Editorials

Severe mental illness and substance misuse

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7177.137 (Published 16 January 1999) Cite this as: BMJ 1999;318:137

Research is needed to underpin policy and services for patients with comorbidity

  1. Tim Weaver, Research fellow.,
  2. Adrian Renton, Reader in social medicine,
  3. Gerry Stimson, Professor of sociology of health behaviour,
  4. Peter Tyrer, Professor of community psychiatry
  1. Department of Social Science and Medicine, Imperial College of Science, Technology, and Medicine, London SW6 1RQ
  2. Department of Psychiatry, Imperial College of Science, Technology, and Medicine, London W2 1PD

    Evidence from the United States suggests that half of all patients with schizophrenia also have a substance misuse disorder.1 This comorbidity is associated with poor prognosis and heavy use of expensive inpatient care through recurrent “revolving door” admissions.2 The phenomenon has only recently been recognised in the United Kingdom, but one survey of psychotic patients in an inner London district found that 36% misused drugs or alcohol. The same survey observed inpatient admission rates among comorbid patients that were almost double those of patients with psychosis alone.3 This high prevalence, the problems of clinical management,4 and a continued rise in the general rate of drug misuse make comorbidity a major public health issue, and the Department of Health is currently inviting applications for research into the prevalence and pattern of comorbidity.

    The term “dual diagnosis” is used increasingly in psychiatric practice to describe this combination of …

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