Prevalence of psychotic symptoms in substance users: a comparison across substances

Smith, Matthew J.; Thirthalli, Jagadisha; Abdallah, Arbi Ben; Murray, Robin M.; Cottler, Linda B.

doi:10.1016/j.comppsych.2008.07.009

« Previous Next »Comprehensive Psychiatry
Volume 50, Issue 3 , Pages 245-250, May 2009

Prevalence of psychotic symptoms in substance users: a comparison across substances

Matthew J. Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Corresponding author. Tel.: +1 312 695 8173l; fax: +1 312 695 6276.
Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
Arbi Ben Abdallah
- Department of Psychiatry, Epidemiology and Prevention Research Group (EPRG), Washington University School of Medicine, St Louis, MO 63101, USA
Robin M. Murray
- Division of Psychiatry and Psychological Medicine, Institute of Psychiatry, London SE5 8AF, United Kingdom
Linda B. Cottler
- Department of Psychiatry, Epidemiology and Prevention Research Group (EPRG), Washington University School of Medicine, St Louis, MO 63101, USA

published online 24 September 2008.

Abstract

Background

Psychotic symptoms (delusions and hallucinations) are reported to be increased among persons using illicit substances, but little is known about the comparative frequency with which the symptoms occur with abuse of different substances. To establish this, we interviewed individuals who had wide experience of commonly used drugs.

Methods

Four hundred seventy-six intravenous drug users, crack-cocaine users, and heroin snorters recruited via street outreach were interviewed using the Composite International Diagnostic Interview-Substance Abuse Model to assess dependence on a number of substances including amphetamines, cannabis, cocaine, and opioids. As a part of this assessment, we assessed a history of delusions and hallucinations in the context of use of, or withdrawal from, these specific substances.

Results

From 27.8% to 79.6% users of amphetamine, cannabis, cocaine, and opiates met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, dependence for that specific substance. The prevalence of psychotic symptoms associated with each specific substance ranged from users with no diagnosis to users with severe dependence as follows: amphetamines (5.2%-100%), cannabis (12.4%-80.0%), cocaine (6.7%-80.7%), and opiates (6.7%-58.2%). The risk of psychotic symptoms increased for respondents who abused (odds ratio [OR], 12.2) or had mild (OR, 17.1), moderate (OR, 47.0), or severe dependence (OR, 114.0) on cocaine when compared to those who were users with no diagnosis. A similar pattern was evident in cannabis, opiate, and amphetamine users.

Conclusions

Most users dependent on illicit substances experience psychotic symptoms in the context of use of, or withdrawal from, these substances. Psychotic symptoms increased with the severity of the substance use disorders for all 4 substances. These findings emphasize the importance of developing services to target this population as they are at a heightened risk for developing psychotic symptoms.