Persons with Severe Mental Illness Are Prone To Substance Use

Severe Mental illnessPeople with severe mental illness (SMI) are more prone to substance abuse than those who are not suffering from severe mental illness. Both epidemiological and clinical studies that have been done on this have attested to this fact. The findings of these researches have also pointed out that Individuals diagnosed with SMI are also at greater risk of hospitalization, homelessness and suicide and experience more difficulty in different spheres of their lives. Most studies have shown that individuals with SMI are more prone to substance abuse. However other studies that have been done on the same issue have not linked the two phenomena. The substances used most frequently by persons with SMI are alcohol, followed by cannabis and stimulants. Sedatives and hallucinogens are used less frequently by those with SMI. Amphetamine use is greater in persons with psychotic disorders compared with the general population. Studies have shown that both cannabis and, to a greater extent, amphetamines can provoke psychosis. Because individuals do not use cannabis or amphetamines alone, but use them in combination with several other substances, examining the effects of the use of a specific substance on mental illness is particularly challenging. A review showed that substance use has adverse long-term effects on cognitive functions in persons with SMI. The substance that has been found to affect the individuals most negatively is alcohol while cannabis use has little influence on the cognitive functions of the individuals.

Several studies have shown that many people with SMI tend to achieve full remission of their substance use while others relapse frequently. Research from different treatment settings indicate that 30 per cent of those with less severe mental illness and heavy substance use attain sustained remission, while up to 60 per cent of those with SMI and less severe substance use attain sustained remission.

There is however a lack of studies on how persons with SMI experience abstaining from substance use. Nevertheless, research on substance use by clients without the comorbidity of mental illness indicates that social support is important to successful change in behavior of these people. Clients claim that they benefit from interventions that address their multiple recovery issues as opposed to ones that emphasize recovery strictly in sobriety terms. Another qualitative study has noted the participants’ view that highly structured programs and cognitive behavioral techniques are crucial to achieving abstinence. Not only is sobriety a lifelong struggle for many clients, but also is perceived as a challenging state because of the risk that the person becomes complacent after achieving sobriety. This may indicate a need for substitute dependency to maintain the abstinence.

It is of importance to examine how individuals with a psychotic disorder experience quitting substance use and to investigate reported experiences of former abstinence periods by participants still using substances. Two qualitative studies with a primary focus on how persons with SMI experience abstaining from substance use have reported that clients view substance use as one of many sources of difficulty over a troubled life course and that social support is critical to staying clean, lack of support in most cases makes it difficult for these individuals to quit using these drugs. One ethnographic study of clients’ perspectives showed that giving up substances was seen as a source of both pleasure and pain, and presupposed a certain level of rationality.

Study findings

In a study done by Henning Pettersen, Torleif Ruud, Edle Ravndal and Anne Landheim with an objective to find out experiences of abstaining from substances of persons diagnosed with SMI. They examined both the reasons given and the requirements and strategies used when abstaining. The main reasons for quitting substance use were social relationships and meaningful activities. It was found that the stated requirements and strategies used in the search for sobriety were detachment towards people and places, positive thinking, controlling feelings and emotions, and fear of dependency. A qualitative study with semi-structured interviews was conducted, and a descriptive and explorative design was applied. This study included a purposeful sample of 11 patients with SMI and substance use being treated by assertive community treatment teams. Henning et al concluded that the results from this study are consistent with those from other qualitative studies on the importance of social relationships and meaningful activities as expressed reasons for abstaining. The strategy of actively avoiding a former adverse milieu to reach sobriety is consistent with findings from one similar study. The strategies of fear of adverse consequences, positive thinking, and controlling feelings and emotions found in the present study have not been reported by other qualitative studies.

The study had eleven participants of which nine were men and two were women. The ages of the participants were between 27-63 years. Most of the participants had a diagnosis of schizophrenia or schizoaffective disorder, but persons diagnosed with bipolar disorder or an unspecified psychotic disorder also participated. For most participants, SMI had preceded their substance use. The treatment of the participants took duration of between 14-30 months after the first interview.

Severe Mental illnessCannabis and amphetamine were the main substances used in the study but alcohol and other prescription drugs were also used to a lesser extent. However most of the participants used a combination of the substances. At the time of the study four of the participants were abstaining from substance use. Their abstinence periods ranged from 3 to 18 month. At the time of the first interview seven of the participants were still using substances. By the second interview, the abstainers were still abstinent and the users had continued their use. The abstaining group and the group of users did not differ significantly in their psychiatric diagnosis or history of substance use. The 11 participants shared their experiences of shorter and longer periods of abstaining from substances. Some of them talked of their abstaining periods retrospectively, and some were abstaining at the time of the interview. From the findings of this study it is therefore safe to conclude that people suffering from SMI are more prone to substance abuse than people who don’t.

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Persons with Severe Mental Illness Are Prone To Substance Use