September 01, 2006

Study Shows Substance Misuse Hinders Recovery From Psychosis and Schizophrenia

Substance misuse significantly hinders recovery from first episode psychosis (one of the key symptoms of schizophrenia), according to a new Australian research published in the British Journal of Psychiatry.

The study examined 103 young people with first episode psychosis and looked at the potential effects of the misuse of drugs such as cannabis and alcohol in relation to remission and relapse of positive symptoms such as hallucinations and delusions.

The study concluded that:

Substance misuse was independently associated with increased risk of in-patient admission, relapse of positive symptoms and shorter time to relapse of positive symptoms after controlling for potential confounding factors. Substance misuse was not associated with remission or time to remission of positive symptoms. Heavy substance misuse was associated with increased risk of in-patient admission, relapse and shorter time to relapse.

Substance misuse is an independent risk factor for a problematic recovery from first-episode psychosis.

The study found that of the 98 young people who achieved remission following a first episode of psychosis, 51 percent of patients who also had a diagnosis of substance misuse experienced a relapse compared to 17 percent of those who had no such diagnosis.

Inpatient admission rates were also longer for young people with first episode psychosis and a diagnosis of substance misuse, with an average of 12 days spent in hospital, compared to an average of 1.4 days for young people without a substance misuse diagnosis.

Principal researcher Darryl Wade said the study had implications for more than just the immediate treatment of patients.

"It has wider relevance in the development and provision of services and the integrated treatment of both disorders - the misuse and the psychotic episodes," he said.

Source: Substance misuse in first-episode psychosis: 15-month prospective follow-up study by D. Wade, S. Harrigan, J. Edwards, P. M. Burgess, G. Whelan, and P. D. McGorry
British Journal of Psychiatry


My 19 year old son with a now diagnosis of schizoaffective disorder was a Marijuana user at 15/16/17 years of age and during these years his mental illness became increasingly worse with the use of Marijuana . The one very notable thing that smoking did was bring on visual hallucinations that were extremely frightening - i.e. people attempting to shoot him, rape him and were on every occasions a prelude to a very major lengthy Psychotic episode which required hospitalization for a very long period. After these hallucinations subsided with antipsychotic medication he then had the worse episodes of depression with suicidal thoughts which left him helpless.
My son after finally realising and making the connection that Marijuana use always resulted in these horrendous hallucinations made the decision not to use the drug again, even though he enjoyed the initial relaxation it gave him - that was before the other negative things started. Since he has not smoked the drug in 2 years he has not had another Hallucinatory episode, although he is still unwell with all the auditory voices and sometimes paranoia present.
I would say that the 3 serious episodes of hallucinations he experienced after his episodes of self medicating with Marijuana, shifted his mental illness into a phase where his Psychosis has been much harder to treat and to respond to the anti psychotics which has eventually resulting in TRS form ( treatment resistance Schizophrenia) of schizoaffective disorder.
Whilst he does not discuss his illness very much these days as he is so very unwell, when others mention Marijuana he becomes very distressed and makes it clear he would never touch the stuff again as it f*cked his life!
I cannot begin to explain how terrifying these hallucinations were for him and to actual witness and attempt to assist our son to realise they were not actually happening was very scary indeed! - on one occasion within an hour of smoking Marijuana he stripped off all his clothes and ran for over 8 hours along a cliff and beaches in a remote part of the country where we were holidaying , and tried to save people he said were drowning in the bay , swimming periodically out into the sea to save these people who were not there! To stand on the shoreline and watch him do this or actually endeavour to swim out after him for many 100's of metres was frightening as neither I or my partner where such strong swimmers and then to lose sight of him as he had swum so far out into the bay and as it was night time we had to just wait until he came back, too scared to leave the beach in case he called for help. We stayed with him the whole time as we were unable to restrain him or convince him it was not happening, taking turns to run along the beaches and cliffs to ensure he was safe - after hours he collapsed with exhaustion and we were only then able to get him to a hospital a 4 hour trip away - by this time his body particularly his feet where cut to pieces from the rocks, but he had felt no pain at the time! The absolutely terrified look on his face whilst this was all happening was very distressing and the way he was describing these people and especially children whom he said were calling out to him from the water in the bay where they were supposedly drowning was just dreadful as he was yelling and crying and distraught that he could not save them and just could not understand how we could not see them ! He still believes to this day he may have actually let those people and children drown!
When people talk about Marijuana being a safe drug, my thoughts go back to these events and I really wish that my son had never ever started his experimenting with the drug, because it is very probable that had he not, he would not be as unwell as is today - yes, he might still have got a mental illness, but I am quite sure it would be no way as serious and treatment resistance, had he have stayed away from the using of Marijuana. After these 3 episodes, the antipsychotics ceased to be as effective as there were previously and his mental illness definitely shifted into a chronic and crippling phase of which he has been unable to

Posted by: RBH at September 14, 2006 12:09 PM

My son is now 29 years old. He has misused substances of just about everything for over 13 years. During that time he has been psychotic, and diagnozed now as schizophrenic. He has been hospitalized in pyschiatric wards on numerous occasions, and is on a mental health section as I write this today -New Year's Day 2007. He is at my home for 2 days, mostly sleeping as he's on medication that seems to make him want to do nothing, and sleep. I am truly tired on drugs being glamourised by ignorant individuals. There is a drug epidemic in the World. My son lives in a very pretty rural town in England, and nowhere is 'safe'. He has become withdrawn in an already soically isolating place, and rejects any kind of help from mental health workers. Maybe they remind him that he is dependent, maybe he's asleep or drozy when they call round. He gets depressed, wanders into a bar for what I hope is a soft drink, and is given drugs by individuals who know my son has a mental illness. Three months ago my son jumped out of his bedroom window during a psychotic attack of seeing and believing things that just weren't real. He broke his ankle. I'm told that he was tested for substance misuse on admission and it was negative. I would suggest this negative result may indicate that the amphetimines my son tells me he took has washed out of his system as he tells me suffered from sleep deprivation for 3 days, and tried marujana and a bottle of vodka to try and 'get some sleep'. He nearly killed himself in a state of 'elation'. During the past years he has done very violent and life threatening stuff. He goes into hospital, comes out, and the whole revolving door scenario just seems to sooner or later start up again. He refuses help, and at the moment doesn't see the need for a re-hab programme as 'he won't ever touch alcohol or drugs again'. So his quality of life is below rock bottom and there is nothing obligitory that can be done when he is not on a mental health section, everything being 'his choice'. The choice situation can be his worst eneny given what he has chosen to do to his mind which affects not just his whole person, but everyone elses. I have a lot of concerns, and not least patient confidentiality. I understand the need of it, I understand that my son is 29 and he has legal rights. That's not a problem when the 29 year old is a rational thinker able to make judgements and form decisions, but my son's communication is somewhere between silence and irrational speech a lot of the time, with mono responses of 'yes' and 'no' more often than not. At the same time the medics are quite happy for me without knowledge of the full picture of what I am dealing with to care for my son when he's granted leave from his mental health section. How ethical and beneficial is that? I have learned more from the internet about illicit drugs, his drug abuse, the symptoms, the psychiatric drugs, their purpose, and side effects etc than I have from doctors, and that's an issue which society and the law seems content with. That to me and every other parents suggests insanity on top of percieved insanity, driving carers to tipping point of insanity. If anyone agrees, or has helpful comments to suggest to me as a worn out mother over the age of 50 who recognises that we are all mortal, then please contact me as I do not know what to do now. I have been in contact with support groups, but this will not address the issues as a whole, and will be help focussed on me when the root cause is linked to 13 years of my son's historical drug abuse and the damage it has caused psychiatrically, not knowing if there's any chance of him turning his life around, or what recovery prospects there may be. Everyone needs hope to keep going, and I feel unless the medics communicate with me, then I am attempting to cope with the situation, but to attempt blindly to find my own hope and support.

Posted by: Jane at December 31, 2006 11:39 PM

Hello, My name is Ken. I am a 53 year old man living in Washington state. I have been researching the internet with hopes to start using marijuana again after two years and 5 months of abstinence. After reading these postings I have decided to keep clean of marijuana. Two and a half years ago I was addmited to the local VA hospital. I was deep in a phycotic break due to constant marijuana use. I was dillusional for over a year up until the police arested me for wandering around talking to the voices. I thought that I had been given powers to travel in time and comunicate with people that were alive thousands of years ago on earth and other planets. I dont know where all of that came from but I truley belived it was true. Well, I spent 2 years in a rehab center. the voices stayed with me for several months constantly. Then after a year it was most days but not all the time. After a year and a half I only heard voices once in a while. During all this time I stayed completely away from marijuana and all drugs and alcohal. After two years The voices stopped talking to me but I still hear them when I am stresses or have anxiety. They sound like they are in the distance. It is like I am listening to a talk radio station. I only hear that once in a while now. About once or twice a month is all. I still have the problem of sleeping alot. I have had a job now for 5 months. I live in an apartment. Things are looking better. Thank you for your stories and God Bless your sons. Tell your sons to stay away from pot. It will take a long time for their minds to improve. They are so young. I think as we adapt to our situation we heal.

I have not been diagnosed with Schizophrenia. Only had this one psychotic break.

Posted by: ken at January 9, 2007 01:55 AM

My son is now 35 and I am worn out with the constant problems. I also feel that all the theraphy he has received has made him worse as he is convinced that myself and his late father caused his problems by sexually abusing him..Which we of course did not.He dosent talk to me for months then when he has a psychotic episode he turns up for help and to scream at me. He is a user of dope and has been for a long time. He will not admit that the dope is probably THE PROBLEM. He has been in mental health unit once but discharged himself and will not go near a hospital again.I am Worn out what is the answer??????

Posted by: carole wakefield at April 27, 2007 06:43 AM

I suffered a psychotic break in the summer of 1975, about three years of very light marijuana use, in prep school in the Appalachins in Virginia. I have had a mild paranoid state of mind that seems to flucuate from obseessive fears to
light mild anxiety states, to total resolution of the anxiety condition. I don't think I smoked marijuana over ten or fifteen times, with a friend at this school when I was seventeen, but after reading this post I feel the drug could have caused the depth of my anxiety and paranoia state, that I have suffered a good deal of my life. An earlier psychologist I had, observed that the schizophrenia was very transient and my mind could enter into periods of total resolution of the symptoms . In fact the earlier psychologist mentioned that she could not find an appropriate diagnosis for my schizoaffective like condition, at least not in the DSM. The research from Yale University and Kings College in London this past June 30, 2007 have given me second thoughts, that such light marijuana use could have been enough to trigger the schizophrenia like condition that has plagued me a good deal of my life. Panic attacks, and in the summer of 1975, a full blown psychotic break that causes a hospitalization. I have a creeping like suspiousness, that comes up, where I look at people and get the vague sense they are either my enemy or have done things to me, or being responsible for past unforutnate bad events that have happened in my life. Its not like its an overwhelming feeling but it creates a substantial annoyance in my mind, of trying to overcome this mild wave of suspisiousness. I have participated with mental health services in my community, and one of the community based workers wrote in her review at one time, that she did not know whether I could ever get a handle on the paranoia that was pervasive in my mind; but after reading the above initial blog, coupled with the research findings out this June 30, 2007, I am going to do more research on the marijuana - schizophrenia connection. This past week I went out with my case manager and she confirmed to me, that mounting scientific evidence will validate psychotic breaks resulting from marijuana use. The fact that the use was so light in my case though leaves me pondering what impact it had on my state of mind. I don't suffer from any auditory hallucinations, but the imagery of visual hallucinations, what I call mind's eye imagery, simmers in the recesses of my mind. And has blown out in full blown states of stark paranoid episodes, in the past. I have not had anything really overly bad since luckily the fall of 1984, of any drastic depth of anxiety. It seems a little better in my early fifties though. But with the latest research findings this late June, I am going to look into this possible connection between marijuana and schizophrenia.

Posted by: HPH at June 30, 2007 12:39 PM

OK. As i read these statements my heart begins to tremble. I may have a way to help all of your loved ones. As a user of marijuana and having schitzophrenia in the family I relized 1 thing about coming back to reality and that is KEEPING MY MIND BUSY ON ANYTHING POSITIVE,AN INTEREST IS A CURE.Beliving to be good in it is also a key.Music,PBS,DISCOVERY,ONLINE RESEARCH,BOOKS,INTERESTING AND HARD FOR THE NORMAL MIND,Challenging and a good one MATH.School plays a big role. I think we should all know by now that the US Media is clearly not doing great things therefor in my opinion it may make you remember certain things and sounds that are on a screen and your eyes and ears as well. Dammit people are destroying themselves and others because of Viacom(MTV) and such. READ KEEP YOUR MIND BUSY.

Posted by: pete at December 8, 2007 03:09 PM

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