First-episode psychosis and substance use

A literature review in the latest issue of Psychiatric Services indicates that after experiencing a first episode of psychosis, about half of those with substance use disorders become abstinent or significantly reduce their alcohol and drug use, even when they don’t receive specialized substance abuse treatment.

Psychiatric researchers in the United States and other countries are studying people in the early stages of schizophrenia, with the goal of stopping this disabling disorder in its tracks. Among individuals who seek treatment for a first episode of psychosis—usually young adults between the ages of 18 and 25—about half have a co-occurring alcohol or drug use disorder, which can greatly reduce their chances of recovery.

The researchers reviewed studies between 1990 and 2009 to examine two questions: do some clients become abstinent after a first episode without specialized substance abuse treatment? Second, among clients who continue to use substances, does receipt of specialized treatment enhance outcomes? The study appears in the September issue of the American Psychiatric Association’s journal Psychiatric Services.

The researchers found that rates of reduction in substance use were similar for individuals with and without specialized substance use treatment. They concluded that a number of factors may contribute to reductions in substance use after first episode of psychosis, including the experience of the episode itself, education about psychosis and the detrimental effects of substance use, and receipt of treatment for psychosis. The researchers also found that clients who adopted abstinence reduced their rates of relapse and hospitalization.

The authors, led by Jennifer P. Wisdom, Ph.D, M.P.H., with the New York Psychiatric Institute, note that research on specialized substance abuse treatment for this population is still in its infancy, and more research is needed. They conclude by recommending elements that researchers should include in future studies to facilitate comparison of results.

Recent research on first-episode psychosis has highlighted the importance of early intervention to limit symptoms and prevent relapses—in effect, arresting the development of schizophrenia. This study looks at one aspect of that—the connection between psychosis and substance abuse. In a related effort, the National Institute of Mental Health is sponsoring a large-scale research project on schizophrenia called RAISE, Recovery After an Initial Schizophrenia Episode. The aim of the project is to explore whether using early and aggressive treatment will reduce symptoms and prevent the gradual deterioration of functioning characteristic of chronic schizophrenia.

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