Substance Use “Dramatically Higher” Among Those With Severe Psychosis Diagnoses


In “the largest assessment of substance use among individuals with severe psychotic illness to date,” researchers from Washington University and the University of Southern California found that the odds of substance use among those with severe psychosis diagnoses is dramatically higher than that of people with less severe diagnoses.  Though the study only establishes a correlation between psychosis and substance use, the lead researcher comments that “the most likely explanation is that substance use contributes to the development of severe mental illness.”

Abstract →

Hartz, S., Pato, C., Madeiros, H., Cavazos-Rehg, P., et al.; Comorbidity of Severe Psychotic Disorders With Measures of Substance Use. JAMA Psychiatry. Online January 1, 2014. doi:10.1001/jamapsychiatry.2013.3726

Of Further Interest:
Severe Mental Illness Tied to Substance Use: Which Comes First? (Decoded Science)
Substance Use ‘Dramatically’ High in Severe Psychosis (MedWire News)
Severe Mental Illness Ups Risk for Mental Illness (PsychCentral)
Severe Mental Illness Tied to Higher Rates of Substance Use (HealthCanal)

Previous articlePrescribing Rights for Psychologists
Next articleSuicide Attempts Similar With Various Antidepressants for Children
Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. More often than not psychiatric disorders among drug or alcohol abusers disappear with prolonged abstinence. Substance induced psychiatric symptoms can occur both in the intoxicated state and also during the withdrawal state.

    Drug and alcohol treatment centers are infamous for starting clients on medication for “dual diagnosis” during the acute and post acute withdrawal phase. Post-acute-withdrawal syndrome (PAWS), describes a set of persistent impairments that occur after withdrawal from alcohol, opiates, benzodiazepines, antipsychotics antidepressants and other substances.

    Almost everyone has anxiety, mood swings and some “psychosis” during acute withdrawal and PAWS !

    Pharma is increasingly pressuring rehab facilities and doctors to add a mental illness diagnoses to recovering patients to sell expensive pills.

    Report comment

  2. This is rather silly. People who suffer trauma are more likely to get involved with substance abuse because society doesn’t allow them to express trauma, doesn’t allow them to understand it (which would also help to expose the trauma of those causing trauma to others, were there more interest in what trauma does other than a means of mind control): does this mean that the controlled substances also caused the need for escape (which is a disease), or is there simply a need for escape and were there acknowledged there might be healthier choices available?

    Report comment

  3. I also wonder how much substance abuse among the “mentally ill” is an effort to reduce side effects from the helpful “medications” they’re taking for their “mental illness.” I agree with Nijinsky (as I almost always do) that it seems obvious that traumatized people are both more likely to use drugs and more likely to have “mental health symptoms” as defined by the system. But I think Copy Cat is also right that some people do become psychotic or depressed or anxious as a result of substance abuse. Of course, the researchers also neglect to examine the number of people who become psychotic or depressed or anxious as a result of their “treatment,” but that’s another issue…

    —- Steve

    Report comment

    • I also wonder how much substance abuse among the “mentally ill” is an effort to reduce side effects from the helpful “medications” they’re taking for their “mental illness.”


      Feeling like a zombie all day on brain disabling “medications” makes people want to drink and do “get high” drugs to overcome the zombiness (anhedonia)

      Anhedonia or “psych med zombie” defined as the inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, music, sexual activities or social interactions. While earlier definitions of anhedonia emphasized pleasurable experience, more recent models have highlighted the need to consider different aspects of enjoyable behavior, such as motivation or desire to engage in an activity (“motivational anhedonia”), as compared to the level of enjoyment of the activity itself (“consummatory anhedonia”)

      Report comment

  4. I learned cocaine from the neighborhood boys who were around 10 years old. One of the parents was a dealer. The kid got hold of it and they all blew their faces out. Lots of blood. I ran and told and my brother got a serious ass kicking (though I don’t know why since my birth mother was a junkie herself).

    I learned heroin from a 13 year old girl.

    So which is it, drugs are cultural and societal or being a natural born psycho is?

    Report comment

      • Oh yeah.

        I smoked my first cigarette when I was 8 years old. At the time, people smoked in grocery stores, theaters, hospitals and schools. People smoked everywhere and there were a whole lot of smokers.

        “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),”

        So, ah… all natural born psychopaths?

        I think science is dishonest.

        Is the fact that I smoke cigarettes proof and evidence of psychopathy? Or, is it that I was born into a culture and society that was HEAVILY cultivated in cigarette smoking?

        Have you people ever visited the BATHROOMS and behind the bleachers of junior high schools? Lots of psychopathy happens in those places. Must be genetic.

        Report comment