Indian Journal of Private Psychiatry

Register      Login

VOLUME 18 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Prevalence of Substance Abuse in Patients Suffering from Schizophrenia: A Cross-sectional Study

Anweshan Ghosh, Swadesh Kanti Mondal, Gulshan Narula, Prosenjit Ghosh

Keywords : Alcohol, Cannabis, Dual diagnosis, Opioids, Schizophrenia, Substance dependence

Citation Information : Ghosh A, Mondal SK, Narula G, Ghosh P. Prevalence of Substance Abuse in Patients Suffering from Schizophrenia: A Cross-sectional Study. Ind J Priv Psychiatry 2024; 18 (1):26-30.

DOI: 10.5005/jp-journals-10067-0145

License: CC BY-NC 4.0

Published Online: 03-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: Compared with non-abusing individuals who have schizophrenia, those with co-occurring schizophrenia and substance use have been found to have higher rates of homelessness, more unemployment, and poorer overall functioning. Various factors like genetic and environmental vulnerability, including family and social influences, early life trauma, and poor frontal lobe functioning, contribute to the development of psychiatric distress and drug abuse. Aims and objectives: This study aimed to assess the prevalence of substance dependence in cases of schizophrenia, and to check the correlation of severity of psychiatric symptoms in schizophrenia with severity of substance dependence. Materials and methods: This study was a cross-sectional non-interventional hospital-based study. Diagnosis of schizophrenia was made according to the International Classification of Diseases 10 (ICD-10). The severity of symptoms of schizophrenia was assessed using Brief Psychiatric Rating Scale (BPRS) and the severity of substance dependence was assessed using Severity of Dependence Scale (SDS). The data obtained were analyzed using SPSS version 26. Results: A total of 50 patients diagnosed with schizophrenia as per the ICD-10 criteria were recruited after their informed consent. Majority of the participants were young lower middle-class male; most of the participants were married (80%), homemakers or students by profession (22% each), belonging to a rural area (54%). Fifty-four percent of them (n = 27) reported having comorbid substance use disorder. The mean BPRS score was found to be 62.4 ± 22.36, while the mean SDS score was 5.3 ± 5.17. The BPRS score was found to be significantly correlated with the SDS score (r = 0.949, p < 0.001). Conclusion: A significant correlation was found between severity of psychiatric symptoms and severity of substance dependence.

  1. Sadock B, Sadock V, Ruiz P. Synopsis of psychiatry. Philadelphia, PA: Wolters Kluwer; 2015.
  2. Drake RE, McLaughlin P, Pepper B, Minkoff K. Dual diagnosis of major mental illness and substance disorder: An overview. New Dir Ment Health Serv 1991;1991(50):3–12. DOI: 10.1002/yd.23319915003.
  3. Soyka M, Albus M, Kathmann N, et al. Prevalence of alcohol and drug abuse in schizophrenic inpatients. Eur Arch Psychiatry Clin Neurosci 1993;242(6):362–372. DOI: 10.1007/BF02190250.
  4. Seibyl JP, Satel SL, Anthony D, et al. Effects of cocaine on hospital course in schizophrenia. J Nerv Ment Dis 1993;181(1):31–37. DOI: 10.1097/00005053-199301000-00006.
  5. Kovasznay B, Fleischer J, Tanenberg-Karant M, et al. Substance use disorder and the early course of illness in schizophrenia and affective psychosis. Schizophr Bull 1997;23(2):195–201. DOI: 10.1093/schbul/23.2.195.
  6. Haywood TW, Kravitz HM, Grossman LS, et al. Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 1995;152(6):856–861. DOI: 10.1176/ajp.152.6.856.
  7. Green AI, Tohen M, Hamer RM, et al. First-episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol. Schizophr Res 2004; 66(2–3):125–135. DOI: 10.1016/j.schres.2003.08.001.
  8. Hambrecht M, Häfner H. Substance abuse and the onset of schizophrenia. Biol Psychiatry 1996; 40(11):1155–1163. DOI: 10.1016/S0006-3223(95)00609-5.
  9. Caspi A, Moffitt TE, Cannon M, et al. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: Longitudinal evidence of a gene × environment interaction. Biol Psychiatry 2005;57(10):1117–1127. DOI: 10.1016/j.biopsych.2005.01.026.
  10. D'Souza DC, Abi-Saab WM, Madonick S, et al. Delta-9-tetrahydrocannabinol effects in schizophrenia: Implications for cognition, psychosis, and addiction. Biol Psychiatry 2005; 57(6): 594–608. DOI: 10.1016/j.biopsych.2004.12.006.
  11. Kavanagh DJ, McGrath J, Saunders JB, et al. Substance misuse in patients with schizophrenia. Drugs 2002;62(5):743–755. DOI: 10.2165/00003495-200262050-00003.
  12. Levin ED, Wilson W, Rose JE, et al. Nicotine haloperidol interactions and cognitive performance in schizophrenia. Neuropsychopharmacology 1996;15(5):429–436. DOI: 10.1016/S0893-133X(96)00018-8.
  13. Adler LE, Hoffer LD, Wiser A, et al. Normalization of auditory physiology by cigarette smoking in schizophrenic patients. Am J Psychiatry 1993;150(12):1856–1861. DOI: 10.1176/ajp.150.12.1856.
  14. Brady KT, Sinha R. Co-occurring mental and substance use disorders: The neurobiological effects of chronic stress. Am J Psychiatry 2005;162(8):1483–1493. DOI: 10.1176/appi.ajp.162.8.1483.
  15. Markou A, Kosten TR, Koob GF. Neurobiological similarities in depression and drug dependence: A self-medication hypothesis. Neuropsychopharmacology 1998;18(3):135–174. DOI: 10.1016/S0893-133X(97)00113-9.
  16. Chambers RA, Krsytall JH, Self DW. A neurobiological basis for substance abuse comorbidity in schizophrenia. Biol Psychiatry 2001;50(2):71–83. DOI: 10.1016/s0006-3223(01)01134-9.
  17. Juckel G, Schlagenhauf F, Koslowski M, et al. Dysfunction of central striatal reward prediction in schizophrenia. Neuroimage 2005;29(2):409–416. DOI: 10.1016/j.neuroimage.2005.07.051.
  18. Heinz A, Reimold M, Wrase J, et al. Correlation of stable elevations in striatal mu-opioid receptor availability in detoxified alcoholic patients with alcohol craving: A positron emission tomography study using carbon 11- labeled carfentanil. Arch Gen Psychiatry 2005;62(1):57–64. DOI: 10.1001/archpsyc.62.1.57.
  19. Matholon DH, Pfefferbaum A, Lim KO, et al. Compounded brain volume deficits in schzophrenia-alcoholism comorbidity. Arch Gen Psychiatry 2003;60(3):245–252. DOI: 10.1001/archpsyc.60.3.245.
  20. Winklbaur B, Ebner N, Sachs G, et al. Substance abuse in patients with schizophrenia. Dialogues Clin Neurosci 2006;8(1):37. DOI: 10.31887/DCNS.2006.8.1/bwinklbaur.
  21. Ambekar A, Agrawal A, Rao R, et al. Magnitude of substance use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.
  22. World Health Organization. ICD-10: International statistical classification of diseases and related health problems. Geneva: World Health Organisation; 2003.
  23. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep 1962;10(3):799–812. DOI:
  24. Leucht S, Kane JM, Kissling W, et al. Clinical implications of brief psychiatric rating scale scores. Brit J Psychiatry 2005;187(4):366–371. DOI: 10.1192/bjp.187.4.366.
  25. Gossop M, Darke S, Griffiths P, et al. The Severity of Dependence Scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction 1995;90(5):607–614. DOI: 10.1046/j.1360-0443.1995.9056072.x.
  26. Ferri P, Marsden J, de Araujo M, et al. Validity and reliability of the Severity of Dependence Scale (SDS) in a Brazilian sample of drug users. Drug Alcohol Rev 2000;19(4):451–455. DOI: 10.1080/713659418.
  27. Kaye S, Darke S. Determining a diagnostic cut-off on the Severity of Dependence Scale (SDS) for cocaine dependence. Addiction 2002;97(6):727–731. DOI: 10.1046/j.1360-0443.2002.00121.x.
  28. Topp L, Mattick RP. Choosing a cut-off on the Severity of Dependence Scale (SDS) for amphetamine users. Addiction 1997;92(7):839–845. DOI:
  29. Swift W, Copeland J, Hall W. Choosing a diagnostic cut-off for cannabis dependence. Addiction 1998;93(11):1681–1692. DOI: 10.1046/j.1360-0443.1998.931116816.x.
  30. Lawrinson P, Copeland J, Gerber S, et al. Determining a cut-off on the Severity of Dependence Scale (SDS) for alcohol dependence. Addict Behav 2007;32(7):1474–1479. DOI: 10.1016/j.addbeh.2006.09.005.
  31. Cuevas CD, Sanz EJ, Fuente JA, et al. The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study. Addiction 2000;95(2):245–250. DOI: 10.1046/j.1360-0443.2000.95224511.x.
  32. Boland R, Verduin M, Ruiz P, et al. Kaplan & Sadock's synopsis of psychiatry. Philadelphia: Wolters Kluwer; 2021.
  33. Volkow ND. Substance use disorders in schizophrenia—clinical implications of comorbidity. Schizophr Bull 2009;35(3):469–472. DOI: 10.1093/schbul/sbp016.
  34. Grant B, Kaplan K, Shepard J, et al. Source and Accuracy Statement for Wave 1 of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 2003.
  35. McBride O, Teesson M, Slade T, et al. Further evidence of differences in substance use and dependence between Australia and the United States. Drug Alcohol Depend 2009;100(3):258–264. DOI: 10.1016/j.drugalcdep.2008.10.011.
  36. NFHS-5 (2019–20). on 12-04-21.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.