Drug and alcohol misuse among in-patients with psychotic illnesses in three inner-London psychiatric units

Abstract

Aims and MethodWard staff were asked to rate whether in-patients with a diagnosis of functional psychotic illness also met criteria for a diagnosis of alcohol or drug misuse or dependence during the preceding 6 months. Those who demonstrated such evidence were then asked to report the nature and extent of their substance use and whether they continued to use as in-patients.Results264 in-patients with psychotic illness were screened for evidence of recent or current alcohol or drug misuse. According to staff reports, 127 (48.9%) met the criteria for substance misuse or dependence. The mean age of those with ‘dual diagnosis' was 34.7 years and 72% were male. Eighty-three (83%) of those with a history of current or recent alcohol or drug misuse reported that they had continued to use alcohol and/or illicit drugs in the in-patient wards during their current admission.Clinical ImplicationsIt appears difficult to prevent in-patients with drug or alcohol misuse problems from continuing to use substances in hospital. Further consideration and investigation of how best to manage this group is therefore required.

A Multi-Method Evaluation of a Substance Misuse Program in a Medium Secure Forensic Mental Health Unit

“…Within forensic services individuals may continue to use substances (Durand, Lelliott & Coyle, 2006;Phillips & Johnson, 2003;Williams & Cohen, 2000) or may engage in other behaviors or rituals (substitution or parallel behaviors) in response to cravings when substances are unavailable. In addition, those in forensic populations are likely to be poly-substance users (e.g., D'Silva & Ferriter, 2003;Oddie & Rodgers, 2007;Thomas & O'Rourke, 2002).…”

Dual Diagnosis: An Exploratory Qualitative Study of Staff Perceptions of Substance Misuse Among the Mentally Ill in Northern India

“…In discussing the extent of dual diagnosis in their own services, participants reported that dual diagnosis was a common problems; participants estimated rate ranges similar to, and higher than, those found in western studies (Phillips & Johnson, 2003;Wright et al 2000).…”

“…It is reported that betel nut has anti-psychotic effects (Kuruppuarachchi & Williams, 2003;Sullivan et al, 2000) and is commonly used throughout the Asian region, however it also is associated with increased prevalence and incidence of oral cancer (Nair et al, 2004;Trivedy et al, 2002). Evidence has been reported of traditional substance use in adult inpatients in acute psychiatric admission wards in central London (Phillips & Johnson, 2003).…”

Predictive validity of the START for unauthorised leave and substance abuse in a secure mental health setting: A pseudo-prospective cohort study

“…Staff in secure units have reported that patients use illicit drugs (Dolan and Kirwan, 2001); and review of case notes suggests that about half of patients in forensic care report 'current substance use' (Scott et al, 2004), but it is not clear how many patients are actually using substances while in inpatient secure care. In general psychiatric inpatient care, use of illicit substances during the first two weeks of admission was 9.7% in the UK (Bowers et al, 2005), but a number of studies suggest that substance abuse is reduced by patients during inpatient care (e.g., Isaac et al, 2005;Phillips and Johnson, 2003); a finding likely to be replicated and amplified in secure care.…”