New study explores how young people with early-onset psychosis view substance use and interventions

A new study led by SMU medical and psychological anthropologist Neely Myers indicates that while young people diagnosed with early psychosis understand the importance of discontinuing the use of substances like cannabis, many are ambivalent about stopping.

Myers, who leads SMU's Mental Health Equity Lab, focuses on helping people with psychosis because it's the least understood and most stigmatized among mental health disorders. Psychosis is a collection of symptoms that affect the mind, in which there has been some break with consensus reality.

The condition often begins in young adulthood, between the late teens and mid-20s. Myers recruited participants for her study from Coordinated Specialty Care (CSC) programs, which provide comprehensive outpatient mental health treatment to persons experiencing an early onset.

Despite the known prevalence of substance use among this demographic and increasing evidence of its connection to psychosis, there has been a lack of specialized interventions during care to address substance use effectively. This includes cannabis, whose use among teenagers is at its highest level in 30 years, with today's teens more likely to use cannabis than alcohol.

"Most people with psychosis don't worry about substance use until it detrimentally affects them, and even then, they are very reluctant to talk about it," Myers said. "Adolescents can look at substance use as a way to be social and manage their own health—for example, to reduce anxiety or physical pain— but using substances like cannabis can worsen their condition. More research is needed to understand why so that early intervention programs can better support young people's mental health."

Published in the journal Early Intervention in Psychiatry, Myers' study aimed to understand the motivations and concerns surrounding substance use among young adults (ages 18 to 30) in CSC programs by engaging them in 60-90 minute person-centered, semi-structured, audio-recorded Zoom interviews.

Many of the participants understood that they should likely reduce substance use but displayed ambivalence about their motivations to do so. They did offer feedback on ways to improve care that included more information about substance use, establishing positive peer communities promoting healthy choices, and the need for strategies that address psychological and physical pain without relying on substance use.

Myers has been working on early psychosis care since 2014 in the North Texas area. Her lab partners with EPINET-National, a larger endeavor to create hubs for research around the country that accelerate advances in early psychosis care and recovery outcomes through learning health care partnerships.