This study examined baseline correlates of substance use in the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness project. Approximately 60% of the sample was found to use substances, including 37% with current evidence of substance use disorders. Users (with and without substance use disorders), compared with nonusers, were significantly more likely to be male, be African-American, have lower educational attainment, have a recent period of homelessness, report more childhood conduct problems, have a history of major depression, have lower negative symptom and higher positive symptom scores on the Positive and Negative Syndrome Scale, and have a recent illness exacerbation. Individuals with comorbid substance use disorders were significantly more likely to be male, report more childhood conduct problems, have higher positive symptom scores on the Positive and Negative Syndrome Scale, and have a recent illness exacerbation. These analyses suggest that substance use disorders in schizophrenia are especially common among men with a history of childhood conduct disorder problems and that childhood conduct disorder problems are potent risk factors for substance use disorders in schizophrenia.
*Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC; †Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC; ‡Department of Psychiatry, Albuquerque Veteran’s Administration Medical Center and the University of New Mexico, Albuquerque, NM; §Department of Psychiatry, University of Iowa School of Medicine, Iowa City, IA; ∥Department of Psychiatry, University of Utah Medical Center, Salt Lake City, UT; ¶Appalachian Psychiatric Healthcare System, Athens, OH; #Psychiatric Research Institute, Wichita, KS; **Department of Psychiatry Yale Medical School and VA Connecticut Health Care System, University School of Medicine, New Haven, CT; and ††Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York, NY.
Send reprint requests to Marvin S. Swartz, MD, Professor, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC Box 3173, Durham, NC 27710.