SUBSTANCE MISUSE AND RISK OF AGGRESSION AND OFFENDING AMONG THE SEVERELY MENTALLY-ILL

Background The aim of this study was to investigate whether 'dual diag nosis' (substance misuse and severe mental illness) is associated with aggression and offending. Method Twenty-seven people meeting the crit eria for both psychotic illness and a substance use disorder and 65 pe ople with psychosis only were interviewed. Case notes were also examin ed and keyworkers asked to rate substance misuse and aggression. Resul ts The severity of aggression and offending among this community treat ment sample was low, individuals with a dual diagnosis were significan tly more likely than those with psychosis only to report any history o f committing an offence (P = 0.001), or recent hostile behaviour (P = 0.001). Keyworkers were more likely to report recent aggression among the dually diagnosed (P = 0.01). Significant differences persisted whe n we used logistic regression to control for potentially con founding demographic and clinical variables. Conclusions Dual diagnosis may be an important factor in aggression and offending among severely mentall y ill individuals in inner-city areas. Accurate risk assessment requir es examination of substance use.