Community Mental Health Journal

, Volume 36, Issue 6, pp 557–569

An Ethnographic Study of the Longitudinal Course of Substance Abuse Among People with Severe Mental Illness


  • Hoyt Alverson
    • New Hampshire-Dartmouth Psychiatric Research Center. Department of AnthropologyDartmouth College
  • Marianne Alverson
    • New Hampshire-Dartmouth Psychiatric Research Center. Department of Community and Family MedicineDartmouth Medical School
  • Robert E. Drake
    • New Hampshire-Dartmouth Psychiatric Research CenterDartmouth Medical School

DOI: 10.1023/A:1001930101541

Cite this article as:
Alverson, H., Alverson, M. & Drake, R.E. Community Ment Health J (2000) 36: 557. doi:10.1023/A:1001930101541


A two-year ethnography conducted among 16 dually diagnosed clients yielded two longitudinal findings. First, four “positive quality of life” factors were strongly correlated with clients' efforts to cease using addictive substances: (1) regular engagement in an enjoyable activity; (2) decent, stable housing; (3) a loving relationship with someone sober who accepts the person's mental illness; and (4) a positive, valued relationship with a mental health professional. Second, the study revealed that five “negative background factors” in participants' childhood homes were predictive of long-term continuation of substance use: (1) substance abuse in childhood home, (2) childhood household in dire poverty, (3) “non-functional” household members, (4) reporting of abuse imputed to care-givers, and (5) serious mental illness in household. The implications of these findings for treatment are discussed.

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© Human Sciences Press, Inc. 2000