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United Kingdom: Royal College study

Substance abuse associated with psychotic illnesses

Substance misuse is found in the majority of people with first episode psychosis, a new study has found. Misuse of alcohol, cannabis and other illegal substances is common among people with psychotic illnesses, and there is evidence that there may be casual links between cannabis and psychosis, according to the report published by the Royal College of Psychiatrists in the United Kingdom.

Current and lifetime substance use was recorded for 123 consecutive referrals to Cameo, a specialist early intervention service in Cambridgeshire.
It revealed that misuse of drugs and alcohol was twice that in the general population of similar age, and was more common in men than women. The study also found that the age at which individuals first used cannabis, cocaine, ecstasy and amphetamines was significantly associated with the age at which the person experienced their first psychotic symptom.

The researchers say that drug prevention measures need to be targeted at children in the pre–teenage years because their data shows that the transition from junior to senior schools might be an important juncture.

The results indicate that substance misuse among psychiatric patients is underestimated and often goes undetected. This has clinical implications because substance use in those with psychotic disorders is strongly associated with non–adherence to treatment and poorer outcomes. By contrast, a reduction in substance misuse after diagnosis is consistent with a reduction in psychotic symptoms and subsequent hospital admissions.

Dual diagnosis services [treating people who are both mentally ill and are abusing substances] should become part of early intervention services, and identification and reduction of substance use or misuse should be a target for such units, and has implications for staff training, the study concludes.

For further information visit the Royal College website at: www.rcpsych.ac.uk.

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