People with serious mental illnesses are disproportionately likely to experience problems with substance abuse. Attempts to self-medicate symptoms of illness and uncomfortable adverse effects of psychiatric medications are widely assumed to be one of the factors contributing to the high rate of psychiatric illness and substance abuse comorbidity. In this article, biological and psychological theories about self-medication in people with serious mental illness are reviewed, and data from a recent study of recovering "dual diagnosis" patients are used to illustrate aspects of self-medication. Recommendations for nursing include assessing the immediate and long-term effects of substance use on psychiatric symptoms, assisting clients to find the most effective psychotropic medication regime, educating clients about drug/medication interactions, and screeningfor additional comorbid conditions.
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