Psychosocial Aspects of Substance Abuse by Clients With Severe Mental Illness

Abstract

As the literature on co-occurring substance abuse in persons with severe mental illnesses has evolved, emphasis on biologic and pharmacologic factors has diverted attention from important psychosocial issues. The authors review recent research showing that a) psychosocial risk factors may explain consistently high rates of substance abuse by these persons, b) substance abuse is for most clients a socio-environmental phenomenon embedded in interpersonal activities, and c) both natural recovery processes and effective treatments rely on developing new relationships, activities, coping strategies, and identities. Thus, psychosocial issues are critical in our attempts to understand and address substance abuse in this population.

Determinants of functioning and well-being among individuals with schizophrenia: An integrated model

“…Although substance use problems among people with mental illness are associated with a variety of compromised outcomes (Drake, Wallach, Alverson, & Mueser, 2002), relatively little research has examined the effect of substance use as a coping strategy on functioning and well-being. Though many researchers assume that coping is the primary aim of substance use (i.e., the self-medication hypothesis), this perspective is contradicted by evidence that the majority of persons with schizophrenia who use substances began doing so before the onset of their psychiatric disorder (Drake et al, 2002).…”

“…Though many researchers assume that coping is the primary aim of substance use (i.e., the self-medication hypothesis), this perspective is contradicted by evidence that the majority of persons with schizophrenia who use substances began doing so before the onset of their psychiatric disorder (Drake et al, 2002). One cross-sectional study (Blanchard et al, 1999) found that persons with schizophrenia who reported using substances to cope with negative affect were more likely to report adverse functional consequences associated with substance use than were those who did not use substances to cope.…”

Interest in and Obstacles to Pursuing Work Among Unemployed Dually Diagnosed Individuals

“…One issue is the low priority currently placed on the rehabilitative process for dually diagnosed persons. Perhaps this is due to the multitude of problems such clients may present, including high rates of hospitalization, HIV infection, homelessness, and violent behavior; such individuals are often difficult to treat, may appear noncompliant and unmotivated, and need specialized programs and assertive outreach (14,15). While there are a few programs that stress vocational outcomes for this target population, few program evaluations have been published and even fewer are methodologically sound (37).…”

“…While such services are insufficiently emphasized [e.g., see (1)] and tend to be offered only after the rehabilitation process-especially abstinence -has been achieved (14,15,53,54), empirical findings suggest that clients do benefit from such services [e.g., (55)(56)(57)]. There has been little effort to extend vocational services to dually diagnosed persons (14).…”

Teaching Medical Students about Communicating with Patients with Major Mental Illness

“…[1][2][3] They also have higher rates of smoking, obesity, physical inactivity, substance abuse, and other risky health behaviors. [4][5][6][7][8][9][10][11] Despite this, numerous barriers impede persons with major mental illness from obtaining medical care beyond psychiatric services. 12,13 Persons themselves may not seek services because of impaired recognition of health needs, fears of coercive treatments, and uncertainty about where to go.…”