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
  • Marianne Alverson
  • Robert E. Drake
Article

Abstract

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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REFERENCES

  1. Alverson, H., Alverson, M., &; Drake, R. E. (under review). Social patterns of substance use among people with dual diagnoses. Mental Health Services Research.Google Scholar
  2. Alverson, H., Alverson, M., Drake, R. E., &; Becker, D. R. (1998). Social correlates of competitive employment among people with severe mental illness. Psychiatric Rehabilitation Journal, 22(1), 34–40.Google Scholar
  3. Alverson, M, Becker, D. R., &; Drake, R. E. (1995). An ethnographic study of coping strategies used by people with severe mental illness participating in supported employment. Psychosocial Rehabilitation Journal, 18(4), 115–28.Google Scholar
  4. Carey, K. B. (1996). Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational, harm reduction approach. Community Mental Health Journal, 32(3), 291–306.Google Scholar
  5. Clark, R. E., Teague, G. B., Ricketts, S. K., Bush, P. W., Xie, H., McGuire, T. G., Drake, R. E., McHugo, G. J., Keller, A. M., &; Zubkoff, M. (1998). Cost of assertive community treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders. Health Services Research, 33(5), 1285–1308.Google Scholar
  6. Drake, R. E., McHugo, G. J., Clark, R. E., Teague, G. B., Xie, H., Miles, K., &; Ackerson, T. H. (1998). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial. American Journal of Orthopsychiatry, 68(2), 201–215.Google Scholar
  7. Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., &; Bond, G. R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24(4), 589–608.Google Scholar
  8. Drake, R. E., Mueser, K. T., Clark, R. E., &; Wallach, M. A. (1996). The course, treatment, and outcome of substance disorder in persons with severe mental illness. American Journal Orthopsychiatry, 66(1), 42–51.Google Scholar
  9. Estroff, S. (1981). Making it crazy: An ethnography of psychiatric clients in an American community. Berkeley: University of California Press.Google Scholar
  10. Estroff, S. (1991) Everybody's got a little mental illness: Accounts of illness and self among people with severe, persistent mental illnesses. Medical Anthropology Quarterly, 5 (4), 331–369.Google Scholar
  11. Goodman, L. A., Rosenberg, S. D., Mueser, K. T., &; Drake, R. E. (1997). Physical and sexual assault history in women with serious mental illness: Prevalence, correlates, treatment, and future research directions. Schizophrenia Bulletin, 23(4), 685–696.Google Scholar
  12. Harris, M. (1998). Trauma recovery and empowerment. New York: The Free Press.Google Scholar
  13. Helzer, J. E., Burnham, A., &; McEvoy. L. T. (1991). Alcohol abuse and dependence. In L. N. Robins &; D. A. Regier (Eds.), Psychiatric disorders in America: The epidemiologic catchment area study (pp. 81–115). New York: The Free Press.Google Scholar
  14. Mueser, K., Bellack, A., &; Blanchard, J. (1992). Comorbidity of schizophrenia and substance abuse. Journal of Consulting and Clinical Psychology, 60, 845–856.Google Scholar
  15. Mueser, K. T., Drake, R. E., &; Noordsy, D. L. (1998). Integrated mental health and substance abuse treatment for severe psychiatric disorders. Journal of Practical Psychiatry and Behavioral Health, 4(3), 129–139.Google Scholar
  16. Robins, L. N., Locke, B. Z., &; Regier, D. A. (1991). An overview of psychiatric disorders in America. In L. N. Robins &; D. A. Regier (Eds.), Psychiatric disorders in America: The epidemiologic catchment area study (pp. 328–366). New York: The Free Press.Google Scholar
  17. Romanucci-Ross, L., Moerman, D. E., Tancredi, L. R. (1997). The anthropology of medicine: From culture to method, (3rd Ed.) Westport, CT: Bergin &; Garvey.Google Scholar
  18. Vaillant, G. E. (1995). Natural history of alcoholism revisited. Cambridge, MA: Harvard University Press.Google Scholar
  19. Watson, A. L., &; Sher, K. J. (1998). Resolution of alcohol problems without treatment: Methodological issues and future directions of natural recovery research. Clinical Psychology: Science and Practice, 5, 1–18.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2000

Authors and Affiliations

  • Hoyt Alverson
    • 1
  • Marianne Alverson
    • 2
  • Robert E. Drake
    • 3
  1. 1.New Hampshire-Dartmouth Psychiatric Research Center. Department of AnthropologyDartmouth CollegeHanover
  2. 2.New Hampshire-Dartmouth Psychiatric Research Center. Department of Community and Family MedicineDartmouth Medical SchoolUSA
  3. 3.New Hampshire-Dartmouth Psychiatric Research CenterDartmouth Medical SchoolUSA

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