When I first stumbled upon this recent study, I had to laugh. I mean, another study that links mental illness with substance abuse? Really? Was there a need to spend more time and money to discover what has been discovered again and again and again? Well, to my surprise, there was.
I’ve heard “10 years” bandied about here and there, over the years, specifically that those who are diagnosed with depression or bipolar disorder average a life-span of 10 years less than the general population. I have no idea where the 10 year number came from, but, obviously, this has caused me some concern. Now I’m even more anxious. This newer study, at Washington University School of Medicine in St. Louis and the University of Southern California showed the average length is much younger – with estimates of death ranging from 12 to 25 years earlier than individuals in the general population. Damn, that’s not good news. The study is published in the Journal of the American Medical Association Psychiatry.
This study did not focus on depression and bipolar only. The study included other illness’, such as schizophrenia and schizoaffective disorder.
In the largest ever assessment of substance use among people with severe psychiatric illness, researchers at Washington University School of Medicine in St. Louis and the University of Southern California have found that rates of smoking, drinking and drug use are significantly higher among those who have psychotic disorders than among those in the general population.
The finding is of particular concern because individuals with severe mental illness are more likely to die younger than people without severe psychiatric disorders. So far this is old news, but wait…
“These patients tend to pass away much younger, with estimates ranging from 12 to 25 years earlier than individuals in the general population,” said first author Sarah M. Hartz, MD, PhD, assistant professor of psychiatry at Washington University. “They don’t die from drug overdoses or commit suicide — the kinds of things you might suspect in severe psychiatric illness. They die from heart disease and cancer, problems caused by chronic alcohol and tobacco use.” 12 – 25 years!!! (gulp)
The study analyzed smoking, drinking and drug use in almost 20,000 people, including 9,142 psychiatric patients diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. The study also analyzed nicotine use, heavy drinking, heavy marijuana use and recreational drug use in more than 10,000 healthy people without mental illness. The numbers are staggering.
The researchers found that 30 percent of those with severe psychiatric illness were binged drinkers. Binge drinking is defined as drinking four servings of alcohol at one time. In comparison, the rate of binge drinking in the general population is 8 percent.
75 percent of the mentally ill are regular smokers compared with 33 percent of the general population.
50 percent of the mentally ill used marijuana compared to 18 percent of the general population.
50 percent of people with psychotic disorders used marijuana regularly compared to 18 percent in the general population.
50 percent of those with mental illness also used other illicit drugs, compared to 12 percent of the general population.
I don’t know about you, but I’m starting to think there’s a whole lot of self-medicating going on.
“I take care of a lot of patients with severe mental illness, many of whom are sick enough that they are on disability,” said Hartz. “And it’s always surprising when I encounter a patient who doesn’t smoke or hasn’t used drugs or had alcohol problems.” As for me, when I was checked into the psych ward at Cedars Sinai hospital; They didn’t ask me if I was taking drugs, they asked me what drugs I was taking. When I discussed it with one of the nurses, I was told it was rare to check someone in who hasn’t been self-medicating, so it’s just assumed you are.
Hartz said another striking finding from the study is that once a person develops a psychotic illness, protective factors such as race and gender don’t have their typical influence.
Earlier research has shown that Hispanics and Asians tend to have lower rates of substance abuse than European Americans. The same is true for women, who tend to smoke, drink and use illicit drugs less often than men.
“We see protective effects in these subpopulations,” Hartz explained. “But once a person has a severe mental illness that seems to trump everything.”
That’s particularly true, she said, with smoking. During the last few decades, smoking rates have declined in the general population. People over age 50 are much more likely than younger people to have been regular smokers at some point in their lives. For example, about 40 percent of those over 50 used to smoke regularly. Among those under 30, fewer than 20 percent have been regular smokers. But among the mentally ill, the smoking rate is more than 75 percent, regardless of the patient’s age.
“With public health efforts, we’ve effectively cut smoking rates in half in healthy people, but in the severely mentally ill, we haven’t made a dent at all,” she said.
Having 10 years of sobriety under my belt, I hope the statistics have turned toward my advantage, but I’m concerned about my brothers and sisters out there who haven’t changed their lives. Those with serious mental illness who have done nothing about their self-medicating than to self-medicate even more.
According to Hertz, “We can do better, but we also need to develop new strategies because many interventions to reduce smoking, drinking and drug use that have worked on other patient populations don’t seem to be very effective in these psychiatric patients.” My hope is that now that we know these daunting figures that more time and money will go to aid the mentally ill in overcoming addictive behavior. We have far too many dying out there.