RAND Corporation.
Veterans Affairs Desert Pacific Mental Health Research, Education, and Clinical Center.
Psychol Serv. 2018 Feb;15(1):21-30. doi: 10.1037/ser0000109. Epub 2017 Mar 13.
Comorbid alcohol and drug use disorders are treatable and have substantial effects on outcomes and health care utilization in people with schizophrenia. While these substance use disorders (SUDs) are thought to be common in patients with schizophrenia, it has been difficult to characterize prevalence and treatment utilization of this population, since administrative data and medical records may not identify patients with schizophrenia who have an SUD diagnosis. In this study, we used an in-person, population-based survey of 801 individuals with schizophrenia who were in treatment within the Veterans Health Administration (VHA) to inform service delivery for patients with these problems. We examined patient- and clinician-reported data on substance use, psychotic symptoms, medication adherence, and quality of life, plus service utilization records, to understand the extent of comorbid substance use in this population and how those with varying levels of alcohol use utilize services. About 15.3% of the population self-reported use but not misuse of alcohol, while 7.4% reported misuse in the past month. We found few differences in demographic characteristics among those who were alcohol nonusers, users, and misusers, though alcohol misusers reported less frequent medication adherence, more frequent other drug use, worse psychotic symptoms, and worse quality of life. Alcohol users and misusers reported less use of general medical, mental health, occupational, and housing services at VHA, compared with nonusers. Targeted outreach efforts are needed to engage veterans with schizophrenia who drink at any level to engage them in services. (PsycINFO Database Record
共病酒精和药物使用障碍是可治疗的，并且对精神分裂症患者的结局和医疗保健利用有重大影响。虽然这些物质使用障碍（SUD）在精神分裂症患者中被认为很常见，但由于行政数据和医疗记录可能无法识别患有 SUD 诊断的精神分裂症患者，因此难以描述该人群的患病率和治疗利用情况。在这项研究中，我们使用了一项针对 801 名在退伍军人事务部（VHA）接受治疗的精神分裂症患者的面对面、基于人群的调查，为这些问题患者的服务提供信息。我们检查了患者和临床医生报告的物质使用、精神病症状、药物依从性和生活质量数据，以及服务利用记录，以了解该人群中合并物质使用的程度，以及不同饮酒水平的患者如何利用服务。大约 15.3%的人群自我报告使用但没有滥用酒精，而 7.4%的人群报告在过去一个月中有滥用行为。我们发现，在非饮酒者、饮酒者和滥用者之间，在人口统计学特征方面几乎没有差异，尽管酒精滥用者报告的药物依从性较低、其他药物使用更频繁、精神病症状更严重、生活质量更差。与非饮酒者相比，酒精使用者和滥用者在 VHA 报告的一般医疗、心理健康、职业和住房服务使用较少。需要有针对性的外展努力来吸引任何程度饮酒的精神分裂症退伍军人参与服务。
