Tobacco Use Associated With Negative Clinical Outcomes in First Episode Psychosis

burning cigarette
burning cigarette
The effect of tobacco smoking, cannabis, and alcohol use on illness severity, non-adherence to medication, psychiatric symptoms, and quality of life in first episode psychosis was assessed.

Tobacco smoking is associated with negative clinical outcomes, including higher ratings of psychiatric symptoms and functional impairment, more missed pills, and lower quality of life (QoL) ratings, while alcohol use is associated with decreased medication adherence and cannabis use is associated with greater impairment in overall functioning and positive symptoms in patients experiencing first episode psychosis, according to the results of a study published in Early Intervention in Psychiatry.

Oladunni Oluwoye, PhD, of the Initiative for Research and Education to Advance Community Health and the Program of Excellence in Addictions Research, Washington, State University in Spokane, and colleagues conducted secondary data analyses on 404 participants between the age of 15 and 40 enrolled in the Recovery After an Initial Schizophrenia Episode—Early Treatment Program (RAISE-ETP) study.  RAISE-ETP investigated the effectiveness of a coordinated specialty care intervention for first episode psychosis (FEP) in community mental health agencies in the United States.

The investigators used generalized estimating equations to determine whether recent tobacco smoking, alcohol, and cannabis use at baseline were associated with severity of illness, number of antipsychotic pills missed, psychiatric symptoms, and QoL during the 24-month treatment period. They controlled for duration of untreated psychosis and treatment group.

Approximately 50% of study participants reported recent tobacco use, 28% alcohol use, and 24% cannabis use at baseline. Tobacco smokers had higher levels of illness severity (β =0.24; P <.005), a higher number of missed pills (β =2.89; P <.05), higher psychiatric symptoms and lower QoL during treatment relative to non-smokers. Individuals using alcohol had a higher number of missed pills (β =3.16; P <.05) during treatment and individuals using cannabis had higher levels of illness severity (β =0.18; P <.05) and positive symptoms (β =1.56; P <.05) relative to non-users.

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Study limitations include self-report of substance use, the use of a treatment-seeking population rather than an epidemiological sample, and the fact that although associations between substance use and outcomes were observed, the effect sizes were not large and may be related to multiple comorbidities.

Nonetheless, the investigators argue that the high prevalence of tobacco smoking and its consistent association with negative clinical outcomes support targeting tobacco smoking in this population.


Oluwoye O, Monroe-DeVita M, Burduli E, et al. Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: data from the national RAISE-ETP study [published online January 22, 2018]. Early Interven Psychiatry. doi:10.1111/eip.12542