January 2, 2014
Drinking, Smoking And Drug Use Much Higher Among Psychiatric Patients
New research from Washington University in St. Louis and the University of Southern California has revealed that people diagnosed with a severe psychiatric illnesses are more likely to smoke tobacco, drink alcohol and use drugs than people without a severe mental condition.
According to a report of the study in JAMA Psychiatry, researchers say the finding was important since people with mental illness tending to die at younger ages than mentally healthy individuals.
"These patients tend to pass away much younger, with estimates ranging from 12 to 25 years earlier than individuals in the general population," said study author Dr. Sarah M. Hartz, an assistant professor of psychiatry at Washington University. "They don't die from drug overdoses or commit suicide — the kinds of things you might suspect in severe psychiatric illness. They die from heart disease and cancer, problems caused by chronic alcohol and tobacco use."
In the study, the researchers looked at the substance use of almost 20,000 people, including over 9,100 patients diagnosed with bipolar disorder, schizophrenia or schizoaffective disorder, a psychiatric condition marked by delusions, and mood disorders such as depression.
The scientists discovered that 30 percent of those with severe mental illness were binge drinkers – compared to 8 percent of the general population. Over 75 percent of psychiatric patients were found to be smokers – compared to 33 percent of those without a severe condition. And half of those with psychiatric illness reported using illicit drugs, compared to 12 percent of healthy individuals.
"I take care of a lot of patients with severe mental illness, many of whom are sick enough that they are on disability," Hartz said. "And it's always surprising when I encounter a patient who doesn't smoke or hasn't used drugs or had alcohol problems."
While prior studies have shown that women, Hispanics and Asians tend to have lower rates of substance abuse than men or whites, this ‘protective’ effect seems to be lost once someone has a mental disorder.
"We see protective effects in these subpopulations," Hartz explained. "But once a person has a severe mental illness, that seems to trump everything."
She added that the loss of a protective effect seems to apply especially to smoking.
"With public health efforts, we've effectively cut smoking rates in half in healthy people, but in the severely mentally ill, we haven't made a dent at all," she said.
While mental health facilities have tended to be permissive when it comes to smoking, Hartz wondered if more aggressively trying to curb nicotine and other substance use in these patients might lengthen their lives.
"Some studies have shown that although we psychiatrists know that smoking, drinking and substance use are major problems among the mentally ill, we often don't ask our patients about those things," she said. "We can do better, but we also need to develop new strategies because many interventions to reduce smoking, drinking and drug use that have worked in other patient populations don't seem to be very effective in these psychiatric patients."