti DJ, Kotov R, Guey LT, Bromet EJ (2010) Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatr 167:987–993

    Article  PubMed  Google Scholar 

  11. Drake RE, Alterman AI, Rosenberg SR (1993) Detection of substance use disorders in severely mentally ill patients. Community Ment Health J 29:175–192

    Article  PubMed  CAS  Google Scholar 

  12. Goldfinger SM, Schutt RK, Seidman LJ, Turner WM, Penk WE, Tolomiczenko GS (1996) Self-report and observer measures of substance abuse among homeless mentally ill persons in the cross-section and over time. J Nerv Ment Dis 184:667–672

    Article  PubMed  CAS  Google Scholar 

  13. Potvin S, Sepehry AA, Stip E (2006) A meta-analysis of negative symptoms in dual diagnosis schizophrenia. Psychol Med 36:431–440

    Article  PubMed  Google Scholar 

  14. Furr-Holden CD, Anthony JC (2003) Epidemiologic differences in drug dependence: a US-UK cross-national comparison. Soc Psychiatr Psychiatr Epidemiol 38:165–172

    Article  Google Scholar 

  15. Rehm J, Room R, van den Brink W, Jacobi F (2005) Alcohol use disorders in EU countries and Norway: an overview of the epidemiology. Eur Neuropsychopharmacol 15:377–388

    Article  PubMed  CAS  Google Scholar 

  16. Rehm J, Room R, van den Brink W, Jacobi F (2005) Problematic drug use and drug use disorders in EU countries and Norway: an overview of the epidemiology. Eur Neuropsychopharmacol 15:389–397

    Article  PubMed  CAS  Google Scholar 

  17. European Monitoring Centre for Drugs and Drug Addiction-EMCDDA (2010) The state of the drugs problem in the European Union and Norway. Office for Official Publications of the European Communities, Luxembourg

    Google Scholar 

  18. Bebbington PE, Angermeyer M, Azorin JM, Brugha T, Kilian R, Johnson S, Toumi M, Kornfeld A (2005) The European Schizophrenia Cohort (EuroSC): a naturalistic prognostic and economic study. Soc Psychiatr Psychiatr Epidemiol 40:707–717

    Article  Google Scholar 

  19. World Health Organization (1973) The international pilot study of schizophrenia. WHO Press, Geneva

    Google Scholar 

  20. Jablensky A, Schwarz R, Tomov T (1980) WHO Collaborative Study on impairments and disabilities associated with schizophrenic disorders. Acta Psychiatr Scand 285(suppl 62):152–159

    Article  Google Scholar 

  21. World Health Organization (1992) SCAN: schedules for clinical assessment in neuropsychiatry. WHO Press, Geneva

    Google Scholar 

  22. Spitzer RL, Williams JB, Gibbon M, First MB (1992) The structured clinical interview for DSM-III-R (SCID). I: rationale, and description. Arch Gen Psychiatr 49:624–629

    Article  PubMed  CAS  Google Scholar 

  23. Hasin D, Hatzenbuehler ML, Keyes K, Ogburn E (2006) Substance use disorders: diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) and international classification of diseases, tenth edition (ICD-10). Addiction 101:59–75

  24. Marwaha S, Johnson S, Bebbington P, Stafford M, Angermeyer MC, Brugha T, Azorin JM, Kilian R, Hansen K, Toumi M (2007) Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. Br J Psychiatr 191:30–37

    Article  Google Scholar 

  25. Norström T (2001) Per capita alcohol consumption and all-cause mortality in 14 European countries. Addiction 96(suppl 1):113–128

    Article  Google Scholar 

  26. World Health Organisation (2010) Global strategy to reduce the harmful use of alcohol. WHO Press, Geneva

    Google Scholar 

  27. Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N (1990) Schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatr 47:589–593

    Article  PubMed  CAS  Google Scholar 

  28. Tomov T, Nikolov V (1990) Reliability of SCAN categories and scores: results of the field trials. In: Stefanis CN, Rabavilas AD, Soldatos CR (eds) Psychiatry: a world perspective. Excerpta Medica, Amsterdam, vol 1, pp 107–112

  29. European Monitoring Centre for Drugs and Drug Addiction-EMCDDA (2003) The state of the drugs problem in the European Union and Norway. Office for Official Publications of the European Communities, Luxembourg

    Google Scholar 

  30. McCrone P, Menezes PR, Johnson S, Scott H, Thornicroft G, Marshall J, Bebbington P, Kuipers E (2000) Service use and costs of people with dual diagnosis in South London. Acta Psychiatr Scand 101:464–472

    Article  PubMed  CAS  Google Scholar 

  31. Johnson S, Thornicroft G, Afuwape S, Leese M, White IR, Hughes E, Wanigaratne S, Miles H, Craig T (2007) Effects of training community staff in interventions for substance misuse in dual diagnosis patients with psychosis (COMO study)—cluster randomised trial. Br J Psychiatr 191:451–452

    Article  CAS  Google Scholar 

  32. Craig TKJ, Johnson S, McCrone P, Afuwape S, Hughes E, Gournay K, White I, Wanigaratne S, Leese M, Thornicroft G (2008) Integrated care for co-occurring disorders: psychiatric symptoms, social functioning, and service costs at 18 months. Psychiatr Serv 59:276–282

    Article  PubMed  Google Scholar 

  33. Hughes E, Wanigaratne S, Gournay K, Johnson S, Thornicroft G, Finch E, Marshall J, Smith N (2008) Training in dual diagnosis interventions (the COMO Study): randomised controlled trial. BMC Psychiatr. doi:10.1186/1471-244X-8-12

    Google Scholar 

  34. Altamura AC, Serati M, Albano A, Paoli RA, Glick ID, Dell’Osso B (2011) An epidemiologic and clinical overview of medical and psychopathological comorbidities in major psychoses. Eur Arch Psychiatr Clin Neurosci 261:489–508

    Article  Google Scholar 

  35. Heider D, Bernert S, König HH, Matschinger H, Hogh T, Brugha TS, Bebbington PE, Azorin M, Angermeyer MC, Toumi M (2009) Medical mental health care costs of schizophrenia in France, Germany and the United Kingdom—Findings from the European Schizophrenia Cohort (EuroSC). Eur Psychiatr 24:216–224

    Article  Google Scholar 

  36. Fowler IL, Carr VJ, Carter NT, Lewin TJ (1998) Patterns of current and lifetime substance use in schizophrenia. Schizophr Bull 24:443–455

    Article  PubMed  CAS  Google Scholar 

  37. Lagerberg TV, Sundet K, Aminoff SR, Berg AO, Ringen PA, Andreassen OA, Melle I (2011) Excessive cannabis use is associated with earlier age at onset in bipolar disorder. Eur Arch Psychiatr Clin Neurosci 261:397–405

    Article  Google Scholar 

  38. Pompili M, Serafini G, Innamorati M, Biondi M, Siracusano A, Di Giannantonio M, Giupponi G, Amore M, Lester D, Girardi P, Möller-Leimkühler AM (2012) Substance abuse and suicide risk among adolescents. Eur Arch Psychiatr Clin Neurosci. doi:10.1007/s00406-012-0292-0

    Google Scholar 

Download references

Acknowledgments

This study was funded by grants from Lundbeck A/S and from the German Federal Ministry of Education and Research. Our thanks to all the patients and staff that helped with the study and to the Camden and Islington Mental Health and NHS Foundation Trust and the Leicestershire Partnership NHS Trust R&D Programme and to those who collected the data and otherwise contributed to the main study.

Conflict of interest

Giuseppe Carrà, Sonia Johnson, Dirk Heider and Traolach Brugha have not received any financial support by pharmaceutical companies in recent years. Paul Bebbington and Matthias C. Angermeyer are in retirement and have not received any financial support by pharmaceutical companies in recent years. Jean-Michel Azorin has received unrestricted research grants from H. Lundbeck A/S. Mondher Toumi was an employee of H. Lundbeck A/S.

Author information

Authors and Affiliations

  1. Department of Mental Health Sciences, University College London, Charles Bell House. 67-73 Riding House Street, London, W1W 7EY, UK

    Giuseppe Carrà, Sonia Johnson & Paul Bebbington

  2. Department of Psychiatry, University of Leipzig, Leipzig, Germany

    Matthias C. Angermeyer & Dirk Heider

  3. Department of Health Sciences, University of Leicester, Leicester, UK

    Traolach Brugha

  4. SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, Marseille, France

    Jean-Michel Azorin

  5. Health Economics Department, Lundbeck SA, Paris, France

    Mondher Toumi

Authors
  1. Giuseppe Carrà
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonia Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Bebbington
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias C. Angermeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dirk Heider
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Traolach Brugha
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Michel Azorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mondher Toumi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Carrà.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carrà, G., Johnson, S., Bebbington, P. et al. The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC). Eur Arch Psychiatry Clin Neurosci 262, 607–616 (2012). https://doi.org/10.1007/s00406-012-0305-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-012-0305-z

Keywords

Search

Navigation