Violence exposure in childhood predicted premorbid substance use before first psychosis episode

Violence and Environmental Adversity (a factor combining community violence, housing instability, and other environmental stressors) was significantly associated with 5 of 6 substance use variables. Interpersonal Abuse was unassociated with substance use. Neglect and Lack of Connectedness was associated only with lower cannabis use likelihood. Gender stratification showed stronger effects on tobacco use among females.

Cross-sectional study of 247 first-episode psychosis patients from 6 inpatient psychiatric units in Atlanta and Washington, D.C. 14 childhood adversity scales reduced to 3 factors via factor analysis. Regression analyses tested associations with premorbid substance use.

Understanding what drives substance use before psychosis onset can inform early intervention. The finding that environmental violence (not just personal abuse) is the dominant predictor suggests that community-level interventions could reduce both substance use and psychosis risk.

Most adversity research in psychosis focuses on individual-level trauma (abuse, neglect). This study shifts attention to environmental and community-level violence as a distinct and more powerful predictor of premorbid substance use, suggesting different intervention points.

Cross-sectional design. Predominantly African American urban sample may not generalize. Retrospective adversity assessment subject to recall bias. Cannot determine causation.