Social Psychiatry and Psychiatric Epidemiology

, Volume 40, Issue 12, pp 939–946 | Cite as

The associations between substance use disorders, schizophrenia-spectrum disorders, and Axis IV psychosocial problems

  • Michael T. Compton
  • Paul S. Weiss
  • Joyce C. West
  • Nadine J. Kaslow
Original Paper



Substance abuse among individuals with schizophrenia-spectrum disorders (SSDs) is associated with a range of adverse psychosocial outcomes in the areas of occupational functioning, housing stability, economic independence, access to health care, and involvement with the legal system. The aim of this study was to estimate the effects of substance use disorders (SUDs), SSDS, and dual diagnosis with both disorders on the risk for six important Axis IV psychosocial problems. This was accomplished using a large dataset of patients who are representative of individuals in routine US psychiatric practice.


Weighted data from the 1999 Study of Psychiatric Patients and Treatments from a practice-based research network of the American Psychiatric Institute for Research and Education were analyzed. Some 615 US psychiatrists provided detailed clinical, psychosocial, and health services information on 1,843 patients, including 285 patients with one or more SUDs without an SSD, 180 patients with a diagnosis of an SSD without substance abuse comorbidity, and 68 dually diagnosed patients. Logistic regression models were used to determine effect estimates (adjusted odds ratios), and corresponding 95% confidence intervals were calculated.


After adjusting for sociodemographic variables and for SSD diagnosis, SUD diagnosis was independently associated with increased risk for five of the Axis IV psychosocial problems of interest (occupational problems, housing problems, economic problems, problems with access to health care services, and problems related to interaction with the legal system/crime) when compared to all other psychiatric patients (n=1,310). After adjusting for the sociodemographic variables and for SUD diagnosis, SSD diagnosis (compared to all other psychiatric diagnoses) was associated with Axis IV economic problems, but not with the other five psychosocial problems of interest. The presence of both an SUD and an SSD diagnosis (dual diagnosis) was associated with a greater risk for four of the six Axis IV psychosocial problems studied, compared to the risks associated with either diagnosis alone. Limiting the substance of abuse to alcohol resulted in similar findings.


Although SUDs are associated with increased risk for poor social adjustment, the comorbidity of SUDs and SSDs is associated with greatly compounded psychosocial burdens. These findings, from a large sample of representative US psychiatric patients, demonstrate the ongoing need for improved services and policies for those specially burdened patients with the dual diagnosis of both an SSD and substance abuse or dependence.

Key words

schizophrenia substance abuse dual diagnosis comorbidity axis IV psychosocial problems 


  1. 1.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, Text revision, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    Barrowclough C, Haddock G, Tarrier N et al (2001) Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry 158:1706–1713CrossRefPubMedGoogle Scholar
  3. 3.
    Bartels SJ, Drake RE, Wallach MA (1995) Long-term course of substance use disorders among patients with severe mental illness. Psychiatr Serv 46:248–251PubMedGoogle Scholar
  4. 4.
    Cantor-Graae E, Nordström LG, McNeil TF (2001) Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophr Res 48:69–82CrossRefPubMedGoogle Scholar
  5. 5.
    Cuffel BJ, Shumway M, Chouljian TL et al (1994) A longitudinal study of substance use and community violence in schizophrenia. J Nerv Ment Dis 182:704–708PubMedGoogle Scholar
  6. 6.
    Drake RE, Mueser KT (2000) Psychosocial approaches to dual diagnosis. Schizophr Bull 26:105–118PubMedGoogle Scholar
  7. 7.
    Drake RE, McHugo GJ, Noordsy DL (1993) Treatment of alcoholism among schizophrenia outpatients: 4-year outcomes. Am J Psychiatry 150:328–329PubMedGoogle Scholar
  8. 8.
    Hellerstein DJ, Rosenthal RN, Miner CR (2001) Integrating services for schizophrenia and substance abuse. Psychiatr Q 72:291–306CrossRefPubMedGoogle Scholar
  9. 9.
    Hunt GE, Bergen J, Bashir M (2002) Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophr Res 54:253–264CrossRefPubMedGoogle Scholar
  10. 10.
    Kavanagh DJ, McGrath J, Saunders JB et al (2002) Substance misuse in patients with schizophrenia: epidemiology and management. Drugs 62:743–755PubMedGoogle Scholar
  11. 11.
    Modestin J, Gladen CJS, Christen S (2001) A comparative study on schizophrenia patients with dual-diagnosis. J Addict Dis 20:41–51CrossRefPubMedGoogle Scholar
  12. 12.
    Pincus HA, Zarin DA, Tanielian TL et al (1999) Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network. Arch Gen Psychiatry 56:441–449PubMedGoogle Scholar
  13. 13.
    Räsänen P, Tiihonen J, Isohanni M et al (1998) Schizophrenia, alcohol abuse, and violent behavior: a 26-year followup study of an unselected birth cohort. Schizophr Bull 24:437–441PubMedGoogle Scholar
  14. 14.
    Ridgely MS, Goldman HH, Willenbring M (1990) Barriers to the care of persons with dual diagnoses: organizational and financing issues. Schizophr Bull 16:123–132PubMedGoogle Scholar
  15. 15.
    Rothbard AB, Kuno E, Hadley TR et al (2004) Psychiatric service utilization and cost for persons with schizophrenia in a Medicaid managed care program. J Behav Health Serv Res 31:1–12PubMedGoogle Scholar
  16. 16.
    Salloum IM, Moss HB, Daley DC (1991) Substance abuse and schizophrenia: impediments to optimal care. Am J Drug Alcohol Abuse 17:321–336PubMedGoogle Scholar
  17. 17.
    Sevy S, Robinson DG, Solloway S et al (2001) Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. Acta Psychiatr Scand 104:367–374CrossRefPubMedGoogle Scholar
  18. 18.
    Shah BV, Barnwell BG, Bieler GS (2001) SUDAAN user's manual, release 8.0: software for the statistical analysis of correlated data. Research Triangle Institute, Research Triangle Park, NCGoogle Scholar
  19. 19.
    Smith J, Hucker S (1994) Schizophrenia and substance abuse. Br J Psychiatry 165:13–21PubMedGoogle Scholar
  20. 20.
    Swofford CD, Scheller-Gilkey G, Miller AH et al (2000) Double jeopardy: schizophrenia and substance abuse. Am J Drug Alcohol Abuse 26:343–353CrossRefPubMedGoogle Scholar
  21. 21.
    Wilk JE, West JC, Narrow WE et al (2002) Comorbidity patterns in routine psychiatric practice. Poster presentation. 2002 American Psychiatric Association meetingGoogle Scholar
  22. 22.
    Zarin DA, Pincus HA, West JC et al (1997) Practice-based research in psychiatry. Am J Psychiatry 154:1199–1208PubMedGoogle Scholar
  23. 23.
    Ziedonis DM (2004) Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives. CNS Spectr 9:892 (894–904,925)PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Michael T. Compton
    • 1
    • 2
  • Paul S. Weiss
    • 3
  • Joyce C. West
    • 4
  • Nadine J. Kaslow
    • 1
  1. 1.Dept. of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaUSA
  2. 2.Dept. of PsychiatryGrady Memorial HospitalAtlantaUSA
  3. 3.Dept. of BiostatisticsRollins School of Public Health of Emory UniversityAtlantaUSA
  4. 4.American Psychiatric Practice Research NetworkAmerican Psychiatric Institute for Research and EducationArlingtonUSA

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