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Original Investigation |

Comorbidity of Severe Psychotic Disorders With Measures of Substance Use

Sarah M. Hartz, MD, PhD1; Carlos N. Pato, MD, PhD2; Helena Medeiros, MSW2; Patricia Cavazos-Rehg, PhD1; Janet L. Sobell, PhD2; James A. Knowles, MD, PhD2; Laura J. Bierut, MD1; Michele T. Pato, MD2 ; for the Genomic Psychiatry Cohort Consortium
[+] Author Affiliations
1Washington University in St. Louis, Missouri
2University of Southern California, Los Angeles
JAMA Psychiatry. 2014;71(3):248-254. doi:10.1001/jamapsychiatry.2013.3726.
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Importance  Although early mortality in severe psychiatric illness is linked to smoking and alcohol, to our knowledge, no studies have comprehensively characterized substance use behavior in severe psychotic illness. In particular, recent assessments of substance use in individuals with mental illness are based on population surveys that do not include individuals with severe psychotic illness.

Objective  To compare substance use in individuals with severe psychotic illness with substance use in the general population.

Design, Setting, and Participants  We assessed comorbidity between substance use and severe psychotic disorders in the Genomic Psychiatry Cohort. The Genomic Psychiatry Cohort is a clinically assessed, multiethnic sample consisting of 9142 individuals with the diagnosis of schizophrenia, bipolar disorder with psychotic features, or schizoaffective disorder, and 10 195 population control individuals.

Main Outcomes and Measures  Smoking (smoked >100 cigarettes in a lifetime), heavy alcohol use (>4 drinks/day), heavy marijuana use (>21 times of marijuana use/year), and recreational drug use.

Results  Relative to the general population, individuals with severe psychotic disorders have increased risks for smoking (odds ratio, 4.6; 95% CI, 4.3-4.9), heavy alcohol use (odds ratio, 4.0; 95% CI, 3.6-4.4), heavy marijuana use (odds ratio, 3.5; 95% CI, 3.2-3.7), and recreational drug use (odds ratio, 4.6; 95% CI, 4.3-5.0). All races/ethnicities (African American, Asian, European American, and Hispanic) and both sexes have greatly elevated risks for smoking and alcohol, marijuana, and drug use. Of specific concern, recent public health efforts that have successfully decreased smoking among individuals younger than age 30 years appear to have been ineffective among individuals with severe psychotic illness (interaction effect between age and severe mental illness on smoking initiation, P = 4.5 × 105).

Conclusions and Relevance  In the largest assessment of substance use among individuals with severe psychotic illness to date, we found the odds of smoking and alcohol and other substance use to be dramatically higher than recent estimates of substance use in mild mental illness.

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Figure.
Substance Use Among Subgroups

Frequency of alcohol use (A), smoking (B), marijuana use (C), and other drug use (D) contrasted among subgroups. The odds ratios (ORs) correspond to the odds of the prevalence of the symptom among cases with chronic psychotic illness vs control individuals. The ORs are contrasted with one another. The subgroups include African American (n = 4579), Asian (n = 905), European American (n = 8056), and Hispanic (n = 4988) individuals; females (n = 9390); males (n = 10 501); those aged younger than 30 years (n = 5336); those aged 30 to 49 years (n = 8635); and those aged 50 years and older (n = 5946).aP < .001; OR is statistically different from the reference (European descent for ethnicity, male for sex, and 30-49 years for age group).bP < .05; OR is statistically different from the reference (European descent for ethnicity, male for sex, and 30-49 years for age group).

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