title: Walking the fine line: self-reported reasons for substance use in persons with severe mental illness.
abstract: Many theoretical models have been proposed to explain the relationship between severe mental illness (SMI) and substance use. Because many of these are contradictory quantitative American studies, a qualitative, exploratory study of a Scandinavian sample may offer a new perspective. The aim of the study is to explore reasons for substance use through analysis of the participants' experiences. A qualitative study with semistructured interviews was used. Purposeful sampling (N=11) of patients with substance use disorder (SUD) and SMI, who were included in assertive community treatment teams, was completed. Inclusion criteria are increased quality of life or increased general functioning, and decreased substance use, after a minimum of 12 months in treatment. Reasons given for using substances were categorized as (a) controlling the symptoms of mental illness, (b) counteracting medication side effects, or (c) balancing the ambiguity. The conclusion is that the study findings mainly support secondary substance use models in explaining the comorbidity of SMI and substance use. However, there is some support for the traditional self-medication hypothesis (SMH), iatrogenic vulnerability, and the supersensitivity model. This may be because the majority of the study participants reported having a mental illness with subsequent substance use. The expressed ambivalence to substance use also lends some support to bidirectional models.
authors.affiliation: National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway; SERAF - Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway; henning.pettersen@medisin.uio.no.
authors.forename: Henning
authors.initials: H
authors.lastname: Pettersen
authors.affiliation: Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Torleif
authors.initials: T
authors.lastname: Ruud
authors.affiliation: SERAF - Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
authors.forename: Edle
authors.initials: E
authors.lastname: Ravndal
authors.affiliation: National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway.
authors.forename: Anne
authors.initials: A
authors.lastname: Landheim
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology; D003156:Community Mental Health Services; D015897:Comorbidity; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D008960:Models, Psychological; D009664:Norway / Q000453:epidemiology; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D036301:Qualitative Research; D011788:Quality of Life; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology; D012651:Self Medication / Q000523:psychology*; D057566:Self Report; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents
keywords: Psychotic disorder; assertive community treatment; models of comorbidity; patient experiences; qualitative study; self-medication