Development and validation of a scale for assessing reasons for substance use in schizophrenia: The ReSUS scale
Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Brunswick Street, Manchester, United Kingdom. Addictive behaviors
(Impact Factor: 2.76).
04/2009; 34(10):830-7. DOI: 10.1016/j.addbeh.2009.03.004
This paper reports on the development of a questionnaire to assess self reported reasons for substance use in schizophrenia: the 'reasons for substance use in schizophrenia' (ReSUS) scale and explores the relationship between reasons for use, psychiatric symptoms and substance use in a sample of 230 people with psychosis. Principal components analysis revealed three subscales: "coping with distressing emotions and symptoms", "social enhancement and intoxication" and "individual enhancement". Predicted associations were partially supported. 'Coping' reasons for use were related to positive symptoms, general symptoms, global functioning, depression and suicide behaviour as well as substance use (quantity of use and problems related to use). 'Individual enhancement' reasons were related to positive symptoms, to global functioning and to negative consequences of substance use. 'Social enhancement and intoxication' reasons were related to negative consequences of use but not to psychopathology. The findings suggest that the ReSUS is a reliable and valid instrument which can be used to explore self reported reasons for substance use and their relationship to psychotic symptoms in people with schizophrenia and other psychotic disorders.
Available from: Ian Hamilton
- "This diversity goes beyond exploring the full range of mental health and substance use issues, varied by itself, but would need to take account of an equally varied range of settings and workforce that a single instrument would be deployed in. Given all these variables a single dual diagnosis assessment is unrealistic, it is more likely that there will be continuing development of problem-specific instruments such as the Dartmouth Assessment of Lifestyle Instrument (DALI) (Rosenberg et al., 1998) and Reasons for Substance Use in Schizophrenia (ReSUS) (Gregg et al., 2009a) both of which were developed for use with people who have severe mental health problems. The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) is an example of a broader instrument which has proved to be reliable and can be used in a variety of settings (Samet et al., 1996; Delgadillo et al., 2011). "
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– It is more than 30 years since attention turned to the issue of the relationship between substance use and mental health. The purpose of this paper is to reflect on the progress to date that has been made in advancing the knowledge and understanding.
– The author has drawn on the available literature, identifying key contributions from a variety of fields which have helped to shape the understanding of the issues in relation to dual diagnosis. The ten themes are not presented in order of importance.
– Achievements have been made in attracting the attention of clinicians, researchers, policy makers and commissioners to this issue. Overall the author is left with a clearer understanding of what treatments are not effective and the challenges of determining what is.
– This paper seeks to instigate a discussion about where the collective knowledge stands on this important and challenging area of practice and research.
- "Previous research suggests that cannabis use expectancies regarding the benefits of cannabis are strongly and consistently associated with failure to quit (Boden et al. 2013). There is good evidence that people with psychosis perceive positive effects from their substance use (Schofield et al. 2006; Gregg et al. 2009a, b), including a means of coping with or reducing psychotic and affective symptoms and enhancing social interactions, and our therapists reported that the majority of participants reported deriving considerable benefits from cannabis use. Consistent with this research are reported findings from longitudinal studies that cast doubt on the commonly held belief that worse clinical outcomes for cannabis users with established psychosis are specifically due to the cannabis use (Zammit et al. 2008). "
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Cannabis use is high amongst young people who have recently had their first episode of psychosis, and is associated with worse outcomes. To date, interventions to reduce cannabis consumption have been largely ineffective, and it has been suggested that longer treatment periods are required.
In a pragmatic single-blind randomized controlled trial 110 participants were randomly allocated to one of three conditions: a brief motivational interviewing and cognitive behavioural therapy (MI-CBT) intervention (up to 12 sessions over 4.5 months) with standard care from an early intervention service; a long MI-CBT intervention (up to 24 sessions over 9 months) with standard care; or standard care alone. The primary outcome was change in cannabis use as measured by Timeline Followback.
Neither the extended nor the brief interventions conferred benefit over standard care in terms of reductions in frequency or amount of cannabis use. Also the interventions did not result in improvements in the assessed clinical outcomes, including symptoms, functioning, hospital admissions or relapse.
Integrated MI and CBT for people with cannabis use and recent-onset psychosis does not reduce cannabis use or improve clinical outcomes. These findings are consistent with those in the published literature, and additionally demonstrate that offering a more extended intervention does not confer any advantage. Many participants were not at an action stage for change and for those not ready to reduce or quit cannabis, targeting associated problems rather than the cannabis use per se may be the best current strategy for mental health services to adopt.
Available from: Sreeraj Vs
- "Details of the sociodemographic and clinical variables were designed in a specially designed clinical Performa. A modified version of the Reasons for Substance Use Scale (ReSUS) was used to assess the reasons for taking alcohol, as reported by the patients. It was a 35- item questionnaire rated with the five-point Likert scale. "
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Consumption of alcohol has been attributed to different reasons by consumers. Attitude and knowledge about the substance and addiction can be influenced by the cultural background of the individual. The tribal population, where alcohol intake is culturally accepted, can have different beliefs and attributes causing one to take alcohol. This study attempts to examine the reasons for alcohol intake and the belief about addiction and their effect on the severity of addiction in people with a different ethnic background.
Materials and Methods:
The study was conducted at a Psychiatric institute with a cross-sectional design. The study population included patients hailing from the Jharkhand state, twenty each, belonging to tribal and non-tribal communities. Patients fulfilling the ICD 10 diagnostic criteria of mental and behavioral disorders due to the alcohol dependence syndrome, with active dependence, were taken, excluding those having any comorbidity or complications. The subjects were assessed with specially designed Sociodemographic-Clinical Performa, modified version of Reasons for Substance Use scale, Addiction Belief scale, and the Alcohol Dependence scale.
Statistical Analysis and Results:
A significantly high number of tribals cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol. Addiction was severe in those consuming alcohol to cope with distressing emotions. Belief in the free-will model was noted to be stronger across the cultures, without any correlation with the reason for intake. This cross-sectional study design, which was based on patients, cannot be easily generalized to the community.
Societal acceptance and pressure as well as high emotional problems appears to be the major etiology leading to higher prevalce of substance depedence in tribals. Primary prevention should be planned to fit the needs of the ethnics.
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