EARLY-ONSET SUBSTANCE-ABUSE AND COMMUNITY VIOLENCE BY OUTPATIENTS WITH CHRONIC MENTAL-ILLNESS

Objective: This study examined the relationship between violence and s ubstance abuse among patients with chronic mental illness living in th e community Methods: All referrals over a one-year period to an urban assertive community treatment team were evaluated systematically with a standardized intake protocol. Thirty-seven patients with a history o f violence in the community were compared with 27 patients without suc h a history on a variety of clinical and demographic variables. Result s: More than half of the patients (58 percent) had a history of violen ce in the community The only significant differences between those wit h a history of violence and those without involved alcohol or drug use , The single best predictor of violence was the onset of alcohol or dr ug abuse in late childhood or early adolescence. Conclusions: In this sample, very early onset of substance abuse among people who developed mental illness was associated with the greatest risk of community vio lence, Thus at least some of the causal determinants of violence in th is sample may precede the onset of adult mental illness.