Rural and urban differences in patients with a dual diagnosis

Objectives: To evaluate the differences between two cohorts of patients wit h severe mental illness (schizophrenia-spectrum or bipolar disorder) and co -occurring substance-use disorders, living in either predominantly rural ar eas or urban areas. Methods: Two study groups of patients with a dual diagn osis, recruited using the same criteria, were evaluated, including 225 pati ents from New Hampshire and 166 patients from two cities in Connecticut. Th e two study groups were compared on demographic characteristics, housing, l egal problems, psychiatric and substance use diagnoses, substance use and a buse, psychiatric symptoms, and quality of life. Results: Patients in the C onnecticut study group had higher rates of cocaine-use disorder, more invol vement in the criminal justice system, more homelessness, and were more lik ely to be from minority backgrounds. The Connecticut group also had a highe r proportion of patients with schizophrenia and more severe symptoms, as we ll as lower rates of marriage, educational attainment, and work than the Ne w Hampshire study group. Alcohol-use disorder was higher in the New Hampshi re group. Subsequent analyses within the Connecticut group indicated that a lthough African American patients had higher rates of cocaine-use disorder than white patients, cocaine disorder and not minority status was most stro ngly related to criminal involvement and homelessness. Conclusions: Because of the substances abused and the greater degree of psychiatric illness sev erity, patients with a dual diagnosis who are living in urban areas may req uire greater ancillary services, such as residential programs, Assertive Co mmunity Treatment, and jail diversion programs in order to treat their diso rders successfully. (C) 2001 Elsevier Science B.V. All rights reserved.