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Violence, Mental Illness and Substance Abuse
by admin on: April 1st, 2011

Generally speaking, when a patient presents with comorbid substance abuse and mental illness, there is a substantial increase for the risk of violence in these patients. Broadly speaking, treating the violent behavior in patients diagnosed with mental illness and substance abuse requires treating both the underlying psychopathology and the substance abuse together. A recent publication in the Journal of the American Medical Association (August 2010) has re-explored this issue by focusing on the violent behavior.

However, before reviewing this data, the authors started with a non-substance abuse situation???to the emerging evidence in the literature, there are at least two pathways to violence that may occur in schizophrenics. The first pathway is associated with the schizophrenic having a long history of antisocial behavior problems that often begin during childhood. The second pathway is associated with the schizophrenic who does not have the aforementioned history; rather, he or she presents with acute psychotic symptoms.

Studies indicate that antipsychotic medications may reduce the risk for violence in the second case, but not the first. Individuals who present with schizophrenia and substance abuse may go down one of several pathways to violence, dependent on the drug they are abusing. For example, a schizophrenic who abuses alcohol may become violent, as alcohol may exacerbate underlying psychiatric symptoms. In addition, violence exhibited by schizophrenics with substance abuse problems occurs in individuals living in the community as well as those who are hospitalized.

Complicating matters, some schizophrenics possess maladaptive personality attributes which may play a role in their violent behavior either directly or indirectly. It follows that these personality attributes may predispose an individual to a substance abuse problem, which then leads to more violent behavior. Due to the circularity of this phenomenon, it should be stressed that it is possible to treat these patients (of course), but attempts to diagnosis the etiology of the violent behavior (inherent or related to drugs) should be addressed.

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