in dual dx's, drug abuse trtmt reduces violence more than trtmt of mental illness

[HereSince1628]

This is consistent with oft cited studies that suggest substance abuse has stronger correlation with risk of violence more than mental illness

------------------------------------------------------------------------
If a person is dually diagnosed with a severe mental illness and a substance abuse problem, are improvements in their mental health or in their substance abuse most likely to reduce the risk of future violence?

Although some may believe that improving symptoms of mental illness is more likely to lessen the risk for future episodes of violence, a new study from the University at Buffalo Research Institute on Addictions (RIA) suggests that reducing substance abuse has a greater influence in reducing violent acts by patients with severe mental illness.

"We were surprised to find that the severity of the patient's psychiatric symptoms was not the primary factor in predicting later aggression," says Clara Bradizza, senior research scientist at RIA and co-author of the study. "Rather, the patient's substance abuse was the factor most closely associated with future aggression."

Although the vast majority of people with mental illness do not engage in violent acts, the risk of violence is greater among the severely mentally ill than among the general population, and the connection between severe mental illness, substance abuse and aggression is a significant concern for community safety, treatment programs and public policy.

<snip, more>


Yue Zhuo, Clara M. Bradizza, Stephen A. Maisto. The influence of treatment attendance on subsequent aggression among severely mentally ill substance abusers. Journal of Substance Abuse Treatment, 2014; 47 (5): 353 DOI: 10.1016/j.jsat.2014.06.010

http://www.sciencedaily.com/releases/2014/10/141001133127.htm

[dixiegrrrrl]

1. I do not see why they were "surprised" to see the results.

First of all, many people are misdiagnosed with a mental illness problem when what they have is a substance abuse problem.
and the most common mis-diagnoses, in my experience, has been bi-polar, a label given to people who were using crack cocaine.
Dual diagnosis was not even a "thing" until late 1980's, and not commonly accepted for years after that.

So I would like to see how their diagnosis' were made of the study subjects.

More basically, the use of cocaine or whiskey seemed to produce the most aggressive behavior, in my experience with patients and their families.
successful sub. abuse treatment often resulted in the absence of any "bi-polar " symptoms.

Sadly, a lot of people had to carry around a mis-placed Mental Health diagnosis after their substance abuse was no longer a factor.

[HereSince1628]

2. The full text requires an account, the abstract says this...

"...longitudinal data collected from 278 patients over a 6-month period following admission to an outpatient dual diagnosis treatment program..."

I imagine using patients from dual diagnosis treatment program introduces some bias toward patients who were cooperative help-seekers. I have no real idea how that would effect the analysis, if any.

Misdiagnosis is a continuing problem. My experience is a psychiatric diagnosis is rather more hypothesis than what is experienced in with "physical" health problems.

It's also my experience that psychotherapy is often the same regardless of dx. So in a practical sense differential diagnosis isn't something that's much worried about, until a patient doesn't move toward resolution.