Study Shows Effects of Substance Abuse on Violence by Psychiatric Patients

DRUG USE TRENDS May-June 1998

People discharged from psychiatric hospitals who do not abuse alcohol or drugs are no more likely to commit violent acts than their neighbors who do not abuse alcohol or drugs, according to a study published in the Archives of General Psychiatry (Henry J. Steadman, PhD, et al, "Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods" Archives of General Psychiatry, May 1998, pp. 393-401; Bruce G. Link, PhD, and Ann Stueve, PhD, "New Evidence of the Violence Posed by People With Mental Illness," Archives of General Psychiatry, May 1998; Fox Butterfield, "Studies of Mental Illness Show Links to Violence," New York Times, May 15, 1998, p. A14; Martha Irvine, "Mentally ill not violent, study says," Denver Post, May 15, 1998, p. 8A; Sandra G. Boodman, "Are Former Mental Patients More Violent?" Washington Post, May 19, 1998, Health section, p. 7).

The authors enrolled 1136 patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence against others every 10 weeks during their first year after discharge from the hospital. Patient self-reports were augmented by reports from collateral informants and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks. The study was funded by the John D. and Catherine T. MacArthur Foundation.

Substance abuse symptoms were measured by periodic administration of the Michigan Alcoholism Screening Test (MAST) and the Drug Abuse Screening Test (DAST). Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups. A higher portion of patients reported symptoms of substance abuse than of others in their neighborhoods. Eighty-six percent of violent acts by recently discharged mental patients who abuse substances are directed at friends and relatives and occur in the home.

"The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring [with] substance abuse diagnosis or symptoms," according to the study. Mentally ill persons are twice as likely as other people to be alcoholics or using illicit drugs, the report said. Patients with substance abuse problems are five times more likely than the general population to be violent, while substance abusers who are not ex-patients are three times more likely to commit a violent act.

"If we are to reduce violent behavior, then substance abuse services need to be provided to discharged patients," John Monahan, a professor of legal medicine at the University of Virginia School of Law and coauthor of the article. "What often happens now is that a patient is discharged from a psychiatric hospital and given a referral to a substance abuse treatment center across town" Mike Faenza, president of the National Mental Health Association said the report underscored the need to "bring mental health and substance abuse treatment services together."

National Mental Health Association - 1021 Prince St., Alexandria, VA 22314, Tel: (703) 684-7722.

Lead author of the study: Henry J. Steadman, PhD - Policy Research Associates, 262 Delaware Ave., Delmar, NY 12054, Tel: (518) 439-7415, Fax: (518) 439-7612.