Several limitations should be noted. First, our measure of substance use was admittedly limited by patients’ self-report [37], and since substance use was not quantified, we are precluded from commenting on the rates of change in terms of drug or alcohol consumption over the follow-up. Given the potential for underreported substance use, our estimates should be interpreted with caution. Second, questions may arise in terms of the applicability of our results because our sample was selected from the MacArthur Violence Risk Assessment Study, which required participants to ‘be at risk for future violence’[37–38]. The investigators of the parent study endorsed their results as ‘fairly representative of the community behaviors of psychiatric patients discharged from acute inpatient facilities’ [37–38], which suggests our findings should be comparatively representative in terms of the sample we selected. Indeed, the MacArthur Violence Risk Assessment Study has not been replicated, and future research will be needed to test these effects in samples more generalizable to the recent literature on substance abuse in SMI. Third, there may be concerns about our use of the DSM-III-R [43]. We
