title: Comorbidity of severe psychotic disorders with measures of substance use.
abstract: OBJECTIVE
  Although early mortality in severe psychiatric illness is linked to smoking and alcohol, to our knowledge, no studies have comprehensively characterized substance use behavior in severe psychotic illness. In particular, recent assessments of substance use in individuals with mental illness are based on population surveys that do not include individuals with severe psychotic illness.
  
  
  OBJECTIVE
  To compare substance use in individuals with severe psychotic illness with substance use in the general population.
  
  
  METHODS
  We assessed comorbidity between substance use and severe psychotic disorders in the Genomic Psychiatry Cohort. The Genomic Psychiatry Cohort is a clinically assessed, multiethnic sample consisting of 9142 individuals with the diagnosis of schizophrenia, bipolar disorder with psychotic features, or schizoaffective disorder, and 10,195 population control individuals.
  
  
  METHODS
  Smoking (smoked >100 cigarettes in a lifetime), heavy alcohol use (>4 drinks/day), heavy marijuana use (>21 times of marijuana use/year), and recreational drug use.
  
  
  RESULTS
  Relative to the general population, individuals with severe psychotic disorders have increased risks for smoking (odds ratio, 4.6; 95% CI, 4.3-4.9), heavy alcohol use (odds ratio, 4.0; 95% CI, 3.6-4.4), heavy marijuana use (odds ratio, 3.5; 95% CI, 3.2-3.7), and recreational drug use (odds ratio, 4.6; 95% CI, 4.3-5.0). All races/ethnicities (African American, Asian, European American, and Hispanic) and both sexes have greatly elevated risks for smoking and alcohol, marijuana, and drug use. Of specific concern, recent public health efforts that have successfully decreased smoking among individuals younger than age 30 years appear to have been ineffective among individuals with severe psychotic illness (interaction effect between age and severe mental illness on smoking initiation, P = 4.5 × 105).
  
  
  CONCLUSIONS
  In the largest assessment of substance use among individuals with severe psychotic illness to date, we found the odds of smoking and alcohol and other substance use to be dramatically higher than recent estimates of substance use in mild mental illness.
authors.affiliation: Washington University in St. Louis, Missouri.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Hartz
authors.affiliation: University of Southern California, Los Angeles.
authors.forename: Carlos N
authors.initials: CN
authors.lastname: Pato
authors.affiliation: University of Southern California, Los Angeles.
authors.forename: Helena
authors.initials: H
authors.lastname: Medeiros
authors.affiliation: Washington University in St. Louis, Missouri.
authors.forename: Patricia
authors.initials: P
authors.lastname: Cavazos-Rehg
authors.affiliation: University of Southern California, Los Angeles.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Sobell
authors.affiliation: University of Southern California, Los Angeles.
authors.forename: James A
authors.initials: JA
authors.lastname: Knowles
authors.affiliation: Washington University in St. Louis, Missouri.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Bierut
authors.affiliation: University of Southern California, Los Angeles.
authors.forename: Michele T
authors.initials: MT
authors.lastname: Pato
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology*; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology