Correlates of substance use in a large naturalistic cohort of young people with early and emerging psychosis

Background: Substance use remains a barrier to recovery for young people accessing early intervention services for psychosis. While correlates of use have been explored in populations experiencing a First Episode of Psychosis (FEP), sample sizes have been small and less research assesses cohorts at Ultra-High Risk of psychosis (UHR). Methods: : This study uses data from a naturalistic cohort including UHR and FEP participants (N= 1252) to elucidate clinical correlates of use in the past three months of any illicit substance, amphetamine-type stimulants (ATS), cannabis, and tobacco. Moreover network analysis of these substances and additionally alcohol, cocaine, hallucinogens, sedatives, inhalants, and opioids was completed. Results: : Young people with FEP used substances at significantly higher rates than those at UHR. High confluence of use was seen between substances. In the FEP group, participants who had used any illicit substance, ATS, and/or tobacco had increased positive symptoms and decreased negative symptoms. Young people with FEP who used cannabis had increased positive symptoms. In the UHR group participants who had used any illicit substance, ATS, and/or cannabis in the past 3 months showed decreased negative symptoms compared to those who had not. Conclusion: A distinct clinical picture of more florid positive symptoms and alleviated negative symptoms seen in those who use substances in the FEP group appears muted in the UHR cohort. Treating young people at UHR in early intervention services represents an opportunity to address substance use early in order to improve outcomes, particularly in those who go on to experience FEP.