McCreadie et al (Reference McCreadie2002) report on the problem use of drugs and alcohol by people with schizophrenia. This is an excellent study as the pattern of use by patients is compared with controls from the general population, although the findings — that problem use is greater among patients — are unsurprising. It is impressive that the study included tobacco use, often disregarded as a ‘problem’ drug despite the obvious financial implications for patients surviving on state benefits. Previous studies quoted in the paper indicate that patients with schizophrenia often have been smoking for many years prior to the onset of the illness.

We are very interested to know whether the data collected for the study show that particular groups of patients appear to be more at risk from problem substance use, in order to focus efforts on helping them. Our experience is that admission to a psychiatric ward leads to increased tobacco use, and patients who have given up smoking recommence and continue smoking post-discharge, despite anti-smoking strategies. Also, we would like to know whether the study shows, or the authors know of, cultures that may be at lesser risk for developing problem use, accepting that numbers of ethnic minorities in the study sample may be small.