Skip to main content Accessibility help

Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study

  • I. Harrison (a1), E. M. Joyce (a2), S. H. Mutsatsa (a1), S. B. Hutton (a3), V. Huddy (a1), M. Kapasi (a1) and T. R. E. Barnes (a1)...



The impact of co-morbid substance use in first-episode schizophrenia has not been fully explored.


This naturalistic follow-up of a cohort of 152 people with first-episode schizophrenia examined substance use and clinical outcome in terms of symptoms and social and neuropsychological function.


Data were collected on 85 (56%) of the patient cohort after a median period of 14 months. Over the follow-up period, the proportion of smokers rose from 60% at baseline to 64%. While 30% reported lifetime problem drinking of alcohol at baseline, only 15% had problem drinking at follow-up. Furthermore, while at baseline 63% reported lifetime cannabis use and 32% were currently using the drug, by the follow-up assessment the latter figure had fallen to 18.5%. At follow-up, persistent substance users had significantly more severe positive and depressive symptoms and greater overall severity of illness. A report of no lifetime substance use at baseline was associated with greater improvement in spatial working memory (SWM) at follow-up.


Past substance use may impede recovery of SWM performance in people with schizophrenia in the year or so following first presentation to psychiatric services. The prevalence of substance use other than tobacco tends to diminish over this period, in the absence of specific interventions. Persistent substance use in first-episode schizophrenia is associated with more severe positive and depressive symptoms but not negative symptoms, and should be a target for specific treatment intervention.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study
      Available formats


Corresponding author

*Address for correspondence: Professor T. R. E. Barnes, Division of Neuroscience and Mental Health, Imperial College Faculty of Medicine, Charing Cross Campus, St Dunstan's Road, London W6 8RP, UK. (Email:


Hide All
Addington, J, Addington, D (2001). Impact of an early psychosis program on substance use. Psychiatric Rehabilitation Journal 25, 6066.
Addington, J, Duchak, V (1997). Reasons for substance use in schizophrenia. Acta Psychiatrica Scandinavica 96, 329333.
Ambrose, ML, Bowden, SC, Whelan, G (2001). Working memory impairments in alcohol-dependent participants without clinical amnesia. Alcoholism: Clinical and Experimental Research 25, 185191.
Andreasen, N (1990). Methods for assessing positive and negative symptoms. In Schizophrenia: Positive and Negative Symptoms and Syndromes. Modern Problems in Pharmacopsychiatry (ed. Andreasen, N.), pp. 7385. Karger: Basel.
Asberg, M, Montgomery, SA, Perris, C, Schalling, D, Sedvall, G (1978). A comprehensive psychopathological rating scale. Acta Psychiatrica Scandinavica 271 (Suppl.), 527.
Barnes, TRE (1989). A scale for rating drug-induced akathisia. British Journal of Psychiatry 154, 486491.
Barnes, TRE, Mutsatsa, SH, Hutton, SB, Watt, HC, Joyce, EM (2006). Comorbid substance use and age at onset of schizophrenia. British Journal of Psychiatry 188, 237242.
Battachary, S, Powell, JH (2001). Recreational use of 3,4-methylenedioxymethamphetamine (MDMA) or ‘ecstasy’: evidence for cognitive impairment. Psychological Medicine 31, 647658.
Birchwood, M, Smith, J, Cochrane, R, Wetton, S, Copestake, S (1990). Social Functioning Scale: the development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry 157, 853859.
Block, RI, Erwin, WJ, Ghoneim, MM (2002). Chronic drug use and cognitive impairments. Pharmacology, Biochemistry and Behavior 73, 491504.
Bühler, B, Hambrecht, M, Löffler, W, an der Heiden, W, Häfner, H (2002). Precipitation and determination of the onset and course of schizophrenia by substance use – a retrospective and prospective study of 232 population-based first illness episodes. Schizophrenia Research 54, 243251.
Caspari, D (1999). Cannabis and schizophrenia: results of a follow-up study. European Archives of Psychiatry and Clinical Neuroscience 249, 4549.
Condren, RM, O'Connor, J, Browne, R (2001). Prevalence and patterns of substance misuse in schizophrenia: a catchment area case-control study. Psychiatric Bulletin 25, 1720.
Croft, RJ, Mackay, AJ, Mills, AT, Gruzelier, JG (2001). The relative contributions of ecstasy and cannabis to cognitive impairment. Psychopharmacology 153, 373379.
David, AS (1990). Insight and psychosis. British Journal of Psychiatry 156, 798808.
Drake, RE, Brunette, MF (1998). Complications of severe mental illness related to alcohol and other drug disorders. In Recent Developments in Alcoholism (ed. Galanter, M.), pp. 285299. Plenum: New York.
Drake, RE, Xie, H, McHugo, GJ, Green, AI (2000). The effects of clozapine on alcohol and drug use disorders among patients with schizophrenia. Schizophrenia Bulletin 26, 441449.
Duke, PJ, Pantelis, C, Barnes, TRE (1994). South Westminster Schizophrenia Survey. Alcohol use and its relationship to symptoms, tardive dyskinesia and illness onset. British Journal of Psychiatry 164, 630636.
Duke, PJ, Pantelis, C, McPhillips, MA, Barnes, TRE (2001). Comorbid substance misuse among people with schizophrenia in the community: an epidemiological study in central London. British Journal of Psychiatry 179, 501513.
Fletcher, JM, Page, JB, Francis, DJ, Copeland, K, Naus, MJ, Davis, CM, Morris, R, Krauskopf, D, Satz, P (1996). Cognitive correlates of long-term cannabis use in Costa Rican men. Archives of General Psychiatry 53, 10511057.
Gouzoulis-Mayfrank, E, Daumann, J, Tuchtenhagen, F, Pelz, S, Becker, S, Kunert, HJ, Fimm, B, Sass, H (2000). Impaired cognitive performance in drug free users of recreational ecstasy (MDMA). Journal of Neurology, Neurosurgery and Psychiatry 68, 719725.
Grech, A, Van Os, J, Jones, PB, Lewis, SW, Murray, RM (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry 20, 349353.
Green, AI, Tohen, MF, Hamer, RM, Strakowski, SM, Lieberman, JA, Glick, I, Clark, WS; HGDH Research Group (2004). First-episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol. Schizophrenia Research 66, 125136.
Guy, W (1976). ECDEU Assessment Manual for Psychopharmacology, pp. 76338. National Institute for Mental Health: Rockville, MD.
Hunt, GE, Bergen, J, Bashir, M (2002). Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophrenia Research 54, 253264.
Hutton, SB, Puri, BK, Duncan, LJ, Robbins, TW, Barnes, TRE, Joyce, EM (1998). Executive function in first-episode schizophrenia. Psychological Medicine 28, 463473.
Joyal, CC, Hallé, P, Lapierre, D, Hodgins, S (2003). Drug abuse and/or dependence and better neuropsychological performance in patients with schizophrenia. Schizophrenia Research 63, 297299.
Joyce, E, Hutton, S, Mutsatsa, S, Gibbins, H, Webb, E, Paul, S, Robbins, T, Barnes, TRE (2002). Executive dysfunction in first-episode schizophrenia and relationship to duration of untreated psychosis: the West London Study. British Journal of Psychiatry 181 (Suppl. 43), 3844.
Kapasi, M, Hutton, SB, Mutsatsa, S, Barnes, TRE, Joyce, EM (2004). Treatment effects of conventional and atypical antipsychotics on cognition following a first episode of schizophrenia. Journal of Psychopharmacology 18, A63.
Kavanagh, DJ, Waghorn, G, Jenner, L, Chant, DC, Carr, V, Evans, M, Hemnan, H, Jablensky, A, McGrath, JJ (2004). Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophrenia Research 66, 115124.
Lambert, M, Conus, P, Lubman, DI, Wade, D, Yuen, H, Moritz, S, Naber, D, McGorry, PD, Schimmelmann, BG (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatrica Scandinavica 112, 141148.
Liddle, PF, Barnes, TRE (1990). Syndromes of chronic schizophrenia. British Journal of Psychiatry 157, 558561.
Linszen, DH, Dingemans, PM, Lenoir, ME (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273279.
Lundqvist, T (2005). Cognitive consequences of cannabis use: comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions. Pharmacology, Biochemistry and Behavior 81, 319330.
Magura, S, Kang, SY (1996). Validity of self-reported drug use in high risk populations: a meta-analytical review. Substance Abuse and Misuse 31, 11311153.
Martin, GW, Wilkinson, DA, Kaur, BM (1988). Validation of self-reported cannabis use by urine analysis. Addictive Behaviors 13, 147150.
McCleery, A, Addington, J, Addington, D (2006). Substance misuse and cognitive functioning in early psychosis: a 2 year follow-up. Schizophrenia Research 88, 187191.
Montgomery, SA, Asberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382389.
Morgan, MJ, McFie, L, Fleetwood, H, Robinson, JA (2002). Ecstasy (MDMA): are the psychological problems associated with its use reversed by prolonged abstinence? Psychopharmacology 159, 294303.
Mutsatsa, S, Joyce, EM, Hutton, S, Webb, E, Gibbins, H, Paul, S, Barnes, TRE (2003). Clinical correlates of early medication compliance: West London first episode schizophrenia study. Acta Psychiatrica Scandinavica 108, 439446.
Nelson, H, Willison, J (1991). The Revised National Adult Reading Test (NART) – Test Manual, 2nd edn. NFER-Nelson: Windsor.
Ornstein, TJ, Iddon, JL, Baldacchino, AM, Sahakian, BJ, London, M, Everitt, BJ, Robbins, TW (2000). Profiles of cognitive dysfunction in chronic amphetamine and heroin abusers. Neuropsychopharmacology 23, 113126.
Pencer, A, Addington, J (2003). Substance use and cognition in early psychosis. Journal of Psychiatry and Neuroscience 28, 4854.
Potvin, S, Briand, C, Proteau, A, Bouchard, RH, Lipp, O, Lalonde, P, Nicole, L, Lesage, A, Stip, E (2005). CANTAB explicit memory is less impaired in addicted schizophrenia patients. Brain and Cognition 59, 3842.
Potvin, S, Stip, E, Roy, JY (2003). Clozapine, quetiapine and olanzapine among addicted schizophrenic patients: towards testable hypotheses. International Clinical Psychopharmacology 18, 121132.
Rodgers, J (2000). Cognitive performance amongst recreational users of ‘ecstasy’. Psychopharmacology 151, 1924.
Sahakian, B, Owen, A (1992). Computerised assessment in neuropsychiatry using CANTAB. Journal of the Royal Society of Medicine 85, 399402.
Salyers, MP, Mueser, KT (2001). Social functioning, psychopathology and medication side effects in relation to substance use and abuse in schizophrenia. Schizophrenia Research 48, 109123.
Santin, LJ, Rubio, S, Begega, A, Arias, JL (2000). Effects of chronic alcohol consumption on spatial reference and working memory tasks. Alcohol 20, 149159.
Schooler, NR, Kane, JM (1982). Research diagnoses for tardive dyskinesia. Archives of General Psychiatry 39, 486487.
Sevy, S, Robinson, DG, Holloway, S, Alvir, JM, Woerner, MG, Bilder, R, Goldman, R, Lieberman, J, Kane, J (2001). Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. Acta Psychiatrica Scandinavica 104, 367374.
Simpson, GM, Angus, JWS (1970). A rating scale for extrapyramidal side-effects in drug-induced extrapyramidal disorders. Acta Psychiatrica Scandinavica 212, 1119.
Smelson, DA, Losonczy, MF, Davis, CW, Kaune, M, Williams, J, Ziedonis, D (2002). Risperidone decreases craving and relapses in individuals with schizophrenia and cocaine dependence. Canadian Journal of Psychiatry 47, 671675.
Sorbara, F, Liraud, F, Assens, F, Abalan, F, Verdoux, H (2003). Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects. Schizophrenia Research 18, 133136.
Spencer, CR, Castle, D, Michie, PT (2002). Motivations that maintain substance use among individuals with psychotic disorders. Schizophrenia Bulletin 28, 233247.
Wade, D, Harrigan, S, Edwards, J, Burgess, PM, Whelan, G, McGorry, PD (2006). Course of substance misuse and daily tobacco use in first-episode psychosis. Schizophrenia Research 81, 145150.
Weaver, T, Madden, P, Charles, V, Stimson, G, Renton, A, Tyrer, P, Barnes, TRE, Bench, C, Middleton, H, Wright, N, Paterson, S, Shanahan, W, Seivewright, N, Ford, Con behalf of the Comorbidity of Substance Misuse and Mental Illness Collaborative (COSMIC) study team (2003). Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry 183, 304313.
Weiss, RD, Najavits, LM, Greenfield, SF, Soto, JA, Shaw, SR, Wynerm, D (1998). Validity of substance use self-reports in dually diagnosed outpatients. American Journal of Psychiatry 155, 127128.
Weissenborn, R, Duka, T (2003). Acute alcohol effects on cognitive function in social drinkers: their relationship to drinking habits. Psychopharmacology 165, 306312.


Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study

  • I. Harrison (a1), E. M. Joyce (a2), S. H. Mutsatsa (a1), S. B. Hutton (a3), V. Huddy (a1), M. Kapasi (a1) and T. R. E. Barnes (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed