1. Jouko Miettunen University of Oulu, Finland
Prevalence of alcohol use disorders in schizophrenia – A systematic review and meta-analysis
Jouko Miettunen
University of Oulu, Finland

2. Disclosure I have no financial relationships to disclose
I will not discuss off label use and/or investigational use in my presentation.

3. Introduction
Previous systematic reviews have found a wide range of rates (12-55%) of alcohol use disorder in schizophrenia samples
Previous studies published between the years were reviewed by Mueser et al. and those from the years by Cantor-Graae et al.
Mueser et al. Schizophr Bull 1990;16:31-55
Cantor-Graae et al. Schizophr Res 2001;48:69-82

4. Population lifetime prevalence of alcohol abuse or dependence
Reference (country)
Male
Female
Ross 1995 (Canada)
19.2 %
4.8 %
Chen et al 1993 (Hong Kong)
8.9 %
0.6 %
Wittchen et al 1992 (Germany)
21.0 %
5.1 %
Wells et al 1989 (New Zealand)
32.0 %
6.1 %
Bland et al 1988 (Canada)
29.3 %
6.7 %
Canino et al 1987 (USA)
24.6 %
2.0 %
Somers et al. Can J Psychiatry 2004;49:373-84

5. Schizophrenia and alcohol
Schizophrenia patients with alcohol use disorders have
more psychotic symptoms and more severe depressive symptoms (less negative symptoms?)
poorer treatment compliance
increased somatic morbidity
risk for violence, criminality and suicides
more negative psychosocial events e.g. divorce and unemployment
more admissions and longer hospitalization periods
Potvin et al. Psychol Med 2006;36: ; Potvin et al. Aust N Z J Psychiatry 2007;41: ; Drake & Mueser. Alcohol Health Res World 1996;20:87-93; Dixon. Schizophr Res 1999;35(suppl.):93-100; Gregg et al. Clin Psychol Rev 2007;27:

6. Aim
Our aim is to present recent studies of alcohol use disorders (AUDs) in schizophrenia, estimate overall prevalence, and characteristics affecting the prevalence of AUDs

7. Methods
We conducted a search using three literature databases and a manual search on articles published in
Metaregression was used to study how prevalence is affected by different study characteristics
Articles that reported diagnoses according to DSM or ICD diagnostic systems were included
We compared results with those of cannabis use disorders

8. Alcohol use disorders in schizophrenia
Altogether 60 studies met our criteria
median of current AUD prevalence was 9.4% (IQR = , 18 studies)
median of lifetime AUD prevalence 20.6% (IQR = , 47 studies)

9. Prevalence of alcohol use disorders in schizophrenia patients by type of alcohol use diagnosis
Number of studies
Mean (%)
Median (%)
Inter-Quartile Range
Range
Lifetime
- abuse 19
17.0
13.5
- dependence 10
22.3
18.7
- abuse or dependence 29
24.5
20.6
- total 47
23.4
Current 9
10.6
4.6 4
13.0
11.4 8
12.8
10.5 18
12.4
9.4
Total 60
20.9
17.8

12. Comparison of studies 1996-2008
Alcohol use disorders
Cannabis use disorders
Current diagnosis
Number of studies 18 10
Median (IQR) %
9.4 ( )
16.0 ( )
Lifetime diagnosis 47 28
20.6 ( )
27.1 ( )

13. Comparison of studies 1996-2008
Current alcohol vs. cannabis use disorders (7)
2 younger (mean age < 30 years) samples with more cannabis
5 older (mean age > 30 years) samples with more alcohol
Lifetime alcohol vs. cannabis use disorders (24)
8 studies with more cannabis
14 studies with more alcohol
2 with no difference

14. Diagnostic criteria ICD-10 vs. DSM-IV
Alcohol use that causes either physical or mental damage in the absence of dependence is categorized in ICD-10 as harmful
This category highlights the somatic problems related to alcohol use more than abuse in DSM-IV
This may lead to lower rate of abuse in younger populations in ICD-10
Kaczynski Pollock et al. J Stud Alcohol 2000;61:439–46.
Hiller. Eur Arch Psychiatry Neurol Sci 1989;239:101–8.

15. Conclusion
Approximately every fifth schizophrenia patient had lifetime AUD diagnosis
The decrease seen in prevalence estimates may be explained by stricter AUD criteria in diagnostic systems

16. Conclusion
Alcohol and cannabis use disorder are both common schizophrenia
Alcohol use disorders were more common in older than in younger schizophrenia patient samples
When contrasted to the most recent review there might be a descending trend in AUD prevalence in schizophrenia patients

17. Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J
Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J. Prevalence of alcohol use disorders in schizophrenic psychoses – A systematic review and meta-analysis. Acta Psychiatr Scand 2009; doi: /j x
Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J. Rate of cannabis use disorders in clinical samples of patients with schizophrenia: A meta-analysis. Schizophr Bull 2009; doi: /schbul/sbp031

18. Research Group Koskinen Johanna, MD Isohanni Matti, MD, PhD
Department of Psychiatry, University of Oulu, Finland
Koskinen Johanna, MD
Isohanni Matti, MD, PhD
Löhönen Johanna, MA
Miettunen Jouko, PhD
Department of Psychiatry, University of Kuopio, Finland
Koponen Hannu, MD, PhD
This study has been supported by the Academy of Finland