Substance Use Risk Behaviors Among People With Schizophrenia and Their Association With Psychiatric and Situational Factors
In the United States, psychiatric patients with identified comorbid alcohol or other drug use disorders have a significantly higher rate of HIV infection than those without (McKinnon and Cournos 1998), even if they have never injected drugs. In this population, any lifetime instance of drug injection or needle sharing appears to increase the risk of being HIV infected more than sixfold (Ayuso-Mateos et al. 1997; Horwath et al. 1996; Rosenberg et al. 2001).
Similar to the case for the general population, HCV infection in psychiatric patients is most strongly associated with injection drug use, and to a lesser extent with other drug use and poverty. Of 122 patients identified with HCV in Rosenberg’s study, 91 were injection drug users, 21 reported sniffing cocaine, 17 had used crack, and 24 had used both types of cocaine, with only 7 reporting no drug-related risks (Rosenberg et al. 2001).
A history of drug injection has been noted among 1% to 26% of psychiatric patients (Carey et al. 1997; Rosenberg et al. 2001; Susser et al. 1996), and 5% to 12% report having ever shared needles or other injection paraphernalia (Carey et al. 1997; Rosenberg et al. 2001).
Moreover, psychiatric patients who inject tend to do so intermittently rather than regularly, so drug injection histories often are overlooked in mental health settings. In a group of chronically ill psychiatric patients, drug injection was not predicted by psychiatric diagnosis, chronicity, level of functioning, or psychiatric symptoms (Horwath et al. 1996).
In another study, drug injection was significantly more common among those with depressive disorder than among those with schizophrenia, and patients with bipolar disorder had the lowest rates of all (McDermott et al. 1994). As in the general population, alcohol or other drugs often are part of psychiatric patients’ sexual experience and may decrease the motivation or ability to have protected sex.
HIV and Hepatitis C in Patients With Schizophrenia
Fifteen percent to 45% of psychiatric inpatients and outpatients reported using substances during sex in the past year (Carey et al. 1997; Chuang and Atkinson 1996; Katz et al. 1994; Menon and Pomerantz 1997), with comparable rates seen in men and women.
Milton L. Wainberg, M.D.
Francine Cournos, M.D.
Karen McKinnon, M.A.
Alan Berkman, M.D.
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