Diagnosing Substance Abuse and Dependence in Schizophrenia

People with mental illness are more likely to be diagnosed with a substance use disorder than people without mental illness. For individuals with severe mental illness (SMI), substance use rates are even higher. Some SMI’s that have the highest levels of substance use disorder include depression, bipolar, and schizophrenia. This can make treating either condition more challenging. Therefore, it is essential to know if a client is dealing with substance abuse or substance dependency. Currently, several different diagnostic tools and assessment methods are used to determine the level of use. However, until now, no research has compared the validity and accuracy of these methods.

Sarah L. Desmarais of the Department of Psychology at North Carolina State University wanted to find out if one method was superior to another and tested several different approaches on a sample of 1,460 adults with schizophrenia. She used clinical ratings, collateral assessments, urine and hair tests, and self-reports and compared them to the Structured Clinical Interview for DSM-IV Disorders (SCID) ratings. She found that overall, the methods she used provided similar results to the SCID. She also found that none of the approaches provided clear distinction between substance dependence and substance abuse.

This finding was particularly concerning because it has been theorized that SMI prevents people from using substances without abusing them. However, that was not found to be supported in this study. In fact, many of the participants used substances without having significant impairment or dependency. But because dependency can have a dramatic impact on treatment and mental illness outcomes, it is important for future work to explore this issue more thoroughly. Until then, Desmarais believes her results show that there was not one test that clearly outperformed any other. She said, “Differences in diagnostic accuracy, when they were found, were relatively small in nature, providing limited support for superiority of one assessment approach over another.” In sum, she said that deciding which test to administer should be based on the overall treatment plan, financial limitations, and time constraints, and not on the minute differences in results from one test to another.

Desmarais, S. L., Van Dorn, R. A., Sellers, B. G., Young, M. S., and Swartz, M. S. (2012). Accuracy of self-report, biological tests, collateral reports and clinician ratings in identifying substance use disorders among adults with schizophrenia. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0031256

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  • sharon k

    January 30th, 2013 at 5:46 AM

    while having a severe mental illness may play a role in how a person uses a substance it may not always be to the same degree in all the people.why some banned substances were initially made as medications.also the way each of these substances has an effect can also depend on the particular mental illness.research should continue on this in order to help those affected.

  • Benny

    January 30th, 2013 at 11:51 PM

    If a mental illness can impair a person’s judgement skills and come in the way of deaddiction it sounds like a very difficult situation. Not only is there the mental illness to cope with but also the substance use issue. It can also come in the way of adhering to treatment and medications and may prolong the treatment period, thereby increasing chances of dropping out altogether. A very dangerous situation indeed.

  • timon

    January 31st, 2013 at 2:44 PM

    interesting to learn about people with schizophrenia and a substance issue. when one’s perceptions change due to this disorder wouldn’t the perception about the substance and its effects change too? it would bring a change but I don’t know in which direction. maybe it helps the cause of quitting or worsens things, but it would be interesting to study this at a larger scale.

  • Leigh Anne

    January 31st, 2013 at 2:48 PM

    I would presume that people with a mental illness may turn to substances like cigarettes or alcohol could be a way for them to cope?

  • Cathy

    February 4th, 2013 at 7:46 PM

    With all the medications people are put on to treat mental illness,when you add illegal or illegally uses drugs you are creating a chemical stew and it is very difficult to tell where the mental illness ends and the drugs begin. When my son abuses xanax…his drug of choice he is a walking billboard for bipolar disease. But off the drugs he shows no sign of mental illness.

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