Substance Use Disorder Among People With First-Episode Psychosis: A Systematic Review of Course and Treatment

Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, 1051 Riverside Drive, Box 100, New York, NY 10032, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 09/2011; 62(9):1007-12. DOI: 10.1176/
Source: PubMed


People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the response to specialized substance abuse treatments.
The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes?
Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of abstinence or reduction.
Experience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis. Specialized interventions for others need to be developed and tested.

Download full-text


Available from: Jennifer I Manuel, Sep 18, 2015
  • Source
    • "For instance , cannabis was shown to be most commonly used by younger male patients (Koskinen et al., 2009, 2010), and reports on substance use at the time of the first psychotic episode show cannabis abuse between 28 and 50% of patients, alcohol abuse between 21 and 43%, and class A drugs approximately 55% (Green et al., 2004; Barnett et al., 2007), although lower rates have also been reported (Chand et al., 2014). However, approximately 50% of patients with substance abuse became abstinent or drastically decreased drug consumption following their first psychotic episode, as shown by a meta-analysis including studies published between 1990 and 2009 (Wisdom et al., 2011). Use of alcohol and nicotine may, instead, persist. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In the past 25 years, research on the human brain has been providing a clear path toward understanding the pathophysiology of psychiatric illnesses. The successes that have been accrued are matched by significant difficulties identifying and controlling a large number of potential confounding variables. By systematically and effectively accounting for unwanted variance in data from imaging and postmortem human brain studies, meaningful and reliable information regarding the pathophysiology of human brain disorders can be obtained. This perspective paper focuses on postmortem investigations to discuss some of the most challenging sources of variance, including diagnosis, comorbidity, substance abuse and pharmacological treatment, which confound investigations of the human brain.
    Schizophrenia Research 11/2014; 167(1). DOI:10.1016/j.schres.2014.10.019 · 3.92 Impact Factor
  • Source
    • "Highly structured therapy programs that integrate intensive outpatient treatment, case management services and behavioral therapies (such as contingency management) are the most effective in treating severe comorbid conditions. A systematic review conducted by Wisdom et al [128] shows that many subjects (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. This percentage could further improve if knowledge on this issue were to grow. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cannabis is among the most widely used illicit substances. Epidemiological and neuroscientific evidence, though poorly integrated, have established a strong association between cannabis use and increased risk of psychosis. Chronic cannabis use, especially of new synthetic varieties, may trigger psychosis and precipitate schizophrenia in vulnerable individuals. However, the specific pathways by which cannabis affects brain function are unclear. It seems likely that a complex genetic-environmental interaction may underlie the link between cannabis exposure and psychosis onset, with multiple genetic variations and several environmental factors (i.e., trauma or maltreatment during childhood) involved. Also, the possible role of basic symptoms in cannabis users is still not fully acknowledged. Basic symptoms may possibly be a marker for the development of full schizophrenia in cannabis users and their recognition may play a role in prevention strategies. Moreover, the differential impact of different types of cannabis has been generally overlooked and little is known about possible pharmacological treatment approaches (with antipsychotics, cannabis agonists, cannabis antagonists) for cannabis users at risk of psychosis. The aim of the present review is to open this issue with a broad introduction on the clinical and pathophysiological link between cannabis abuse and psychosis onset.
    Current pharmaceutical design 06/2012; 18(32):4991-8. DOI:10.2174/138161212802884627 · 3.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: El cannabis es una de las drogas con efectos adversos psiquiátricos más perjudiciales, fundamentalmente por el aumento del riesgo de cuadros psicóticos. Además, es una de las drogas de mayor consumo entre pacientes con trastornos mentales graves con efectos nocivos para la evolución de los mismos. Por lo tanto, es necesario intervenir sobre la dependencia de cannabis de forma concomitante al tratamiento del trastorno mental con el que, con frecuencia, coexiste. Las intervenciones psicoterapéuticas son eficaces en la dependencia de cannabis; las más estudiadas son las estrategias motivacionales y las técnicas cognitivo-conductuales que se han mostrado superiores a las técnicas usadas para los grupos control, aunque son comunes la baja adherencia a los tratamientos y las frecuentes recaídas. Respecto a las intervenciones farmacológicas, existe una notable escasez de datos procedentes de ensayos clínicos. Por un lado, se han investigado fármacos útiles para otros trastornos mentales y adictivos, en general, con resultados negativos, y, por otro lado, fármacos que actúan específicamente sobre el sistema cannabinoide. En este momento, los datos más positivos proceden de los ensayos con fármacos que actúan sobre el sistema cannabinoide como son los antagonistas cannabinoides, el cannabidiol, la nabilona y, principalmente, el dronabinol. Respecto al tratamiento de los trastornos mentales comórbidos, existen igualmente pocos datos procedentes de ensayos clínicos. La información procedente de los estudios observacionales y de los casos clínicos publicados recomienda el uso de inhibidores selectivos de la recaptación de la serotonina para los cuadros depresivos y de ansiedad, los antipsicóticos atípicos para la manía y los anticomiciales para el tratamiento de mantenimiento del trastorno bipolar en estos pacientes. De la experimentación animal proceden datos interesantes que sugieren que el sistema cannabinoide puede ser una diana terapéutica para tratar cuadros depresivos y de ansiedad en pacientes con esta patología dual. Igualmente, el tratamiento de la psicosis y la dependencia ha de ser conjunto. La psicoterapia cognitivo-conductual y las estrategias motivacionales han demostrado su eficacia en esta población. Los casos clínicos destacan que la abstinencia de cannabis va a ser uno de los factores más relevantes en la evolución de la psicosis, y que la mayoría de los clínicos optan por el uso de antipsicóticos atípicos para el manejo de estos cuadros, aunque tienen escasos efectos sobre el consumo
    Trastornos Adictivos 01/2011; 13(3).
Show more