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Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990–2017: systematic review and meta-analysis

Hunt, GE, Large, MM, Cleary, M ORCID: 0000-0002-1453-4850, Lai, HMX and Saunders, JB 2018 , 'Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990–2017: systematic review and meta-analysis' , Drug and Alcohol Dependence, vol. 191 , pp. 234-258 , doi: 10.1016/j.drugalcdep.2018.07.011.

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Background: Comorbidity is highly prevalent between substance use disorders (SUDs) and schizophrenia. Thissystematic review and meta-analysis estimated prevalence rates of SUDs in epidemiological and treatmentseekingpatients diagnosed with schizophrenia or first episode psychosis.Methods: A literature search of Medline, EMBASE, PsycINFO and CINAHL databases was conducted from 1990 to2017 inclusive. Prevalence of co-morbid SUDs and schizophrenia were extracted and odds ratios (ORs) werecalculated using random effects meta-analysis. Combining like studies was dictated how authors reported substanceuse.Results: There were 123 included articles with a total sample size of 165,811 subjects that yielded six epidemiologicalstudies, 11 national or state case-registry studies, 20 large cohort studies and 86 clinical studies usingin- or out-patient samples. The prevalence of any SUD was 41.7%, followed by illicit drugs (27.5%), cannabis(26.2%), alcohol (24.3%) and stimulant use (7.3%). Meta-analysis showed the pooled variance of any SUD inmales was 48% which was significantly higher than that for females with schizophrenia (22.1%, OR 3.43, 95%CI 3.01, 3.92). Patients with SUD had an earlier age of onset of schizophrenia. Meta-regression showed prevalenceincreased over time for illicit drugs but not for other substances, including alcohol.Conclusions: The meta-analysis revealed that SUDs in schizophrenia is highly prevalent and rates have notchanged over time. This indicates SUD are difficult to treat in this patient population and there is an urgent needfor more informative studies to help develop better prevention, detection and treatment of SUDs in persons withschizophrenia and co-morbid disorders.

Item Type: Article
Authors/Creators:Hunt, GE and Large, MM and Cleary, M and Lai, HMX and Saunders, JB
Keywords: Schizophrenia, Substance use, Dependence, Cannabis, Alcohol, Psychosis
Journal or Publication Title: Drug and Alcohol Dependence
Publisher: Elsevier Sci Ireland Ltd
ISSN: 0376-8716
DOI / ID Number: 10.1016/j.drugalcdep.2018.07.011
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Copyright 2018 Elsevier B.V.

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