Page last updated: February 14, 2014
Alcohol, tobacco, drug use far higher in severely mentally ill

Researchers at Washington University School of Medicine in St Louis and the University of Southern California have found that rates of smoking, drinking and drug use are significantly higher among those who have psychotic disorders than among those in the general population. Their study analysed smoking, drinking and drug use in nearly 20,000 people including 9,142 psychiatric patients diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder.

The investigators found that 30% of those with severe psychiatric illness engaged in binge drinking, (4 drinks in one session), compared to a rate of 8% in the general population. Among those with mental illness, more than 75% were regular smokers, compared with 33% of those in the control group. There were similar findings with heavy marijuana use: 50% of people with psychotic disorders used marijuana regularly, versus 18% in the general population. Half of those with mental illness also used other illicit drugs, while the rate in the general population is 12%.

First author, Sarah Hartz, assistant professor of psychiatry at Washington University said previousresearch indicates that Hispanics and Asians tend to have lower rates of substance abuse than European Americans. Women also tend to smoke, drink and use illicit drugs less often than men. However, a striking finding from the study is that once a person develops a psychotic illness, protective factors such as race and gender don’t have their typical influence.

Individuals with severe mental illness are more likely to die younger, on average 12-25 years older than the general population average. Often this is from heart disease and cancer caused by chronic alcohol and tobacco use rather than from psychiatric illness. The question for Hartz is whether being more aggressive in trying to curb nicotine, alcohol and substance use in patients with severe psychiatric illness can lengthen their lives. Hartz believes health professionals who treat the mentally ill need to do a better job of trying to get them to stop smoking, drinking and using drugs.

Source: Moderate alcohol consumption enhances vaccineinduced responses in rhesus macaques. Hartz SM et al. JAMA Psychiatry, published online Jan. 1, 2014.

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