Cannabis Use Among People With Psychosis Varied Dramatically Across Four African Countries

Significant variations in cannabis consumption were observed across the four African countries studied. Males had consistently higher odds of alcohol, tobacco, and khat consumption compared to females. People with bipolar disorder had higher odds of alcohol use than those with schizophrenia. Unlike US studies, education level was not significantly associated with substance use frequency for most substances.

Data from the Neuropsychiatric Genetics of African Populations-Psychosis project, a large case-control study. Substance use assessed with ASSIST v3. Ordinal regression examined frequency of alcohol, tobacco, cannabis, and khat use across sex, education, and country in people with bipolar disorder and schizophrenia.

Most substance use research in psychosis comes from Western countries. This large multi-country African study reveals that patterns differ substantially from US and European populations, suggesting that interventions cannot simply be imported from Western settings.

The finding that education-substance use relationships differ between Africa and the US challenges the assumption that sociodemographic risk factors for substance use are universal. Effective prevention in African psychiatric populations requires locally informed approaches.

Cross-sectional design, substance use measured by frequency not quantity, ASSIST may not capture cultural patterns of use, four countries cannot represent all of Africa, possible reporting bias in psychiatric populations, selection effects in case-control recruitment