Skip to main content
Log in

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

  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

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.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  • Alverson, H., Alverson, M., &; Drake, R. E. (under review). Social patterns of substance use among people with dual diagnoses. Mental Health Services Research.

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Estroff, S. (1981). Making it crazy: An ethnography of psychiatric clients in an American community. Berkeley: University of California Press.

    Google Scholar 

  • 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 

  • 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 

  • Harris, M. (1998). Trauma recovery and empowerment. New York: The Free Press.

    Google Scholar 

  • 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 

  • Mueser, K., Bellack, A., &; Blanchard, J. (1992). Comorbidity of schizophrenia and substance abuse. Journal of Consulting and Clinical Psychology, 60, 845–856.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • Vaillant, G. E. (1995). Natural history of alcoholism revisited. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • 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 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alverson, H., Alverson, M. & Drake, R.E. An Ethnographic Study of the Longitudinal Course of Substance Abuse Among People with Severe Mental Illness. Community Ment Health J 36, 557–569 (2000). https://doi.org/10.1023/A:1001930101541

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1001930101541

Keywords

Navigation