Alcohol and Cannabis Use in Urban, African American, First-Episode Schizophrenia-Spectrum Patients: Associations With Positive and Negative Symptoms

Michael T. Compton, M.D., M.P.H.; Neil E. Whicker, M.D.; and Karen M. Hochman, M.D.

Objective: On the basis of limited prior research on associations between symptoms and substance use in first-episode psychosis, a retrospective chart review was conducted to test 2 hypotheses: (1) the presence of positive symptoms is associated with alcohol use prior to admission and (2) the absence of prominent negative symptoms is associated with cannabis use prior to admission.

Method: Eligible patients included those admitted for a first episode of psychosis in a public-sector, university-affiliated hospital that serves a predominantly African American, socially disadvantaged, urban population. The 72 patients included in the analysis were 18 to 40 years of age, and all were African American. Using a structured data collection instrument, discharge summaries of consecutively admitted patients from January 2002 to March 2005 were reviewed to extract data on basic demographic and clinical characteristics, the presence of 11 symptoms, and alcohol and cannabis use within 6 months prior to hospitalization.

Results: Alcohol use in the 6 months prior to hospitalization was associated with a higher frequency of positive psychotic symptoms among first-episode patients. Cannabis use was associated with a lower likelihood of having prominent negative symptoms. These associations remained even after controlling for relevant covariates in logistic regression models.

Conclusion: Although the direction of causality cannot be established, the association between positive psychotic symptoms and alcohol use may represent a self-medication effect, whereas the association between lesser negative symptoms and cannabis use may result from the fact that interpersonal deficits and reduced hedonic capacity minimize drug-seeking activities.

(J Clin Psychiatry 2007;68:1939-1945)

Received Dec. 15, 2006; accepted April 3, 2007. From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Ga.

This study was supported by a grant from the National Institute of Mental Health to Dr. Compton (K23 MH067589).

Results from this study were presented in a poster at the 5th International Conference on Early Psychosis, October 2006, Birmingham, United Kingdom, and in the following abstract: Compton MT, Whicker NE, Hochman K. Alcohol and cannabis use in urban, African American, first-episode psychosis patients: associations with positive and negative symptoms. Schizophr Res 2006;86(suppl):S99.

The authors report no additional financial or other relationship relevant to the subject of this article.

Corresponding author and reprints: Michael T. Compton, M.D., M.P.H., Emory University School of Medicine, 49 Jesse Hill Jr. Dr., S.E., Room #333, Atlanta, GA 30303 (e-mail: mcompto@emory.edu).