Among 547 adolescents with serious emotional disturbances, ages 12 to 18, this study assessed (1) prevalence of DSM-III substance use disorders (i.e., alcohol and marijuana abuse/dependence), and (2) comorbidity with DSM-III Axis I disorders. Factors of age, sex, state location, and type of treatment program also were examined. Data were analyzed by logistic regression. Significant factors (p less than 0.05) associated with severe alcohol or marijuana abuse/dependency diagnosis included (1) residential mental health treatment program, 2.37 Odds Ratio (OR); (2) conduct disorder diagnosis, 2.18 OR; (3) depression diagnosis, 1.75 OR; (4) states, 1.43 OR; (5) age, 1.29 OR; and (6) a depression x facility interaction, 1.91 OR.

Substance Abuse Prevalence and Comorbidity with Other Psychiatric Disorders among Adolescents with Severe Emotional Disturbances

Numerous pharmacological agents have been shown to have powerful effects on cognitive behavior. Schizophrenia-like reactions have been reported in some instances. There have also been persistent reports of drug abuse among psychiatric patients before and during hospitalization. These phenomena have led to speculation that psychoactive substances are affecting the course and outcome of psychiatric illnesses, and in particular, schizophrenia. This report first reviews the evidence for psychotomimetic effects of various drugs, and then focuses on reports of the effect that substance abuse has on the course of schizophrenia and long-term outcome. The evidence to date indicates that there is a need for a large epidemiologicaJ analysis of the interplay between drug abuse and schizophrenia as well as more intensive case studies of afflicted individuals. This discussion concludes with suggestions for improved research methods and two designs for future investigations.

Impact of Substance Abuse on the Course and Outcome of Schizophrenia

Interview survey data were collected on a large (n = 4730) general population sample of adults subsequently classified as “never homeless” (NH) or “formerly homeless” (FH), with the latter group consisting of persons who had past experience of at least a one-month period with no regular place to live. The objective was to analyze differences, as a function of this classification, in the prevalence, age of onset, comorbidity, temporal sequencing, and service utilization pertinent to alcohol-use and other psychiatric disorders. Almost half of the FH group were found to have a one-year DSM diagnosis, nearly twice the rate seen in the NH group. Moreover, at 15.1%, the prevalence of alcohol-use disorder (AUD) comorbid with one or more other psychiatric disorders was five times that reported by NH participants. Subsequent analyses addressed differences between the FH (n = 167) and NH (n = 1031) groups within the subset who met criteria for one or more psychiatric diagnoses. Focusing on drinking behavior, we fou...

Alcohol use and other psychiatric disorders in the formerly homeless and never homeless: prevalence, age of onset, comorbidity, temporal sequencing, and service utilization.

Individuals who have a dual diagnosis of substance abuse and chronic mental illness pose unique challenges in the delivery of vocational rehabilitation services. Barriers to service provision include an underestimation of prevalence; agency classifications that require a separation of disability conditions into primary and secondary disability; a lack of counselors’ awareness of the unique needs of this population; and the impact of negative attitudes and stigma on vocational success. Although individuals with dual diagnosis can benefit from rehabilitation services and stable employment, changes in the traditional service delivery system are recommended. To address the unique needs of this population, rehabilitation practitioners are encouraged to seek specialized training and continuing education through regional training programs and interagency consultation.

Vocational Rehabilitation Needs of Individuals Dually Diagnosed with Substance Abuse and Chronic Mental Illness

Counseling Students' Conceptions of Substance Dependence and Related Initial Interventions

This review examines the incidence, problems and treatment issues involved when dealing with individuals who have a psychiatric disorder and concurrent substance abuse problem. There is an increasing number of these clients evidenced in psychiatric and substance abuse rehabilitation facilities and the reasons are not very clear. Suggestions are offered for a pilot treatment program and future directions recommended for addressing the special needs of this subpopulation.

Phillip Lett

Papers

Dual Diagnosis: Psychiatric Disorder & Substance Abuse