Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: Data from the national RAISE-ETP study

The primary aim of this study was to examine the effect of recent tobacco, alcohol and
cannabis use on treatment outcomes among participants experiencing first episode psychosis
(FEP). Secondary data analyses were conducted on 404 participants enrolled in the Recovery
After an Initial Schizophrenia Episode—Early Treatment Program (RAISE-ETP) study. RAISEETP
investigated the effectiveness of a coordinated specialty care (CSC) intervention for FEP
in community mental health agencies in the United States. Generalized estimating equations
were used to examine whether recent tobacco smoking, alcohol, and cannabis use at baseline
were associated with illness severity, number of antipsychotic pills missed, psychiatric symptoms
and quality of life during the 24-month treatment period, after controlling for duration of
untreated psychosis and treatment group. At baseline, roughly 50% (n = 209) of participants reported recent tobacco, 28%
(n = 113) alcohol and 24% (n = 95) cannabis use. Tobacco smokers had higher levels of illness
severity (β = .24; P < .005), a higher number of missed pills (β = 2.89; P < .05), higher psychiatric
symptoms and lower quality of life during treatment relative to non-smokers. Alcohol users
had a higher number of missed pills (β = 3.16; P < .05) during treatment and cannabis users
had higher levels of illness severity (β = .18; P < .05) and positive symptoms (β = 1.56; P < .05)
relative to non-users. Tobacco, alcohol and cannabis use are common in youth seeking treatment for
FEP. Tobacco smoking was associated with more negative clinical outcomes. These findings
have implications for including interventions targeting these areas of substance use within current
CSC models.