Elsevier

Biological Psychiatry

Volume 40, Issue 11, 1 December 1996, Pages 1155-1163
Biological Psychiatry

Original article
Substance abuse and the onset of schizophrenia

https://doi.org/10.1016/S0006-3223(95)00609-5Get rights and content

Up to 60% of chronic schizophrenic patients are reported to abuse alcohol or drugs. This comorbidity raises the question whether one disorder is a consequence of the other. With the structured interview “IRAOS,” the onset and course of schizophrenia and substance abuse were retrospectively assessed in a representative first-episode sample of 232 schizophrenic patients. Information by relatives validated the patients' reports. Alcohol abuse prior to first admission was found in 24%, drug abuse in 14%—twice the rates in the general population. Alcohol abuse more often followed than preceded the first symptom of schizophrenia. Drug abuse preceded the first symptom in 27.5%, followed it in 37.9%, and emerged within the same month in 34.6% of the cases. The study demonstrates a remarkable association between first-episode schizophrenia and substance abuse, but a unidirectional causality is not supported, nor is a specific psychotic disorder in comorbid cases.

References (36)

  • BlandRC et al.

    Schizophrenia: Lifetime co-morbidity in a community sample

    Acta Psychiatr Scand

    (1987)
  • Bundesminister für Gesundheit

    Daten des Gesundheitswesens Ausgabe 1991

  • CuffelBJ

    Prevalence estimates of substance abuse in schizophrenia and their correlates

    J Nerv Ment Dis

    (1992)
  • DixonL et al.

    Drug abuse in schizophrenic patients: Clinical correlates and reasons for use

    Am J Psychiatry

    (1991)
  • DrakeRE et al.

    Alcohol use and abuse in schizophrenia

    A prospective community study

    J Nerv Ment Dis

    (1989)
  • DrakeRE et al.

    Diagnosis of alcohol use disorders in schizophrenics

    Schizophr Bull

    (1990)
  • HäfnerH et al.

    First onset and early symptomatology of schizophrenia

    A chapter of epidemiological and neurobiological research into age and sex differences

    Eur Arch Psychiatry Clin Neurosci

    (1992)
  • HäfnerH et al.

    The influence of age and sex on the onset and early course of schizophrenia

    Br J Psychiatry

    (1993)
  • Cited by (290)

    • The link between schizophrenia and substance use disorder: A unifying hypothesis

      2018, Schizophrenia Research
      Citation Excerpt :

      Patients with schizophrenia are quite vulnerable to substance use disorders (Regier et al., 1990; Stinson et al., 2006); according to the Epidemiological Catchment Area study, 47% of patients with schizophrenia have serious problems with drug or alcohol use during their lifetime compared to 16% of the general population. Regarding specific substances: tobacco, alcohol, cannabis and cocaine use disorders occur commonly in patients with schizophrenia (Mueser et al., 1990; Volkow, 2009), with lifetime prevalence ranging from 60 to 90% for cigarette smoking, as well as 21–86% for alcohol (Volkow, 2009), 17–83% for cannabis (Degenhardt and Hall, 2001; DeQuardo et al., 1994; Dixon et al., 1991; Hambrecht and Hafner, 1996; Karam et al., 2002; Mueser et al., 1995; Perala et al., 2007; Peralta and Cuesta, 1992; Ringen et al., 2008; Volkow, 2009) and 15–50% for cocaine use (Chambers et al., 2001; Mueser et al., 1990) – rates at-least three-times greater than those in the general population (Regier et al., 1990). Importantly, in this population, such high rates of substance use disorders are problematic: co-occurring substance use disorder has been associated with clinical exacerbations, non-compliance with treatment, poor global functioning, violence, suicide and increased rates of relapse and re-hospitalization (DeQuardo et al., 1994; Dickey and Azeni, 1996; Henquet et al., 2010; Juckel et al., 2006; Kivlahan et al., 1991; Knudsen and Vilmar, 1984; Linszen et al., 1994; Negrete and Knapp, 1986; Peralta and Cuesta, 1992; Regier et al., 1990; Sayers et al., 2005; Smith et al., 1997; Swendsen et al., 2011; Treffert, 1978; van Dijk et al., 2012).

    View all citing articles on Scopus

    The Deutsche Forschungsgemeinschaft (German Research Association) supported this study within the Sonderforschungsbereich (Special Research Branch) 258.

    View full text