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Acta Psychiatr Scand. 2015 Jul;132(1):60-8. doi: 10.1111/acps.12382. Epub 2015 Jan 9.

Alcohol confounds relationship between cannabis misuse and psychosis conversion in a high-risk sample.

Author information

1
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA.
2
Department of Psychiatry, Hofstra/North Shore-LIJ School of Medicine, Hempstead, NY, USA.
3
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
4
Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY, USA.
5
Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
6
Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
7
Department of Psychology, School of Medicine, Yale University, New Haven, CT, USA.
8
Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA.
9
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
10
Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA.
11
Department of Psychology, Emory University, Atlanta, GA, USA.

Abstract

OBJECTIVE:

Cannabis use has been examined as a predictor of psychosis in clinical high-risk (CHR) samples, but little is known about the impact of other substances on this relationship.

METHOD:

Substance use was assessed in a large sample of CHR participants (N = 370, mean age = 18.3) enrolled in the multisite North American Prodrome Longitudinal Study Phase 1 project. Three hundred and forty-one participants with cannabis use data were divided into groups: No Use (NU, N = 211); Cannabis Use without impairment (CU, N = 63); Cannabis Abuse/Dependence (CA/CD, N = 67). Participants (N = 283) were followed for ≥2 years to determine psychosis conversion.

RESULTS:

Alcohol (45.3%) and cannabis (38.1%) were the most common substances. Cannabis use groups did not differ on baseline attenuated positive symptoms. Seventy-nine of 283 participants with cannabis and follow-up data converted to psychosis. Survival analysis revealed significant differences between conversion rates in the CA/CD group compared with the No Use (P = 0.031) and CU group (P = 0.027). CA/CD also significantly predicted psychosis in a regression analysis, but adjusting for alcohol use weakened this relationship.

CONCLUSION:

The cannabis misuse and psychosis association was confounded by alcohol use. Non-impairing cannabis use was not related to psychosis. Results highlight the need to control for other substance use, so as to not overstate the cannabis/psychosis connection.

KEYWORDS:

alcohol use; cannabis use; clinical high-risk; prodromal states; psychosis; substance use

PMID:
25572323
PMCID:
PMC4537180
DOI:
10.1111/acps.12382
[Indexed for MEDLINE]
Free PMC Article

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