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

Jennifer P. Wisdom, Jennifer I. Manuel, Robert E. Drake

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)1007-1012
Number of pages6
JournalPsychiatric Services
Volume62
Issue number9
DOIs
StatePublished - Sep 2011

ASJC Scopus subject areas

  • Psychiatry and Mental health

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