First Episode of Psychosis: Stopping Drug Use Improves Prognosis Interview with:
Melissa Anne Elin Authen Weibell
Consultant Psychiatrist
Helse Stavanger HF

Medical Research: What is the background for this study?

Dr. Weibell: Little is known about the effect of different patterns of substance use on outcomes in first-episode psychosis and the few studies that exist are often cross-sectional and heterogeneous. This new study investigated different patterns of substance use in an epidemiological first-episode psychosis (FEP) sample longitudinally, with the hypothesis that continuous use would predict poorer outcomes compared to never users or stop users.

The study included 301 patients aged 16-65 with first episode non-affective included (1997-2001) from three separate catchment areas in Norway and Denmark. Four patterns of substance use were defined; never used (153 patients), persistent use(43), completely stopped use having previously used (36), and on-off use (48) during the first 2-years of follow-up. 184 patients were followed up at 10 years and compared on symptom levels and remission status.

Medical Research: What are the main findings?

Dr. Weibell: The researchers found patients who stopped using within the first two years of entering treatment had similar 10-year outcomes as patients who had never used with significantly lower symptom levels (including depressive symptoms) compared to patients with on-off or persistent use.

There was a trend for persistent users showing increasing negative symptoms over time. Importantly, there was a large and significant difference in remission rates, with 57% of never users and 63% of ‘stop’ users achieving remission at 10 years compared to 32% for on-off users and 34% for persistent users.

Medical Research: What should clinicians and patients take away from your report?

Dr. Weibell: Our results show that substance use cessation in first-episode psychosis is associated with similar outcomes to first-episode psychosis patients who never used any substances; on-off use may be almost as detrimental to mental health as persistent use. The harmful effects of substance use in first-episode psychosis can be substantially reduced if clinicians are able to assist patients to stop using altogether early on in the course of treatment.

There are few longitudinal studies with long-term follow-up of first-episode psychosis patients with regards to substance use, so this study is really exciting and has a strong and easy to follow clinical take-home message for first episode psychosis patients: “stop using drugs early on and you will probably do better in the long-term”. For clinicians, we need to focus on stopping use as early as possible and probably at the same time that we are treating the initial psychosis. This study also presents a strong argument against the legalisation of cannabis.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Weibell: There is little evidence currently that any specific treatment programs can bring about sustained abstinence among patients with psychosis. Reducing substance use among FEP patients could improve the course of psychosis and treatment of substance use should be viewed as a key element of treatment programs, alongside initiation and maintenance of antipsychotic medication and psychosocial programs.  The development of effective treatments for substance use in FEP patients should remain a focus and priority for further research.

upcoming International Early Psychosis Conference abstract discussing:

People who continue illegal substance use are much less likely to recover from first-episode psychosis


Last Updated on November 26, 2014 by Marie Benz MD FAAD