Substance abuse and quality of life among severely mentally ill consumers: A longitudinal modeling analysis

Department of Public Health Sciences, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
Social Psychiatry and Psychiatric Epidemiology (Impact Factor: 2.54). 11/2007; 42(10):810-8. DOI: 10.1007/s00127-007-0236-6
Source: PubMed


Evidence suggests that substance abuse negatively affects both psychiatric symptom severity and quality of life (QOL) in people with severe mental illness (SMI). However, these relationships have not been examined simultaneously, nor have they been characterized over time. Thus, it is difficult to appreciate the extent to which substance abuse exerts an enduring effect on psychiatric symptoms and distress and/or QOL in this population. The purpose of this study is to test a conceptual model linking these factors together.
Subjects were participants in a longitudinal evaluation of community mental healthcare in Ontario (n = 133). Comprehensive consumer assessments were conducted at treatment entry, and at 9 and 18 months. Subjects were receiving intensive case management or assertive community treatment throughout the 18-month study period. Structural equation modelling was used to examine the concurrent and longitudinal relationships between substance abuse, symptoms and distress, and QOL.
The prevalence of substance abuse was 55.0%. The SEM analysis suggested that substance abuse at baseline was associated with elevated symptomatology and distress and lower QOL, and that these effects endured after 18 months of treatment. Psychiatric symptoms and distress mediated the negative relationship between substance abuse and QOL.
The mediating role played by symptom and distress levels in the relationship between substance abuse and QOL suggests the importance of closely monitoring changes in these factors among SMI patients with substance problems. Tracking symptom severity and distress levels over time will allow service providers to intervene and potentially improve the QOL of individuals with SMI.

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    • "Previous studies on QoL of opiate-dependent individuals have reported lower QoL scores among persons with co-occurring psychiatric problems when compared with individuals without psychiatric co-morbidity [12]. Similar findings can be observed in studies among persons with severe mental illnesses, in which a negative effect of substance abuse on QoL has been demonstrated [76, 77]. It appears that individuals with a so-called dual diagnosis are more vulnerable for having a poor QoL. "
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    ABSTRACT: This study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals' QoL. Participants (n = 159) were interviewed about their current QoL, psychological distress and severity of drug-related problems, using the Lancashire Quality of Life Profile, the Brief Symptom Inventory and the Addiction Severity Index. Potential determinants of QoL were assessed in a multiple linear regression analysis. Five years after the start of methadone treatment, opiate-dependent individuals report low QoL scores on various domains. No association was found between drug-related variables and QoL, but a significant negative impact of psychological distress was identified. Severity of psychological distress, taking medication for psychological problems and the inability to change one's living situation were associated with lower QoL. Having at least one good friend and a structured daily activity had a significant, positive impact on QoL. Opiate-dependent individuals' QoL is mainly determined by their psychological well-being and a number of psychosocial variables. These findings highlight the importance of a holistic approach to treatment and support in methadone maintenance treatment, which goes beyond fixing the negative physical consequences of opiate dependence.
    Quality of Life Research 02/2011; 20(1):139-50. DOI:10.1007/s11136-010-9732-3 · 2.49 Impact Factor
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    • "This means that age of individuals who abuse substance had significant influence on all aspects of their quality of life. This corroborates opinions of previous researchers that substance abuse negatively affects psychiatric symptoms severity as well as quality of life of individuals with mental illness (Foster et al., 1999; Lorenz et al., 2001; Rudolf and Watts, 2002; Morgan et al., 2003; Fassino et al., 2004; Okoro et al., 2004; Vorma et al., 2004; Dalgard et al., 2004; Chen et al., 2006; Costenbader et al., 2007; Urbanoski et al., 2007; Korthuis et al., 2008; Lahmek et al., 2009). The fact that both the educational attainment and occupational status had significant influence on quality of life of individuals who abuse illicit drug in all the domains of WHOQOL-BREF shows that individuals suffering from substance abuse disorder but have higher educational qualification and are employed have a higher quality of life. "

    Journal of Clinical Medicine Research 01/2011; 3(6):73-81.
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    • "It is estimated that 25% of the roughly new HIV infected per year occur through injection drug use (Fielin, 2004). Urbanoski et al. (2007) suggested that substance abuse negatively affects both psychiatric symptoms' severity and the quality of life in people with mental illness. Bail, Richardson, Connelly, and Bulosa (2005) evaluated the psychiatric symptoms, psychosocial problems and treatment responses of personality-disoriented substance abusers receiving services within a homeless drop-in center of the Neighborhood Coalition for Shelter Inc. in the upper east side of Manhattan. "
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    ABSTRACT: Integrated care services specifically designed for the mentally ill homeless with HIV/AIDS
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