Tobacco, alcohol, and cannabis use all worsen first-episode psychosis treatment outcomes | Research

The takeaway

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.

Mental health professionals, people experiencing psychosis, and researchers studying substance use in psychiatric populations.

50% of first-episode psychosis patients smoked tobacco

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Moderate: large secondary analysis of a well-designed national study with 24-month follow-up, but observational design.

When this study was published

Published in 2019.

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.

Questions still open

Would integrating substance use treatment into first-episode psychosis programs improve outcomes? Does cannabis cessation after a first episode reduce positive symptom severity?

Common 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 the original research

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

View on PubMed ↗Publisher’s paper ↗

Citation

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