Substance use and violence among psychiatric inpatients


  • D. Stewart PhD,

    Research Fellow, Corresponding author
    1. Institute of Psychiatry, Kings College London, London, UK
    • Correspondence:

      D. Stewart

      Health Service and Population Research

      Institute of Psychiatry

      Kings College London

      PO Box 30

      David Goldberg Centre

      De Crespigny Park


      SE5 8AF



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  • L. Bowers RMN PhD

    Professor of Psychiatric Nursing
    1. Institute of Psychiatry, Kings College London, London, UK
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Accessible summary

  • Nursing staff on inpatient psychiatric wards often think that patient violence and aggression is caused by alcohol or illicit drug use.
  • This study reports on how frequently patients use alcohol or drugs and whether this is linked to incidents of violence and aggression.
  • There were relatively few incidents of substance use among the patients in the sample. There was no link between physical violence and substance use on wards, but there was an association with verbal aggression.
  • More research is needed to examine how nurses intervene when a patient has used alcohol or drugs.


Nursing staff on psychiatric wards often attribute patient violence and aggression to substance use. This study examined incidents of alcohol and illicit drug use among acute psychiatric inpatients and associations between substance use and violence or other forms of aggression. A sample of 522 adult psychiatric inpatients was recruited from 84 acute psychiatric wards in England. Data were collected from nursing and medical records for the first 2 weeks of admission. Only a small proportion of the sample was reported to have used or been under the influence of alcohol (5%) or drugs (3%). There was no physical violence during a shift when a patient had used alcohol or drugs. Substance using patients were also no more likely than others to behave violently at any point during the study period. However, incidents of substance use were sometimes followed by verbal aggression. Beliefs that substance using patients are likely to be violent were not supported by this study, and could impact negatively on therapeutic relationships between nurses and this patient group. Future studies are needed to examine how staff intervene and interact with intoxicated patients.