Adversity in childhood/adolescence and premorbid tobacco, alcohol, and cannabis use among first‐episode psychosis patients

Abstract

Aim Premorbid substance use is widely recognized as a crucial factor in early psychosis. We explored the effects of childhood/adolescent adversity on premorbid tobacco, alcohol, and cannabis use. We hypothesized that adversity in childhood would be associated with an increased likelihood of use, and amount of intake, of tobacco, alcohol, and cannabis. We analysed which domains of adversity have the greatest impact. Methods First‐episode psychosis patients were enrolled from six inpatient psychiatric units in Atlanta, Georgia and Washington, D.C. Premorbid substance use was thoroughly measured, and childhood/adolescent adversity was rated using 14 scales/subscales. Factor analysis was used to reduce these scales/subscales to the three domains of adversity (termed Violence and Environmental Adversity, Interpersonal Abuse, and Neglect and Lack of Connectedness). Regression analyses determined associations between adversity domains and premorbid substance use. Results Our sample (n = 247) primarily consisted of African Americans (86.2%) and males (74.5%). Violence and Environmental Adversity was significantly associated with five of six substance use variables and marginally associated with the sixth. Interpersonal Abuse was unassociated with substance use, and Neglect and Lack of Connectedness was associated only with a lower likelihood cannabis use. When Violence and Environmental Adversity results were stratified by gender, effects on tobacco use and amount of tobacco use were stronger among females. Conclusions Childhood/adolescent trauma and adversity have meaningful associations with premorbid substance use in first‐episode psychosis patients. First‐episode psychosis and clinical high‐risk treatment settings may benefit from expanding the assessment of childhood/adolescent adversity to include factors pertaining to violence exposure and adversities beyond abuse and neglect.

Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood

“…Of note, no differences emerged in terms of both lifetime traumatic experiences and childhood abuse as well as cannabis and alcohol consumption since high rates were reported in both groups. Trauma and drug abuse have been previously reported as intertwined risk factors and early markers of the vulnerability of affective and non‐affective psychoses 56,57 . In consideration of the high rates reported in the present study, they represent universal or transdiagnostic targets of primary preventive strategies.…”

“…Trauma and drug abuse have been previously reported as intertwined risk factors and early markers of the vulnerability of affective and non-affective psychoses. 56,57 In consideration of the high rates reported in the present study, they represent universal or transdiagnostic targets of primary preventive strategies. In addition, specific prodromal symptoms such as Social isolation or Increased energy or goal-directed activity should be firstly recognized by psychiatrists but also by general practitioners, families and teachers as warning signs that signal a need to provide primary preventive strategies.…”

Remission with or without comorbid substance use disorders in early psychosis: long-term outcome in integrated care (ACCESS III study)

“…Up to 70% of FEP patients suffer from comorbid SUDs (Rabinowitz et al, 1998;Verma et al, 2002;Lambert et al, 2005;Addington and Addington, 2007;Wisdom et al, 2011) and the most commonly used substances are cannabis (lifetime rates ranging between 22% and 47%, Mueser et al, 1990Mueser et al, , 1992Mueser et al, , 2000 and alcohol (about 30%, Wisdom et al, 2011;Oluwoye et al, 2019;Langlois et al, 2021). There is consistent evidence that using cannabis in FEP can lower the threshold for experiencing new relapses or hospitalizations (Tarricone et al, 2014;Patel et al, 2016;Schoeler et al, 2016a,b) and triggering psychotic symptoms (van Dijk et al, 2012).…”

Adverse childhood experiences and smoking status in children: A systematic review and meta‐analysis

“…The details of each database are given in Appendix . After screening the manuscripts, finally, 39 studies (Afifi et al, 2012; Afifi et al, 2020; Alcalá, von Ehrenstein, & Tomiyama, 2016; Bhengu et al, 2020; Blalock et al, 2011; Chang et al, 2019; Chartier, Walker, & Naimark, 2009; Dube et al, 2003; Duke, 2018; Forster et al, 2018; Gonçalves et al, 2016; Grest et al, 2021; Halvaiepour & Nosratabadi, 2022; Hayre, Goulter, & Moretti, 2019; Hughes et al, 2019; Iakunchykova et al, 2015; Joannès, Castagné, & Kelly‐Irving, 2022; Kristman‐Valente, Brown, & Herrenkohl, 2013; Liu et al, 2022; Meadows et al, 2019; Mersky, Topitzes, & Reynolds, 2013; Mills et al, 2014; Mingione et al, 2012; Moss et al, 2020; Mouton et al, 2016; Ofuchi, Zaw, & Thepthien, 2020; Ramiro, Madrid, & Brown, 2010; Rehkopf et al, 2016; Sartor et al, 2016; Taha et al, 2014; Velemínský et al, 2020; Warne et al, 2017; Woo et al, 2019; Wu et al, 2010; Young‐Wolff et al, 2019; Zhang et al, 2020) were included in the meta‐analysis, and three studies (Jun et al, 2008; Langlois et al, 2021; Shin, McDonald, & Conley, 2018) were used in the systematic review and meta‐analysis process. The year of publication of the earliest and last publication included in this analysis was, respectively, 2003 and 2022.…”