Washington University School of Medicine and the University of Southern California recently undertook the largest-ever survey of drug, alcohol and tobacco use among people with severe mental illnesses. They found that people with significant psychiatric problems are far more likely to use alcohol, tobacco or illegal drugs.
The survey, published recently in the online journal JAMA Psychiatry, examined the substance use of nearly 20,000 people. Of the individuals surveyed, 9,142 had diagnoses of schizophrenia, schizoaffective disorder or bipolar disorder. Just over 10,000 of the people surveyed had no known diagnosis of mental illness.
The researchers found that the rates of smoking, drinking and drug use among those who have psychotic disorders are significantly higher than among those in the general population.
Thirty percent of the 9,142 people with severe mental illnesses engaged in binge drinking, compared to 8 percent of those without mental illness. Fifty percent of those with mental illness smoked marijuana on a regular basis, compared to 18 percent of the non-mentally ill. The study found that 50 percent of those with psychiatric disorders also used other kinds of illegal drugs, compared to only 12 percent of the general population. Finally, the researchers found that 75 percent of the mentally ill in the survey were regular smokers, compared to 33 percent of those in the control group.
The researchers also found that severe mental illness seemed to eliminate substance use trends that are normally seen in the general population. Women and those with Asian or Hispanic heritage have lower rates of substance abuse in the general population but abuse substances at the same rate as other demographics when mental illness is involved. In the general population, young people are less likely to have smoked regularly at some point in their lives than older people, but the 75 percent of the severely mentally ill who smoke holds true regardless of the age of the patients.
Legislation, anti-smoking campaigns and evolving attitudes have had a major impact on smoking rates in the general population. However, these and other influences have not succeeded in impacting smoking rates among the severely mentally ill.
Regarding Substance Abuse as a “Secondary Problem”
There are various possible explanations for the high rates of substance use among the severely mentally ill. One contributing factor is a tendency to self-medicate, or use alcohol or drugs as a distraction, coping mechanism or short term relief from the struggles of living with a mental illness.
Dr. Sarah M. Hartz, assistant professor of psychiatry at Washington University and lead author on this study, suggests that the attitudes and methods of doctors treating the mentally ill also contribute to this widespread substance abuse problem. She notes that severe psychiatric illness is such a major health problem that doctors sometimes downplay or ignore substance problems.
Even in recent years, smoking was often permitted in psychiatric hospitals and mental wards. While smoking has now been prohibited in these places, Hartz feels that this is an indication of the tolerance that mental health professionals have for substance problems. Smoking in particular is often seen as a minor health problem compared to major illnesses such as schizophrenia or bipolar disorder.
Many doctors will not ask severely mentally ill patients about alcohol or drug use, even though they know that these problems are common in this population. With all of the challenges involved in treating severe mental illness, dealing with co-morbid substance abuse can seem like an impossible problem to remedy. Furthermore, traditional methods of recovering from substance abuse are often ineffective.
Some psychiatrists even fear that the stress of attempting to quit drugs or alcohol could endanger the mental stability of this type of patient.
For the researchers involved in this new study, the life expectancy for patients with severe mental illness made their findings even more troublesome. Studies estimate that the severely mentally ill die between 12 and 25 years earlier, on average, than members of the general population. They worry that if substance abuse continues to go unaddressed in people with severe psychiatric illness, it will continue to contribute to premature death among this already at-risk population.