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People with mental illness are significantly more likely to smoke, drink and use drugs. According to the largest assessment of substance use among people with severe psychiatric illness, rates of smoking, drinking and drug use are significantly higher among those who have psychotic disorders than those in the general population.

Researchers said the findings are worrying because people with severe mental illness are significantly more likely to die younger than those without severe psychiatric disorders.

"These patients tend to pass away much younger, with estimates ranging from 12 to 25 years earlier than individuals in the general population," first author Sarah M. Hartz, MD, PhD, assistant professor of psychiatry at Washington University said in a news release. "They don't die from drug overdoses or commit suicide - the kinds of things you might suspect in severe psychiatric illness. They die from heart disease and cancer, problems caused by chronic alcohol and tobacco use."

After analyzing smoking, drinking and drug use in nearly 20,000 people, researchers found that 30 percent of those with severe psychiatric illness engaged in binge drinking, which is defined as drinking four servings of alcohol at one time. In contrast, 8 percent of the general population engaged in binge drinking.

The study also found that 75 percent of people with mental illness were smokers compared to 33 percent in the control group.

Study results also revealed that 50 percent of people with psychotic disorders used marijuana regularly, versus 18 percent in the general population. They found that half of people with mental illness also used other drugs, while 12 percent of the general population engaged in recreational drug use.

"I take care of a lot of patients with severe mental illness, many of whom are sick enough that they are on disability," said Hartz. "And it's always surprising when I encounter a patient who doesn't smoke or hasn't used drugs or had alcohol problems."

Protective factors also ceased to have their typical influence after a person develops a psychotic illness, according to the study. Previous research reveals that Hispanics and Asians tend to have lower rates of substance abuse compared to White Americans. Women were also less likely to smoke, drink and use recreational drugs compared to men.

"Some studies have shown that although we psychiatrists know that smoking, drinking and substance use are major problems among the mentally ill, we often don't ask our patients about those things," Hartz said. "We can do better, but we also need to develop new strategies because many interventions to reduce smoking, drinking and drug use that have worked in other patient populations don't seem to be very effective in these psychiatric patients."

The findings are published in the journal JAMA Psychiatry.