Skip to main content

Advertisement

Log in

Substance abuse and quality of life among severely mentally ill consumers

A longitudinal modelling analysis

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Evidence suggests that substance abuse negatively affects both psychiatric symptom severity and quality of life (QOL) in people with severe mental illness (SMI). However, these relationships have not been examined simultaneously, nor have they been characterized over time. Thus, it is difficult to appreciate the extent to which substance abuse exerts an enduring effect on psychiatric symptoms and distress and/or QOL in this population. The purpose of this study is to test a conceptual model linking these factors together.

Methods

Subjects were participants in a longitudinal evaluation of community mental healthcare in Ontario (n = 133). Comprehensive consumer assessments were conducted at treatment entry, and at 9 and 18 months. Subjects were receiving intensive case management or assertive community treatment throughout the 18-month study period. Structural equation modelling was used to examine the concurrent and longitudinal relationships between substance abuse, symptoms and distress, and QOL.

Results

The prevalence of substance abuse was 55.0%. The SEM analysis suggested that substance abuse at baseline was associated with elevated symptomatology and distress and lower QOL, and that these effects endured after 18 months of treatment. Psychiatric symptoms and distress mediated the negative relationship between substance abuse and QOL.

Conclusions

The mediating role played by symptom and distress levels in the relationship between substance abuse and QOL suggests the importance of closely monitoring changes in these factors among SMI patients with substance problems. Tracking symptom severity and distress levels over time will allow service providers to intervene and potentially improve the QOL of individuals with SMI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Addington J, Addington D (1997) Substance abuse and cognitive functioning in schizophrenia. J Psychiatry Neurosci 22:99–104

    PubMed  CAS  Google Scholar 

  2. American Psychiatric Association (2000) Handbook of psychiatric measures. American Psychiatric Association, Washington, DC

    Google Scholar 

  3. Arbuckle JL (2003) AMOS 5. Small Waters Corp, Chicago, IL

  4. Bellack AS, Gearon JS (1998) Substance abuse treatment for people with schizophrenia. Addict Behav 23:749–766

    Article  PubMed  CAS  Google Scholar 

  5. Bjorkman T, Hansson L (2002) Predictors of improvement in quality of life of long-term mentally ill individuals receiving case management. Eur Psychiatry 17:33–40

    Article  PubMed  CAS  Google Scholar 

  6. Blanchard JJ, Brown SA, Horan WP, et al. (2000) Substance use disorders in schizophrenia: review, integration, and a proposed model. Clin Psychol Rev 20:207–234

    Article  PubMed  CAS  Google Scholar 

  7. Byrne BM (2001) Structural equation modeling with AMOS: basic concepts, applications and programming. Lawrence Erlbaum Associates, Mahwah, NJ

    Google Scholar 

  8. Carey MP, Carey KB, Meisler AW (1991) Psychiatric symptoms in mentally ill chemical abusers. J Nerv Ment Dis 179:136–138

    Article  PubMed  CAS  Google Scholar 

  9. CMHEI Working Group (2004) Making a difference: Ontario’s Community Mental Health Initiative. http://www.ontario.cmha.ca/cmhei/making_a_difference.asp. Accessed 16 March 2005

  10. Cocoo KM, Carey KB (1998) Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients. Psychol Assess 10:408–414

    Article  Google Scholar 

  11. Conigrave KM, Hall WD, Saunders JB (1995) The AUDIT questionnaire: choosing a cut-off score. Addiction 90:1349–1356

    Article  PubMed  CAS  Google Scholar 

  12. Curran GM, Sullivan G, Williams K, et al. (2003) Emergency department use of persons with comorbid psychiatric and substance abuse disorders. Ann Emerg Med 41:659–667

    Article  PubMed  Google Scholar 

  13. Derogatis LR, Cleary PA (1977) Confirmation of the dimensional structure of the SCL-90. A study of construct validation J Clin Psychol 33:981–989

    Article  Google Scholar 

  14. Dickerson FB, Ringel NB, Parente F (1998) Subjective quality of life in out-patients with schizophrenia: clinical and utilization correlates. Acta Psychiatr Scand 98:124–127

    PubMed  CAS  Google Scholar 

  15. Drake RE, Osher FC, Wallach MA (1989) Alcohol use and abuse in schizophrenia: a prospective community study. J Nerv Ment Dis 177:408–414

    Article  PubMed  CAS  Google Scholar 

  16. Foster J, Powell JE, Marshall EJ, et al. (1999) Quality of life in alcohol dependent subjects: a review. Qual Life Res 8:255–261

    Article  PubMed  CAS  Google Scholar 

  17. Galletly CA, Clark CR, McFarlane AC, et al. (1997) Relationships between changes in symptom ratings, neuropsychological test performance and quality of life in schizophrenic patients treated with clozapine. Psychiatry Res 72:161–166

    Article  PubMed  CAS  Google Scholar 

  18. Havassy BE, Arns PG (1998) Relationship of cocaine and other substance dependence to well-being of high-risk psychiatric patients. Psychiatr Serv 49:935–940

    PubMed  CAS  Google Scholar 

  19. Health Canada (2002) Best practices: concurrent mental health and substance use disorders. Health Canada, Ottawa, ON

    Google Scholar 

  20. Kline RB (1998) Principles and practice of structural equation modeling. Guilford Press, New York, NY

    Google Scholar 

  21. Lehman AF (1988) A quality of life interview for the chronically mentally ill. Eval Program Plann 11:51–62

    Article  Google Scholar 

  22. Maisto SA, Carey MP, Carey KB, et al. (2000) Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess 12:186–192

    Article  PubMed  CAS  Google Scholar 

  23. Overall JE, Gorham DR (1988) The Brief Psychiatric Rating Scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacol Bull 24:97–99

    Google Scholar 

  24. Packer S, Husted J, Cohen S, et al. (1997) Psychopathology and quality of life in schizophrenia. J Psychiatry Neurosci 22:231–234

    PubMed  CAS  Google Scholar 

  25. RachBeisel J, Scott J, Dixon L (1999) Co-occurring severe mental illness and substance use disorders: a review of recent research. Psychiatr Serv 50:1427–1434

    PubMed  CAS  Google Scholar 

  26. Regier DA, Farmer ME, Rae DS, et al. (1990) Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. JAMA 264:2511–2518

    Article  PubMed  CAS  Google Scholar 

  27. Ritsner M, Kurs R, Gibel A, et al. (2003) Predictors of quality of life in major psychoses: a naturalistic follow-up study. J Clin Psychiatry 64:308–315

    Article  PubMed  Google Scholar 

  28. Ritsner M, Modai I, Endicott J, et al. (2000) Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients. J Clin Psychiatry 61:880–889

    Article  PubMed  CAS  Google Scholar 

  29. Rudnick A (2001) The impact of coping on the relation between symptoms and quality of life in schizophrenia. Psychiatry 64:304–308

    PubMed  CAS  Google Scholar 

  30. Russo J, Roy-Byrne P, Reeder D, et al. (1997) Longitudinal assessment of quality of life in acute psychiatric inpatients: reliability and validity. J Nerv Ment Dis 185:166–175

    Article  PubMed  CAS  Google Scholar 

  31. Saunders JB, Aasland OG, Babor TF, et al. (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): who collaborative project on early detection of persons with harmful alcohol consumption II. Addiction 88:791–804

    Article  PubMed  CAS  Google Scholar 

  32. Schaar I, Ojehagen A (2003) Predictors of improvement in quality of life of severely mentally ill substance abusers during 18 months of cooperation between psychiatric and social services. Soc Psychiatry Psychiatr Epidemiol 38:83–87

    Article  PubMed  Google Scholar 

  33. Skinner H (1982) The drug abuse screening test. Addict Behav 7:363–371

    Article  PubMed  CAS  Google Scholar 

  34. Smith KW, Larson MJ (2003) Quality of life assessments by adult substance abusers receiving publicly funded treatment in Massachusetts. Am J Drug Alcohol Abuse 29:323–335

    Article  PubMed  Google Scholar 

  35. SPSS Inc (2003) SPSS for Windows: release 12.0.0. Author, Chicago IL

  36. Staley D, El-Guebaly N (1990) Psychometric properties of the drug abuse screening test in a psychiatric patient population. Addict Behav 15:257–264

    Article  PubMed  CAS  Google Scholar 

  37. Strupp HH (1996) The tripartite model and the Consumer Reports study. Am Psychol 51:1017–1024

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karen A. Urbanoski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Urbanoski, K.A., Cairney, J., Adlaf, E. et al. Substance abuse and quality of life among severely mentally ill consumers. Soc Psychiat Epidemiol 42, 810–818 (2007). https://doi.org/10.1007/s00127-007-0236-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-007-0236-6

Key words

Navigation