Nonadherence to antipsychotic medication treatment has
been associated with symptom worsening, including
aggressive behavior.42 The combination of alcohol or
other drug abuse problems with poor adherence to
medication can confer an even higher risk of violent
behavior among persons with severe mental illness.43
Disentangling the effects of substance use and
nonadherence on relapse (and aggressive behavior
secondary to subsequent psychotic symptoms) can be
challenging because both substance use and nonadherence
are robust risk factors for hospitalization