Tobacco, alcohol, and cannabis use all worsen first-episode psychosis treatment outcomes
Among first-episode psychosis patients, tobacco smoking was linked to the most negative outcomes, while cannabis use was associated with higher illness severity and more positive symptoms over 24 months of treatment.
Quick Facts
What This Study Found
At baseline, 50% of first-episode psychosis patients smoked tobacco, 28% used alcohol, and 24% used cannabis. Over 24 months, tobacco smokers had higher illness severity, missed more antipsychotic pills, and had worse psychiatric symptoms. Cannabis users had higher illness severity and more positive symptoms.
Key Numbers
404 participants. 50% (n=209) smoked tobacco, 28% (n=113) used alcohol, 24% (n=95) used cannabis. Cannabis users had higher illness severity (beta=0.18, p<.05) and more positive symptoms (beta=1.56, p<.05).
How They Did This
Secondary analysis of 404 participants in the RAISE-ETP study, which tested coordinated specialty care for first-episode psychosis across community mental health agencies in the US. Used generalized estimating equations over 24 months.
Why This Research Matters
Substance use is extremely common in people experiencing their first psychotic episode. This study shows each substance carries its own pattern of harm, with tobacco being the most broadly damaging to treatment outcomes.
The Bigger Picture
First-episode psychosis programs are a critical window for intervention. If half the patients smoke and a quarter use cannabis, treatment programs that ignore substance use are missing a major driver of poor outcomes.
What This Study Doesn't Tell Us
Observational design; substance use was self-reported at baseline only and may have changed during the study. Cannot determine whether substance use caused worse outcomes or if sicker patients were more likely to use.
Questions This Raises
- ?Would integrating substance use treatment into first-episode psychosis programs improve outcomes?
- ?Does cannabis cessation after a first episode reduce positive symptom severity?
Trust & Context
- Key Stat:
- 50% of first-episode psychosis patients smoked tobacco
- Evidence Grade:
- Moderate: large secondary analysis of a well-designed national study with 24-month follow-up, but observational design.
- Study Age:
- Published in 2019.
- Original Title:
- Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: Data from the national RAISE-ETP study.
- Published In:
- Early intervention in psychiatry, 13(1), 142-146 (2019)
- Authors:
- Oluwoye, Oladunni(2), Monroe-DeVita, Maria(4), Burduli, Ekaterina, Chwastiak, Lydia, McPherson, Sterling, McClellan, Jon M, McDonell, Michael G
- Database ID:
- RTHC-02211
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
What is first-episode psychosis?
It refers to the first time someone experiences psychotic symptoms such as hallucinations or delusions. Early treatment during this period is considered critical for long-term outcomes.
Was cannabis worse than tobacco for psychosis?
Cannabis was associated with higher illness severity and positive symptoms, but tobacco was linked to a broader range of negative outcomes including missed medications, worse symptoms overall, and lower quality of life.
Read More on RethinkTHC
- THC-amygdala-anxiety-brain
- anandamide-weed-withdrawal
- cannabinoid-receptors-recovery-time
- cannabis-developing-brain-teenagers
- cant-enjoy-anything-without-weed
- dopamine-recovery-after-quitting-weed
- endocannabinoid-system-explained-simply
- endocannabinoid-system-withdrawal
- nervous-system-weed-withdrawal-fight-flight
- teen-weed-use-under-18-effects-brain
- thc-brain-withdrawal
- thc-prefrontal-cortex-brain-effects
- weed-cortisol-stress-hormones
- weed-memory-loss-recovery
- weed-motivation-amotivational-syndrome
- weed-nervous-system-effects
- weed-reward-system-brain
Cite This Study
https://rethinkthc.com/research/RTHC-02211APA
Oluwoye, Oladunni; Monroe-DeVita, Maria; Burduli, Ekaterina; Chwastiak, Lydia; McPherson, Sterling; McClellan, Jon M; McDonell, Michael G. (2019). Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: Data from the national RAISE-ETP study.. Early intervention in psychiatry, 13(1), 142-146. https://doi.org/10.1111/eip.12542
MLA
Oluwoye, Oladunni, et al. "Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: Data from the national RAISE-ETP study.." Early intervention in psychiatry, 2019. https://doi.org/10.1111/eip.12542
RethinkTHC
RethinkTHC Research Database. "Impact of tobacco, alcohol and cannabis use on treatment out..." RTHC-02211. Retrieved from https://rethinkthc.com/research/oluwoye-2019-impact-of-tobacco-alcohol
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.