The prevalence of substance use disorders and psychiatric disorders as a function of psychotic symptoms

Abstract Background Psychotic symptoms represent one of the most severe and functionally impairing components of several psychological disorders. One group with particularly high rates of psychotic symptoms is chronic substance users. However, the literature on psychotic symptoms and substance use is quite narrow and has focused almost exclusively on drug-induced psychosis, neglecting the population of substance users with psychotic symptoms occurring independently of acute drug effects. Method The current study examined demographics, substance dependence, and psychiatric comorbidities among substance users with current (CurrSx), past (PastSx), and no psychotic symptoms (NoSx). Patients ( n  = 685) were sequential admissions to a residential substance use treatment center from 2006 to 2009. Results Compared to NoSx, those who endorsed CurrSx were significantly more likely to meet criteria for lifetime alcohol dependence and lifetime amphetamine dependence. CurrSx were more likely than PastSx to meet for lifetime cannabis dependence. Additionally, CurrSx were more likely to meet criteria for a comorbid psychiatric disorder compared to NoSx, and evidenced a greater number of current psychiatric disorders. NoSx were less likely than both CurrSx and PastSx to meet criteria for Borderline Personality Disorder. Conclusion Individuals with non-substance induced psychotic symptoms appear to meet criteria for specific substance use disorders and psychiatric disorders at higher rates than those without psychotic symptoms; these effects were most evident for those with current as opposed to past symptoms. Findings suggest that these individuals may need specialized care to address potential psychiatric comorbidities and overall greater severity levels relative to substance users without psychotic symptoms.