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.

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Available from: Jennifer I Manuel, Sep 18, 2015
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    • "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. "
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