Reasons for increased substance use in psychosis

Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Rutherford House, Manchester Science Park, Manchester, United Kingdom.
Clinical Psychology Review (Impact Factor: 7.18). 06/2007; 27(4):494-510. DOI: 10.1016/j.cpr.2006.09.004
Source: PubMed


Around half of all patients with schizophrenia are thought to abuse drugs or alcohol and there is good evidence to suggest that they have poorer outcomes than their non substance using counterparts. However, despite more than twenty years of research there is still no consensus on the aetiology of increased rates of substance use in people with psychosis. There is a clear need to understand the reasons for such high rates of substance use if treatments designed to help patients abstain from substance use are to be successful. This paper provides an update of the literature examining the reasons for substance use by people with psychosis, and includes a comprehensive review of the self report literature. The main theories as to why people with psychosis use substances are presented. There is evidence to suggest that cannabis may have a causal role in the development of psychopathology but not for other substances. The self report literature provides support for an 'alleviation of dysphoria' model of substance use but there is little empirical support for the self medication hypothesis, or for common factor models and bidirectional models of comorbidity. It is likely that there are multiple risk factors involved in substance use in psychosis and more work to develop and test multiple risk factor models is required.

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    • "Use of stimulants and opiates by patients was much less common. These findings are likely to reflect differences in the course of psychiatric disorders for users of different drug types (Sara et al. 2014) and in the nature of the relationship between specific drugs and psychosis (Gregg et al. 2007). As others have found (Carrà et al. 2012), lifetime prevalence rates of substance use were much higher than current use, indicating temporal fluctuations in patterns of use or some degree of recovery from substance use problems. "
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    ABSTRACT: Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London. Searches were conducted for all patients admitted during 2012 and details of incidents and patient characteristics were extracted for analysis. Substance use was reported for 291 patients, with 25 incidents per 100 patients admitted to hospital. Only half of the incidents were followed by a response that specifically addressed the patients' substance use behaviour. These interactions usually concerned the circumstances and reasons for use, but rarely involved specific support for patients' substance use problems. The likelihood of staff taking any form of action was increased if the patient had been formally admitted, and was reduced if the patient was subject to containment during the shift or had a history of self-harm. The results demonstrate that nurses require specific training and guidance on supporting substance using patients. © 2015 Australian College of Mental Health Nurses Inc.
    No preview · Article · Aug 2015 · International journal of mental health nursing
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    • "The most frequently identified reasons for not changing were: substances help cope with mental health problems; substances help with socialising and reducing social isolation ; and enjoying enhancement of feelings or sensations. None of the perceived reasons for change or not changing were related to outcomes, suggesting that reasons for substance misuse may be idiosyncratic (Gregg et al., 2007). According to MI theory, behaviour change occurs when the reasons for change outweigh the reasons for not changing, but these reasons are likely to vary from person to person (Miller and Rollnick, 1991). "
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    ABSTRACT: This study aimed to explore factors associated with outcomes in a randomised controlled trial of integrated motivational interviewing and cognitive behavioural therapy for psychosis and substance misuse. Clients and therapists completed self-report measures of alliance and clients completed a self-report measure of adult attachment. Trial therapists were also asked to identify challenges in therapy, client strengths and reasons for client making and not making changes in relation to substance misuse. Neither therapist-rated nor client-rated alliance was significantly related to objective outcomes. Client insecure attachment avoidance was associated with poorer symptoms and functioning at 12 and 24 months; although not changes in substance misuse. Therapists' perceptions of therapeutic processes (e.g., challenges to therapy, client strengths, client reasons for change and alliance) were consistent with previous literature. Therapists' perceptions of client improvement were associated with reductions in substance use at the end of treatment and their ratings of therapeutic alliance. Insecure adult attachment styles may be a potentially important predictor of symptom outcomes for people with psychosis and substance misuse. Trial therapists may also provide an important source of information about therapeutic processes and factors associated with outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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    • "Social reasons were also very important followed by relief of boredom. Finally, in a review by Gregg et al. [14], the 'alleviation of dysphoria' model was shown to be largely supported by the self-report literature with little evidence for the self-medication, common factor or bi-directional models of co-morbid substance use. Another review by Pé rez et al. [33] also found that the 3 most popular reasons for substance use from self-report studies were, in order of preference: improvement in positive sensations; relieving dysphoria; social. "
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    ABSTRACT: Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time. FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n=69), 3 months (n=29) and 12 months (n=36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point. Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed 'enhancement' followed by 'coping with unpleasant affect' and 'social motive' more highly for their cannabis use than any other reason. 'Conformity and acceptance' followed closely. 'Relief of positive symptoms and side effects' was the least endorsed motive. Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated 'enhancement' most highly for their cannabis use. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
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