Substance abuse and the onset of schizophrenia

Biol Psychiatry. 1996 Dec 1;40(11):1155-63. doi: 10.1016/S0006-3223(95)00609-5.


Up to 60% of chronic schizophrenic patients are reported to abuse alcohol or drugs. This comorbidity raises the question whether one disorder is a consequence of the other. With the structured interview "IRAOS," the onset and course of schizophrenia and substance abuse were retrospectively assessed in a representative first-episode sample of 232 schizophrenic patients. Information by relatives validated the patients' reports. Alcohol abuse prior to first admission was found in 24%, drug abuse in 14%-twice the rates in the general population. Alcohol abuse more often followed than preceded the first symptom of schizophrenia. Drug abuse preceded the first symptom in 27.5%, followed it in 37.9%, and emerged within the same month in 34.6% of the cases. The study demonstrates a remarkable association between first-episode schizophrenia and substance abuse, but a unidirectional causality is not supported, nor is a specific psychotic disorder in comorbid cases.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Age of Onset
  • Alcohol Drinking / psychology
  • Child
  • Chronic Disease
  • Comorbidity
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Retrospective Studies
  • Schizophrenia / epidemiology
  • Schizophrenic Psychology*
  • Sex Factors
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology*