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Psychiatr Serv. 2011 Sep;62(9):1007-12. doi: 10.1176/appi.ps.62.9.1007.

Substance use disorder among people with first-episode psychosis: a systematic review of course and treatment.

Author information

1
Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, 1051 Riverside Drive, Box 100, New York, NY 10032, USA. jwisdom@nyspi.columbia.edu

Abstract

OBJECTIVE:

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.

METHODS:

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?

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
21885577
PMCID:
PMC3575521
DOI:
10.1176/ps.62.9.pss6209_1007
[Indexed for MEDLINE]
Free PMC Article

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