Skip to main content

Gender Differences in Homeless Persons with Schizophrenia and Substance Abuse

Community Mental Health Journal volume 34, pages 627–642 (1998)Cite this article

Abstract

The purpose of this study was to test thegeneralizability of previous research on genderdifferences between men and women with co-occurringschizophrenia and substance abuse. One hundred eightpatients with schizophrenia or schizoaffective disorderinvolved in a study of treatment for homeless personswere interviewed for information regarding substanceuse, social functioning and support, comorbid disorders, victimization, medical illness, and legaltroubles. We found that women had more children and weremore socially connected than men. Women also had higherrates of sexual and physical victimization, comorbid anxiety and depression, and medical illnessthan men. We conclude that homeless women with dualdisorders, like women with substance use disorders inthe general population, have distinct characteristics, vulnerabilities, and treatment needs comparedwith men. In addition to comprehensive treatment ofpsychiatric and substance use disorders, gender-specificservices should be developed, including prevention and treatment of victimization and relatedproblems as well as help with accessing medicalservices.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

REFERENCES

  • Alexander, M. J. (1996). Women with co-occurring addictions and mental disorders: An emerging profile of vulnerability. American Journal of Orthopsychiatry, 66, 61–70.

    PubMed  Google Scholar 

  • Angermeyer, M. C., Kuhn, L., & Goldstein, J.M. (1990). Gender and the course of schizophrenia: Differences in treated outcomes. Schizophrenia Bulletin, 16, 293–307.

    PubMed  Google Scholar 

  • Anthony, J. C., & Helzer, J. E. (1991). Syndromes of drug abuse and dependence. In L.N. Robins & D. A. Regier (Eds.), Psychiatric disorders in America: The Epidemiologic Catchment Area Study(pp. 116–154). New York: Free Press.

    Google Scholar 

  • Ashley, M. J., Olin, J. S., Rich, W. H., Kornaczewski, A., Schmidt, W., and Rankin, J.G. (1977). Morbidity in alcoholics: Evidence for accelerated development of physical disease in women. Archives of Internal Medicine, 137, 883–887.

    Article  PubMed  Google Scholar 

  • Bardenstein, K. K., & McGlashan, T. H. (1990). Gender differences in affective, schizoaffective, and schizophrenic disorders. Schizophrenia Research, 3, 159–172.

    Article  PubMed  Google Scholar 

  • Barrow, S.M., Hellman, F., Lovell, A. M., Plapinger, J.D., Robinson, C.R., & Struening, E. L. (1985). Personal History Form. New York: New York State Psychiatric Institute.

    Google Scholar 

  • Bartels, S. J., Drake, R. E., Wallach, M. A., & Freeman, D.H. (1991). Characteristic hostility in schizophrenic outpatients. Schizophrenia Bulletin, 17, 163–171.

    PubMed  Google Scholar 

  • Bellack, A. S., Mueser, K. T., Gengerich, S., Agresta, J. (1997). Social Skills Training for Schizophrenia. New York: Guilford Publications.

    Google Scholar 

  • Berger, A., Knutson, J., Mem, J., & Perkins, K. (1977). The self-report of punitive childhood experiences of young adults and adolescents. Child Abuse and Neglect, 12,251–262.

    Article  Google Scholar 

  • Blankfield, A. (1990). Female alcoholics, II. The expression of alcoholism in relation to gender and age. Acta Psychiatrica Scandinavica, 81, 448–452.

    PubMed  Google Scholar 

  • Blume, S. B. (1990). Chemical dependency in women: Important issues. American Journal Drug and Alcohol Abuse, 16, 297–307.

    Google Scholar 

  • Boyd, C.J. (1993). The antecedents of women’s crack cocaine abuse: Family substance abuse, sexual abuse, depression and illicit drug use. Journal of Substance Abuse Treatment, 10, 433–438.

    Article  PubMed  Google Scholar 

  • Boyd, C. J., & Mieczkowski, T. (1990). Drug use, health, family and social support in ª crackº cocaine users. Addictive Behaviors, 15,481–485.

    Article  PubMed  Google Scholar 

  • Brady, K. T., Grice, D. E., Dustan, L., & Randall C. (1993). Gender differences in substance use disorders. American Journal of Psychiatry, 150,1707–1711.

    PubMed  Google Scholar 

  • Brown, F. R., & Anderson, B. (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148,55–61.

    PubMed  Google Scholar 

  • Brunette, M., & Drake, R. E. (1997). Gender differences in patients with schizophrenia and substance abuse. Comprehensive Psychiatry, 38,109–116.

    Article  PubMed  Google Scholar 

  • Carey, K. B., Cocco, K. M., & Simons J. S. (1996). Concurrent validity of clinicians’ ratings of substance abuse among psychiatric patients. Psychiatric Services, 47, 842–847.

    PubMed  Google Scholar 

  • Caton, C. L. M., Shrout, P. E., Dominguez, B., Eagle, P. F., Opler, L. A., Cournos, F. (1995). Risk factors for homelessness among women with schizophrenia. American Journal of Public Health, 85,1153–1156.

    PubMed  Google Scholar 

  • Chavkin, W., Paone, D., Friedmann, P., & Wilets, I. (1993). Psychiatric histories of drug using mothers: Treatment implications. Journal of Substance Abuse Treatment, 10,445–448.

    Article  PubMed  Google Scholar 

  • Childers, S. E., & Harding, C. M. (1990). Gender, premorbid social functioning, and long-term outcome in DSM-III schizophrenia. Schizophrenia Bulletin, 16,309–318.

    PubMed  Google Scholar 

  • Comtois, K. A. & Ries, R. K. (1995). Sex differences in dually diagnosed severely mentally ill clients in dual diagnosis outpatient treatment. American Journal on Addictions, 4,245–253.

    Google Scholar 

  • Cornelius, J. R., Jarrett, P. J., Thase, J. E., Fabrega, H.R., Haas, G.L., Jones-Barlock, A., Mezzich, J.E., & Ulrich, R.F. (1995). Gender effects on the clinical presentation of alcoholics at a psychiatric hospital. Comprehensive Psychiatry, 36,435–550.

    Article  PubMed  Google Scholar 

  • Cyr, M. G., & Moulton, A. W. (1990). Substance abuse in women. Obstetrics and Gynecology Clinics of North America, 17,905–925.

    PubMed  Google Scholar 

  • Del Boca, F. (1994). Sex, gender, and alcoholic typologies. Annals of New York Academy of Sciences, 708,34–49.

    Google Scholar 

  • Denier, C. A., Thevos, A. K., Latham, P. K., & Randall, C. L. (1991). Psychosocial and psychopathology differences in hospitalized male and female cocaine abusers: A retrospective chart review. Addictive Behaviors, 16,489–496.

    Article  PubMed  Google Scholar 

  • Drake, R.E., Alterman, A.I., & Rosenberg, A.I. (1993). Detection of substance use disorders in severely mentally ill patients. Community Mental Health Journal, 29, 175–192.

    PubMed  Google Scholar 

  • Drake, R. E., Mueser, K. T., & McHugo, G. J. (1996). Clinician rating scales: Alcohol Use Scale (AUS), Drug Use Scale (DUS), and Substance Abuse Treatment Scale (SATS). In L. I. Sederer & B. Dickey (Eds.), Outcomes assessment in clinical practice(pp. 113–116). Baltimore, MD: Williams and Wilkins.

    Google Scholar 

  • Drake, R. E., Osher, F. C., Noordsy, D. L., Hurlbut, S. C., Teague, G. B., & Beaudett, M. S. (1990). Diagnosis of alcohol use disorders in schizophrenia, Schizophrenia Bulletin, 16,57–67.

    PubMed  Google Scholar 

  • Drake, R. E., Osher, F. C., & Wallach, M. A. (1989). Alcohol use and abuse in schizophrenia: A prospective community study. Journal of Nervous and Mental Disease, 177,408–414.

    PubMed  Google Scholar 

  • Drake, R. E., Wallach, M. A., Teague, G. B., Freeman, D. H., Paskus, T. S., Clark, T. A. (1991) Housing instability and homelessness among rural schizophrenic patients. American Journal of Psychiatry, 148,330–335.

    PubMed  Google Scholar 

  • Drake, R. E., Wallach, M. A., & Hoffman, J. S. (1989). Housing instability and homelessness among aftercare patients of an urban state hospital. Hospital and Community Psychiatry, 40, 46–51.

    PubMed  Google Scholar 

  • Drake, R. E., Yovetich, N.A., Bebout, R.R., Harris, M.A., & McHugo, G.J. (1997) Integrated treatment for dually diagnosed homeless adults. Journal of Nervous and Mental Disease, 185, 298–305.

    Article  PubMed  Google Scholar 

  • Fischer, P. J. (1991). Alcohol, drug abuse, and mental health problems among homeless persons: A review of the literature, 1980-1990 Executive summary. U.S. Department of Health and Human Services Alcohol, Drug Abuse and Mental Health Administration.

  • Goering, P., Wasylenki, D., St. Onge, M., Paduchak, D., & Lancee, W. (1992). Gender differences among clients of a case management program for the homeless. Hospital and Community Psychiatry, 43, 160–165.

    PubMed  Google Scholar 

  • Goldfinger, S. M., Schutt, R. K., Seidman, L. M., Turner, W. M., Penk, W. E., & Tolomiczenko, G. (1996). Alternative measures of substance abuse among homeless mentally ill persons in the cross-section and over time. Journal of Nervous Mental Disease, 184,667–672.

    Article  Google Scholar 

  • Goldstein, J. M., & Tsuang, M. T. (1990). Gender and schizophrenia: An introduction and synthesis of findings. Schizophrenia Bulletin, 16,179–183.

    PubMed  Google Scholar 

  • Goldstein, J. M. (1988). Gender differences in the course of schizophrenia. American Journal of Psychiatry, 145,684–689.

    PubMed  Google Scholar 

  • Goodman, L. A., Dutton, M. A., & Harris, M. (1995). Episodically homeless women with serious mental illness: Prevalence of physical and sexual assault. American Journal of Orthopsychiatry, 65,468–477.

    PubMed  Google Scholar 

  • Griffin, M. L., Weiss, R. D., Mirin, S. M., & Lange, U. (1989). A comparison of male and female cocaine abusers. Archives of General Psychiatry, 46,122–126.

    PubMed  Google Scholar 

  • Halikas, J. A., Crosby, R. D., Pearson, V. L., Nugent, S. N., & Carlson, G. A. (1994). Psychiatric comorbidity in treatment-seeking cocaine abusers. American Journal on Addictions, 3,25–35.

    Google Scholar 

  • Harris, M. (1996). Treating sexual-abuse trauma with dually diagnosed women. Community Mental Health Journal, 32,371–385.

    PubMed  Google Scholar 

  • Helzer, J. E., Burnam, A., & McEvoy, L. T. (1991). Alcohol abuse and dependence. In L. N. Robins & D. A. Regier (Eds.), Psychiatric Disorders in America(pp. 81–115). New York: Free Press.

    Google Scholar 

  • Hesselbrock, M. N. (1991). Gender comparison of antisocial personality disorder and depression in alcoholism. Journal of Substance Abuse, 3,205–219.

    PubMed  Google Scholar 

  • Hesselbrock, M. N., Meyer, R. E., & Keener, J. J. (1985). Psychopathology in hospitalized alcoholics. Archives of General Psychiatry, 42, 1050–1055.

    PubMed  Google Scholar 

  • Horn, J. L., Skinner, H. A., Wanberg, K. W., & Foster, F. M. (1984). Alcohol Dependence Scale (ADS). Toronto: Addiction Research Foundation of Ontario.

    Google Scholar 

  • Huber, G., Gross, F., Schuttler, R., & Linz, N. (1980). Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin, 6,592–605.

    PubMed  Google Scholar 

  • Irvin, E. A., Flannery, R. B., Penk, W. E., & Hanson, M.A. (1995). The Alcohol Use Scale: Concurrent validity data. Journal of Social Behavior and Personality, 10,899–905.

    Google Scholar 

  • Irwin, K. I., Edlin, B. R., Wong, L., Faruqu, S., McCoy, V., Work, C., Schilling, R., McCoy, C., Evans, P., Holmberg, S., & The Multicenter Crack Cocaine and HIV Infection Study Team. (1995). Urban rape survivors: Characteristics and prevalence of human immunodeficiency virus and other sexually transmitted infections. Obstetrics and Gynecology, 85, 330–336.

    Article  PubMed  Google Scholar 

  • Kalichman, S.C., Sikkema, K.J., Kelly, J.A., Bulto, M. (1995). Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults. Psychiatric Services, 46, 275–280.

    PubMed  Google Scholar 

  • Kessler, R. C., McGonagle, K, A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen. H. U., Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8–19.

    PubMed  Google Scholar 

  • Lehman, A. F. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11,51–62.

    Article  Google Scholar 

  • Lex, B. W. (1991). Some gender differences in alcohol and polysubstance users. Health Psychology, 10,121–132.

    Article  PubMed  Google Scholar 

  • Loranger, A. W. (1984). Sex difference in age at onset of schizophrenia. Archives of General Psychiatry, 41,157–161.

    PubMed  Google Scholar 

  • Lukoff, D., Nuechterlein, K. H., & Ventura, J. (1986). Manual for expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin, 12,594–602.

    Google Scholar 

  • Lundy, A., Gottheil, E., Serota, R. D., Winstein, S. P., Winstein, S. P., & Sterling, R. C. (1995). Gender differences and similarities in African-American crack cocaine abusers. Journal of Nervous and Mental Disease, 183(4), 260–266.

    PubMed  Google Scholar 

  • McCoy, H. & Miles, C. (1992). A gender comparison of health status among users of crack cocaine. Journal of Psychoactive Drugs, 24, 389–397.

    PubMed  Google Scholar 

  • McLellan, A.T., Luborsky, L., O'Brien, C.P., & Woody, G.E. (1980). An improved evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 826–833.

    Google Scholar 

  • Miller, L. J., & Finnerty, M. (1996). Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders. Psychiatric Services, 47,502–506.

    PubMed  Google Scholar 

  • Muenzenmaier, K., Meyer I., Struening, E., & Ferber, J. (1993). Childhood abuse and neglect among women outpatients with chronic mental illness. Hospital and Community Psychiatry, 44,666–670.

    PubMed  Google Scholar 

  • Mueser, K. T., Bellack, A. S., Morrison, R. L., & Wade, J. H. (1990). Gender, social competence, and symptomatology in schizophrenia: A longitudinal analysis. Journal of Abnormal Psychology, 99,138–147.

    Article  PubMed  Google Scholar 

  • Mueser, K. T., Drake, R. E., Clark, R. E., McHugo, G. M., Mercer-McFadden, C., & Ackerson, T. (1995). Evaluating substance abuse in persons with severe mental illness.Cambridge, MA: Human Services Research Institute.

    Google Scholar 

  • Mueser, K.T., Goodman, L. A., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, R., Anciello, P., Foy, D.W. (1998). Trauma and post traumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology.

  • Mueser, K. T., Yarnold, P. R., & Bellack, A. S. (1992). Diagnostic and demographic correlates of substance abuse in schizophrenia and major affective disorder. Acta Psychiatrica Scandinavica, 85, 48–55.

    PubMed  Google Scholar 

  • Mueser, K. T., Yarnold, P. R., Levinson, D. R., Singh, H., Bellack, A. S., Kee, K., Morrison, R. L., Yadalam, K. G. (1990). Prevalence of substance abuse in schizophrenia: Demographic and clinical correlates. Schizophrenia Bulletin, 16, 31–56.

    PubMed  Google Scholar 

  • North, C.S. & Smith, E.M. (1993). A comparison of homeless men and women: Different populations, different needs. Community Mental Health Journal, 29,423–431.

    PubMed  Google Scholar 

  • Regier, D. A., Boyd, J. H., Burke, J. D., Rae, D. S., Myers, J. K., Kramer, M., Robins, L. N., George, L. K., Karno, M., Locke, B. Z. (1988). One month prevalence of mental disorders in the United States. Archives of General Psychiatry, 45,977–986.

    PubMed  Google Scholar 

  • Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. Journal of the American Medical Association, 264, 2511–2518.

    Article  PubMed  Google Scholar 

  • Rosenberg, S. D., Drake, R. E., & Mueser, K. T. (1996). New directions for treatment research on sequelae of sexual abuse in persons with severe mental illness. Community Mental Health Journal, 32, 381–400.

    Google Scholar 

  • Salokangas, R. K. R. (1983). Prognostic implications of the sex of schizophrenic patients. British Journal of Psychiatry, 142,145–151.

    Google Scholar 

  • Schober, R., & Annis, H. M. (1996). Barriers to help-seeking for change in drinking: A gender-focused review of the literature. Addictive Behaviors, 21,81–92.

    Article  PubMed  Google Scholar 

  • Seeman, M. V. (1986). Current outcome in schizophrenia: women vs men. Acta Psychiatrica Scandinavica, 73,609–617.

    PubMed  Google Scholar 

  • Smith, E. M., North C. S., & Spitznagel E. L. (1993). Alcohol, drugs, and psychiatric comorbidity among homeless women: An epidemilogic study. Journal of Clinical Psychiatry, 54, 82–87.

    PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1988). Structured Clinical Interview for DSM-III-R (SCID). New York: NY State Psychiatric Institute Biometrics Department.

    Google Scholar 

  • Susser, E. S., Lin, S. P., & Conover, S. A. (1991). Risk factors for homelessness among patients admitted to a state mental hospital. American Journal of Psychiatry, 148, 1659–1664.

    PubMed  Google Scholar 

  • Szymanski, S., Lieberman, J. A., Alvir, J. M., Mayerhoff, D., Loebel, A., Geisler, S., Chakos, M., Koreen, A., Jody, D., Kane, J., Woerner, M., Cooper, T. (1995). Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. American Journal of Psychiatry, 152, 698–703.

    PubMed  Google Scholar 

  • Tessler, R.C., & Goldman, H.H. (1982). The chronically mentally ill: Assessing community support programs. Cambridge, MA: Ballinger Press.

    Google Scholar 

  • Test, M. A., Burke, S. S., & Wallisch, L. S. (1990). Gender differences of young adults with schizophrenic disorders in community care. Schizophrenia Bulletin, 16, 331–344.

    PubMed  Google Scholar 

  • Test, M. A., Knoedler, W. H., Allness, K.J., & Burke, S. S. (1985). Characteristics of young adults with schizophrenic disorders treated in the community. Hospital and Community Psychiatry, 36, 853–858.

    PubMed  Google Scholar 

  • Test, M. A., Wallisch, L. S., & Ripp, K. (1989). Substance use in young adults with schizophrenic disorders. Schizophrenia Bulletin, 15, 465–476.

    PubMed  Google Scholar 

  • Urbanoo-Marquez, A., Extruch, R., Fernandez-Sola, J., Nicolas, J. M., Pare, J. C., & Rubine, E. (1995). The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men. Journal of the American Medical Association, 274, 149–154.

    Article  PubMed  Google Scholar 

  • Wahl, O. F., & Hunter, J. (1992). Are gender effects being neglected in schizophrenia research? Schizophrenia Bulletin, 18,313–317.

    PubMed  Google Scholar 

  • Wallen, J. (1992). A comparison of male and female clients in substance abuse treatment. Journal of Substance Abuse Treatment, 9,243–248.

    Article  PubMed  Google Scholar 

  • Zankowski, G. L. (1988). Responsive programming: Meeting the needs of chemically dependent women. Alcoholism Treatment Quarterly, 4, 53–66.

    Google Scholar 

  • Ziedonis, D.M., Rayford, B.S., Bryant, K.J., & Rounsaville, B.J. (1994). Psychiatric comorbidity in white and African-American cocaine addicts seeking substance abuse treatment. Hospital and Community Psychiatry, 45, 43–49.

    PubMed  Google Scholar 

Download references

Authors
  1. Mary Brunette
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert E. Drake
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Brunette, M., Drake, R.E. Gender Differences in Homeless Persons with Schizophrenia and Substance Abuse. Community Ment Health J 34, 627–642 (1998). https://doi.org/10.1023/A:1018719203165

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1018719203165

Keywords

  • Public Health
  • General Population
  • Schizophrenia
  • Gender Difference
  • Substance Abuse