Abstract：
In studying substance use disorder (SUD) and violence in severe mental illness (SMI), researchers account for presence of SUD or addictions to specific substances. However these studies fail to comprehensively capture solitary drug use versus specific combinations in a single exhaustive variable with more nuance (e.g., opioids only, alcohol only, both alcohol and opioids only, and so on). Using logistic regression to predict past-year violence, this study compared conventional SUD measurement (Model I: presence versus absence of SUD or specific SUDS) to a newer and more holistic approach (Model II: a single exhaustive variable with both solitary addictions [e.g., opioids only] and specific combinations of addictions [e.g., both opioids and alcohol only]) among 10,551 people with SMI in the National Survey of Drug Use and Health (20,015 - 2019). After adjusting for a wide variety of factors in Model II, people with (1) alcohol use disorders only were 2.24 times more likely to be violent (CI = 1.46-3.45, p <.001); (2) opioid use disorders only were 3.45 times more likely (CI-1.48-8.05, p,>01); (3) both alcohol and cocaine use disorders or cocaine only were 5.85 times more likely (CI = 2.63-13.05, p <.001); and (4) both alcohol and opioid use disorders only were 4.28 times more likely (CI = 1.34-13.71, p <.05). These more nuanced findings in Model II differed substantially from those using conventional SUD assessment in Model I, and the newer and more holistic approach can better reflect the complexity of addiction in relation to violence in SMI. Therefore studies, practices, and policies that address SUD and violence in SMI could be beneficially revisited with this greater comprehensiveness and detail.
摘要：
在研究严重精神疾病中的物质使用障碍（SUD）和暴力（SMI）时，研究人员解释了SUD的存在或对特定物质的成瘾。然而，这些研究未能在一个具有更细微差别的单一穷举变量中全面捕获单独使用药物与特定组合(例如，只有阿片类药物，只有酒精,只有酒精和阿片类药物，等等）。使用逻辑回归预测过去一年的暴力事件，这项研究将传统的SUD测量（模型I：SUD或特定SUDS的存在与不存在）与一种更新且更全面的方法（模型II：具有两种单独成瘾的单个穷举变量[例如，仅阿片类药物]和成瘾的特定组合[例如，仅阿片类药物和酒精]）在全国药物使用和健康调查（20,015-2019）中，有10,551名SMI患者。在对模型II中的各种因素进行调整后，患有(1)酒精使用障碍的人暴力的可能性是2.24倍(CI=1.46-3.45，p<.001)；(2)阿片类药物使用障碍的可能性是3.45倍(CI-1.48-8.05，p，>01）；（3）酒精和可卡因使用障碍或仅可卡因的可能性是5.85倍（CI=2.63-13.05，p<.001）；（4）酒精和阿片类药物使用障碍的可能性仅是4.28倍（CI=1.34-13.71，p<.05）。模型II中这些更细微的发现与模型I中使用常规SUD评估的发现大不相同，更新和更全面的方法可以更好地反映成瘾与SMI暴力有关的复杂性。因此研究,实践,以及解决SMI中SUD和暴力的政策可以以这种更大的全面性和细节得到有益的重新审视。
