Cannabis users with psychotic disorders report lower quality of life and worse functioning, with no improvement from starting or stopping

Among nearly 3,000 people with psychotic disorders, cannabis users had lower quality of life and worse psychosocial functioning, and neither starting nor stopping cannabis use changed outcomes over one year.

Bruins, J et al.·Schizophrenia research·2021·Strong EvidenceProspective Cohort
RTHC-03028Prospective CohortStrong Evidence2021RETHINKTHC RESEARCH DATABASErethinkthc.com/research

Quick Facts

Study Type
Prospective Cohort
Evidence
Strong Evidence
Sample
N=2,994

What This Study Found

Cannabis users (11.4%) had significantly lower quality of life (B=-2.93) and worse psychosocial functioning (B=1.03) than non-users. Specifically, they were less satisfied with family relations and finances and showed more aggression, disruptive behavior, and self-harm. Starting or stopping cannabis did not change outcomes within one year.

Key Numbers

2,994 participants; 36.4% female; mean age 44.4; mean illness duration 17.2 years; 11.4% used cannabis; 255 continuers; 85 discontinuers; 83 starters; 2,571 non-users

How They Did This

Naturalistic cohort study (PHAMOUS) of 2,994 people with psychotic disorders assessed twice (9-15 months apart) between 2014 and 2018, comparing continuers, discontinuers, starters, and non-users.

Why This Research Matters

People with psychosis often report using cannabis to cope or socialize, but this large study found cannabis users actually had worse outcomes across measures. The lack of improvement after stopping suggests accumulated effects from years of use.

The Bigger Picture

The finding that neither starting nor stopping cannabis changed outcomes within one year challenges both the idea that cannabis helps people cope with psychosis and the expectation that quitting will produce rapid improvements.

What This Study Doesn't Tell Us

Observational design cannot establish causation. Cannabis users may differ from non-users in unmeasured ways. One-year follow-up may be too short to detect changes from stopping. Self-reported cannabis use may be underreported.

Questions This Raises

  • ?Would longer follow-up after cannabis cessation eventually show improvements?
  • ?Do the worse outcomes reflect cannabis effects or pre-existing differences between users and non-users?
  • ?Would targeted interventions addressing the reasons for use be more effective than simple cessation?

Trust & Context

Key Stat:
Starting or stopping cannabis did not change quality of life or functioning within one year
Evidence Grade:
Large naturalistic cohort study with nearly 3,000 participants and longitudinal follow-up
Study Age:
Published in 2021 using 2014-2018 data from the Netherlands PHAMOUS cohort.
Original Title:
The association of cannabis use with quality of life and psychosocial functioning in psychosis.
Published In:
Schizophrenia research, 228, 229-234 (2021)
Database ID:
RTHC-03028

Evidence Hierarchy

Meta-Analysis / Systematic Review
Randomized Controlled Trial
Cohort / Case-ControlFollows or compares groups over time
This study
Cross-Sectional / Observational
Case Report / Animal Study

Enrolls participants and follows them forward in time.

What do these levels mean? →

Frequently Asked Questions

Does cannabis help people cope with psychosis?

Despite people with psychosis reporting they use cannabis for coping and socializing, this study of nearly 3,000 patients found cannabis users actually had lower quality of life and worse functioning than non-users.

Does quitting cannabis improve outcomes in psychosis?

Not within one year according to this study. Stopping cannabis did not lead to measurable improvements in quality of life or psychosocial functioning, suggesting the negative effects may accumulate over years of use.

Read More on RethinkTHC

Cite This Study

RTHC-03028·https://rethinkthc.com/research/RTHC-03028

APA

Bruins, J; Pijnenborg, G H M; Visser, E; Castelein, S. (2021). The association of cannabis use with quality of life and psychosocial functioning in psychosis.. Schizophrenia research, 228, 229-234. https://doi.org/10.1016/j.schres.2020.11.059

MLA

Bruins, J, et al. "The association of cannabis use with quality of life and psychosocial functioning in psychosis.." Schizophrenia research, 2021. https://doi.org/10.1016/j.schres.2020.11.059

RethinkTHC

RethinkTHC Research Database. "The association of cannabis use with quality of life and psy..." RTHC-03028. Retrieved from https://rethinkthc.com/research/bruins-2021-the-association-of-cannabis

Access the Original Study

Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.

This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.