Send to:

Choose Destination
See comment in PubMed Commons below
J Subst Abuse Treat. 2014 Nov-Dec;47(5):353-61. doi: 10.1016/j.jsat.2014.06.010. Epub 2014 Jul 13.

The influence of treatment attendance on subsequent aggression among severely mentally ill substance abusers.

Author information

  • 1Sociology and Anthropology Department, St. John's University. Electronic address:
  • 2Research Institute on Addictions, State University of New York at Buffalo.
  • 3Department of Psychology, Syracuse University.


The interrelationships between severe mental illness, substance use, and aggression are of longstanding importance with implications for community treatment programs, treatment research and public policy. Through the analysis of longitudinal data collected from 278 patients over a 6-month period following admission to an outpatient dual diagnosis treatment program, this study examined the association between dual diagnosis treatment attendance and subsequent aggression among individuals diagnosed with both a severe mental illness and a substance use disorder. We also tested substance use and psychiatric symptoms as mediators of this treatment-aggression relationship. The results of structural equation modeling analyses indicated that dual diagnosis treatment was associated with lower levels of subsequent aggression. Mediational analyses indicated that greater treatment involvement was associated with reduced substance use, which was associated with lower levels of aggression; thus, substance use was found to mediate the relationship between dual diagnosis treatment and aggression. Surprisingly, severity of psychiatric symptoms did not predict later aggression. These findings suggest that targeting substance use reduction in treatment may have the additional benefit of reducing the risk of later aggression among dual diagnosis patients.

Copyright © 2014 Elsevier Inc. All rights reserved.


Aggression; Dual diagnosis; Severe mental illness; Substance abuse; Treatment

[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Write to the Help Desk