Psychosis: It’s Not Just the Patients Confusing Perception with Reality


NAMI this month released the results of an online survey of individuals who had experienced psychosis themselves or witnessed it in a family member or friend. Based on more than 4,000 responses, the report may not be statistically valid but it still holds plenty of food for thought.

One of the most arresting results we found was on the topic of substance abuse and first-episode psychosis. “Most individuals who experienced psychosis and their family and friends believed that substance use had no impact at the time of the person’s first psychotic experience,” the survey learned from 1,215 people who had experienced psychosis themselves and 2,882 who had witnessed it. More than two-thirds of the first group and slightly fewer of the second believed substance abuse played no part in the initial onset of illness.

But perception is not reality. A survey of scientific litnami-psychosiserature on the subject that was published one month before the release of NAMI’s survey reports that roughly 50% of all individuals experiencing a first episode of psychosis have a history or dependence on marijuana or alcohol.

“The emerging literature on first-episode psychosis highlights the high prevalence and adverse consequences of substance use, misuse or disorder,” according to “Substance use disorder among people with first-episode psychosis: A systematic review of course and treatment” (Psychiatric Services, Sept. 2011). What’s more, “Once in treatment, continued use of alcohol and other drugs is associated with increased symptoms, adjustment difficulties, treatment nonadherence, relapses and hospitalizations.” Among clients with long-term psychotic disorders, substance use is “associated with multiple adverse outcomes.”

A first episode of psychosis is terrifying for everyone involved. Aside from its symptoms, few of us are prepared to respond swiftly and effectively. As the NAMI survey found, “People don’t know where to turn. They may go looking in wrong places. People who want to help may not know what to do.”

The survey responses on the role of substance abuse are a good illustration of how important it is to validate perception with verifiable information during a psychiatric crisis and afterward. Substance use is deeply implicated in both the onset of psychosis and the likelihood it will recur and result in what health providers call a “bad outcome.” Knowing realities like this can help both the individual who has experienced a first episode of psychosis and the loved ones supporting him or her make sound decisions going forward.

Over the next few days, we’ll be tweeting and posting some of the results of "First Episode: Psychosis – Results from a 2011 NAMI Survey" to our Facebook page. You can follow us on Twitter at @TreatmentAdvCtr  or join our Facebook community.

For online support when someone you know is in crisis, visit the Get Help section of our website.

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