Substance Abuse, Psychosis Affect Men and Women Differently


Significant numbers of the people in the U.S. dealing with serious substance-related issues also have symptoms of a highly destabilizing mental state called psychosis. Some affected individuals meet the basic criteria used to identify a substance- and mental health-related condition called dual diagnosis. In a study published in September 2014 in the Journal of Dual Diagnosis, researchers from two U.S. universities used a two-year project to compare the gender-based differences in the effects of simultaneous substance problems and psychosis-related symptoms. These researchers identified several such differences that may ultimately affect the course of successful treatment.


Psychosis damages mental health in several ways. The two most prominent symptoms of this state are hallucinations that alter the sensory information coming into the body and delusional patterns of thought that, although clearly deeply illogical to an outside observer, persist strongly in the mind of the affected individual. A person impacted by psychosis may also develop problems that include strange gaps or leaps in thought or speech, and ways of thinking and speaking that don’t follow a conventional, organized pattern of communication. Some people with psychosis have any one of several diagnosable mental illnesses strongly linked to this debilitating mental state, including schizophrenia, schizoaffective disorder, schizotypal personality disorder and certain forms of major depression and bipolar disorder. Other people have a condition called substance/medication-induced psychotic disorder, which stems from damaging side effects associated with the use of alcohol, certain illicit/illegal drugs and certain mind-altering medications. Additional possible causes of psychosis include certain forms of epilepsy, Huntington’s disease, stroke, dementia, infections that disrupt normal brain function and Parkinson’s disease.

Substance Problems and Dual Diagnosis

By definition, a person with dual diagnosis has a serious, abuse- or addiction-related problem with alcohol, drug or medication consumption. In some cases, the co-existing mental health component of the condition centers on psychosis stemming from a mental illness or psychosis stemming from substance use. However, a range of other relatively moderate and relatively severe mental health issues can also appear in an individual affected by dual diagnosis, including non-psychosis-related major depression and bipolar disorder, non-psychosis-related personality disorder and a range of anxiety disorders. Overlapping problems with substance abuse/addiction and mental illness are unfortunately relatively common throughout the U.S. In some cases, substance problems precede mental illness; however, non-substance-based mental illness may also precede substance problems. Substances particularly associated with dual diagnosis include alcohol, the stimulants cocaine and methamphetamine, opioid drugs and medications, and marijuana and other forms of cannabis.

Differences in Men and Women

In the study published in the Journal of Dual Diagnosis, researchers from Columbia University and Dartmouth College’s Geisel School of Medicine used data gathered from 385 adults to compare the combined impact of substance problems and psychosis in women to the combined impact of these issues in men. All of the study participants were relatively young people receiving emergency treatment for psychosis-related symptoms who also had a history of recent substance intake. The researchers separated these participants into one group of people with mental illness-related psychosis and a second group of people with substance-related psychosis. Over the next two years, they used six-month assessments to look for gender-based differences in the health outcomes of both of these groups.

The researchers concluded that, compared to the men enrolled in the study, the women were mentally healthier before developing symptoms of dual diagnosis. In addition, the women typically got involved in substance use at a later age and were less likely to have received a misdiagnosis of their condition. However, the researchers also concluded that the women had higher risks for depression symptoms and were much more commonly affected by past physical or sexual abuse. Conversely, the men had a higher rate of past exposure to the criminal justice system.

The study’s authors concluded that women and men have roughly equal chances of meeting the criteria for dual diagnosis. They also concluded that, whether psychosis symptoms are related to substance use or separate mental illness, affected men and women typically see an improvement in their dual diagnosis symptoms over time. This fact holds true even when the method of treatment is not particularly intensive. Still, the authors believe that underlying factors in affected men and women may make gender-based treatment an appropriate option for people with psychosis-related dual diagnosis.

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