Systematic meta-analysis of outcomes associated with psychosis and co-morbid substance use

Objective: To compare the symptoms and social function of patients with psychosis and current substance use to those with psychosis and no history of substance use. Method: The databases EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English that reported the characteristics of patients with psychotic illness who were current substance users and those who had never used substances. The searches yielded 22 articles that met the inclusion criteria. Meta-analysis was used to compare four key outcome variables: positive symptoms, negative symptoms, depression and social function - and three secondary outcomes: violence, self-harm and hospital admissions. Results: Current substance-using patients were significantly younger than non-substance-using patients and were more likely to be male, but did not differ in age at onset of psychosis or in their level of education. Current substance users had higher ratings of positive symptoms and were more likely to have a history of violence. Older studies reported a stronger association between current substance use and positive symptoms than more recently published studies. Current substance users did not differ from non-users on measurements of negative symptoms, depressive symptoms, social function, self-harm, or the number of hospital admissions. Conclusion: Current substance users with psychosis may have more severe positive symptoms than patients who have never used substances, but this result should be interpreted with caution because of demographic differences between substance users and non-substance users.