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									                                                                 Alcohol Abuse Characteristics of Individuals with Co-occurring
                                                                          Psychiatric and Substance Abuse Disorders
                                                                                                   Laurel Mangrum, Ph.D. & Richard Spence, Ph.D
                                                                                                                   University of Texas at Austin, Addiction Research Institute

                       Introduction                                                         Client Characteristics                                                                                  Alcohol Abuse                                                                           Results and Conclusions
                                                                                                                                                                                                    Characteristics                                                        Analyses comparing primary substance of abuse indicated significant group differences in both
The current study examines alcohol abuse characteristics of 50 individuals                  Demographics of Diagnostic Groups                                                                                                                                              the interviewer ( X2 = 9.32, p < .03) and client measures ( X2 = 12.67, p < .01). Interviewer
with co-occurring severe and persistent mental illness and substance abuse                                                                                                                                                                                                 ratings identified alcohol as the primary substance of abuse at a higher rate in the affective
disorders. Previous research in this area has generally been confined to                                                                                                                                                                                                   disorder group (82%) compared to the schizophrenia group (53%). Similarly, the affective
contrasting substance use patterns of individuals with co-occurring disorders                                                                                                                                         Affective Disorder   Schizophrenia                   disorder group also self-identified alcohol as the primary substance of abuse at a greater
                                                                                                        Affective Disorder       Schizophrenia                                Treatment History
with those of singly diagnosed substance abusers or examining the effects        Variable                    (n = 32)               (n = 18)                                  Alcohol Treatment - Lifetime:                                                                frequency than the schizophrenia group (72% vs. 33%). Further, the schizophrenia group more
of the primary-secondary diagnostic dimension of dually diagnosed clients.                                                                                                     Incidence                                    85%                47%         p < .01         often denied having any primary substance of abuse (20%) relative to the affective disorder group
                                                                                 Gender                                                                                        Number of Treatment Episodes                  5                  1          p < .02         (10%). None of the clients in the schizophrenia group self-identified polysubstances as their
Further, in many studies of co-occurring disorders, the designs focus on the      Male                         47%                      83%               p < .01              Number of Detox Treatments                    2                  1           n.s.
level of psychiatric symptom severity rather than substance use dimensions.                                                                                                                                                                                                primary substance of abuse; by contrast, interviewer ratings identified 20% of the schizophrenia
In studies that have compared specific diagnostic categories on substance        Mean Age                      44.5                     37.6              p < .01             Outpatient Treatment Days:                                                                   group as having primary problems with multiple substances. Marijuana was identified as the
use characteristics, the majority of analyses have been limited to exploring                                                                                                   Past 30 Days                                   2                 3            n.s.          primary substance problem only in the schizophrenic group by both the client and the interviewer.
patterns in categorical use of different classes of substances. These studies     Black                        6%                       22%                                   Alcohol Abuse Severity
                                                                                                                                                                                                                                                                           A significantly higher percentage of the affective disorder group had a prior history of alcohol
examining substance use categories have failed to identify distinct patterns      Hispanic                     13%                      50%                                   Clinician Rating:
                                                                                  White                        78%                      28%                                    Alcohol Problem Intensity Rated                                                             treatment (85% vs. 47%) and had a greater number of lifetime treatment episodes relative to the
relative to diagnoses due to inconsistent findings. Research in this area         Other                        3%                        0%               p < .01              Moderate to Extreme                          86%                38%         p < .01         schizophrenia group (5 episodes vs. 1 episode). The groups did not differ in number of lifetime
suggests, however, that alcohol is the most commonly used substance                                                                                                                                                                                                        detox episodes nor on the amount of outpatient substance abuse treatment in the 30 days prior to
across all diagnostic categories. Given the high prevalence of alcohol use,                                                                                                   Client Ratings:
                                                                                                                                                                               Alcohol Problem Intensity Rated                                                             the ASI assessment.
more focused research is needed exploring the extent of alcohol intake and                                                                                                     Moderate to Extreme                          57%                13%         p < .001
level of alcohol abuse symptoms associated with different psychiatric                                                                                                                                                                                                      The affective disorder group demonstrated higher levels of alcohol abuse severity on three of the
                                                                                                                                                                               Need for Alcohol Treatment Rated
diagnoses. This study sought to examine potential differences in alcohol
use patterns by comparing diagnostic groups on measures of alcohol abuse
                                                                                 Primary Substance of Abuse                                                                    Moderate to Extreme                          48%                25%           n.s.          four measures. Approximately one-third of the affective disorder group reported experiencing
                                                                                                                                                                                                                                                                           delirium tremens during their lifetime compared to 6% of the schizophrenia group. In addition,
characteristics and severity.                                                                                                                                                 History of Delirium Tremens                   33%                 6%         p < .05         affective disorder clients rated the severity of their alcohol abuse at a higher level, with a greater
                                                                                                                                                                                                                                                                           proportion self-rating alcohol problem intensity in the moderate to extreme range (56% vs. 13%).
                                                                                                                                                                              Alcohol Abuse Patterns
                                                                                             Client Ratings of Primary Substance                                              Past 30 Days:                                                                                Interviewer ratings of alcohol problem severity also identified a higher percentage of the affective
                                                                                                                                                                               Alcohol Use Days                              7                  5            n.s.          disorder group in the moderate to extreme range (86% vs. 38%). Client self-ratings of need for
               Sample and Method                                                   80%                                                                                         Alcohol Use to Intoxication Days
                                                                                                                                                                               Alcohol Problem Days
                                                                                                                                                                                                                                                                           treatment were not found to be significantly different.
                                                                                                                                                                              Alcohol Use Past 6 Months:                                                                   Measures of alcohol use during the past 30 days revealed no significant differences in the number
                                                                                   60%                                                                                         None or < 1 Time Per Month                   35%                53%                         of alcohol use days, alcohol problem days, or days of intoxication. Patterns of alcohol use and
The sample included 50 individuals receiving treatment services in the             50%
                                                                                                                                                                               1 - 4 Times Per Month                        23%                13%
                                                                                                                                                                                                                                                                           intoxication over the past 6 months also did not differ between the two groups. The schizophrenic
                                                                                                                                                                               2 - 6 Times Per Month                        23%                27%
Texas Dual Diagnosis Pilot Project who had been given the substance use                                                                                                        Daily                                        19%                7%            n.s.          group, however, identified the same patterns in alcohol use and intoxication days, suggesting that
sections of the Addiction Severity Index (ASI) interview during initial                                                                                                                                                                                                    when these clients used alcohol it was to the extent of intoxication.
assessment. The sample consisted of clients diagnosed with schizophrenia           30%                                                                                        Intoxication Frequency Past 6 Months:
                                                                                                                                                                                None or < 1 Time Per Month                  35%                53%
(N=18) or affective disorder (N=32), including major depressive disorder           20%                                                                                          1 - 4 Times Per Month                       29%                13%
                                                                                                                                                                                                                                                                           The results of this study suggest that, among individuals in treatment for co-occurring disorders,
(N=22) and bipolar disorder (N=10). The affective disorder groups were                                                                                                          2 - 6 Times Per Month                       19%                27%                         severity of alcohol use may be greater in individuals with severe and persistent affective disorders
                                                                                   10%                                                                                          Daily                                       16%                7%            n.s.
combined due to initial analyses indicating similar patterns in the two groups                                                                                                                                                                                             relative to clients with schizophrenia. Although the groups did not differ in self-identified alcohol
distinct from the schizophrenia group.                                               0%                                                                                                                                                                                    use and intoxication patterns, lifetime treatment history, rates of delirium tremens, and interviewer
                                                                                            Alcohol    Marijuana      Polysub        Other         None
                                                                                                                                                                                                                                                                           and client alcohol problem severity ratings were higher in the affective disorder group. Further,
Analyses of demographic characteristics indicated that the two diagnostic                                                                                                                                                                                                  client self-ratings indicate that schizophrenic clients may be less aware of the level of severity of
                                                                                                                                                                                                                                                                           abuse. The schizophrenic group more often identified themselves as having no primary
groups were significantly different on the gender, age, and race/ethnicity
                                                                                            Clinician Ratings of Primary Substance                                                                                                                                         substance of abuse and rated their alcohol problem less intensely compared to interviewer
variables. Due to these findings, initial analyses were conducted examining
                                                                                                                                                                                                                                                                           ratings. These findings suggest the importance of examining factors other than categorical use
potential effects of demographic variables on alcohol use patterns.
                                                                                                                                                                                                                                                                           of specific substances when comparing diagnostic categories. Results also suggest careful
Significant findings included a correlation between age and total years of
alcohol use, females were older than males (41 vs. 35 years), and Whites           90%
                                                                                                                                                                                            Acknowledgements                                                               assessment of substance use with schizophrenic clients due to potential deficits in self-
were more likely to report high frequency of intoxication over the past 6          80%

months and to rate themselves as higher in need of alcohol treatment.              70%                                                                                   The authors acknowledge the Texas Dual Diagnosis Pilot research team comprised of
                                                                                                                                                                         representatives of the Texas Department of Mental Health and Mental Retardation
The affective disorder and schizophrenia groups were compared on alcohol                                                                                                 (TDMHMR) and the Texas Commission on Alcohol and Drug Abuse (TCADA). In particular,
                                                                                                                                                                         the contribution of TDMHMR researcher Molly Lopez, Ph.D. is noted for her extensive work
use and severity measures obtained from the ASI, using t-tests for                 40%                                                                                   with the pilot project, including evaluation design, training, and data management.
continuous variables and Chi-square analyses for categorical measures.
The demographic effects revealed during initial analyses were considered                                                                                                 The project was jointly funded by TDMHMR and TCADA. However, the findings and
                                                                                   20%                                                                                   conclusions of this in this presentation are the opinions of the authors and do not
when interpreting results. Analyses indicated that the diagnostic groups
                                                                                                                                                                         necessarily reflect the official position of TDMHMR or TCADA.
differed only on variables that were not associated with demographic               10%

factors, suggesting that the differences were related to diagnoses rather           0%
                                                                                             Alcohol      Marijuana        Polysub             Other
than gender, age, or race/ethnicity.

                                                                                                                                                                                                                                                                      Presented at the Research Society on Alcoholism, Vancouver, Canada, June 27, 2004
                                                                                  Affective Disorders                                                               Schizophrenia

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