Alcohol and cannabis use and mortality in people with schizophrenia and related psychotic disorders

• Published in: Journal of psychiatric research Vol. 46; no. 8; pp. 987 - 993
• Main Authors: Koola, Maju Mathew, McMahon, Robert P, Wehring, Heidi J, Liu, Fang, Mackowick, Kristen M, Warren, Kimberly R, Feldman, Stephanie, Shim, Joo-Cheol, Love, Raymond C, Kelly, Deanna L
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2012; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Age; Alcohol; Alcohol consumption; Alcoholism - epidemiology; Biological and medical sciences; Cannabis; Comorbidity; Female; Humans; Male; Marijuana Abuse - epidemiology; Maryland - epidemiology; Medical sciences; Middle Aged; Mortality; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotic disorders; Psychotic Disorders - epidemiology; Psychotic Disorders - mortality; Retrospective Studies; Risk Factors; Schizophrenia; Schizophrenia - epidemiology; Schizophrenia - mortality; Substance abuse; Substance use; Survival Analysis; Maryland; Substance use; Psychotic disorders; Alcohol; Cannabis; Mortality; Consumption; Schizophrenia; Cannabidaceae; Substance abuse; Psychosis; Alcoholic beverage; Dicotyledones; Angiospermae; Spermatophyta; Drug of abuse; Recreational drug
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2012.04.019

Abstract The impact of co-morbid substance use on mortality is not well studied in psychotic disorders. The objective of this study was to examine the impact of substance use on mortality in people with psychotic disorders and alcohol and/or drug use. We examined the rate of substance use and the risk of substance use on mortality risk over a 4–10 year period in 762 people with psychotic disorders. Deceased patients were identified from the Social Security Death Index and the Maryland Division of Vital Records. Substance use was defined as regular and heavy use or abuse or dependence. Seventy seven percent had co-morbid lifetime substance use, with co-morbid cannabis and alcohol use occurring most commonly. Out of 762 subjects, 62 died during follow up. In a Cox model, predicted mortality risk was higher in age group 35–55 compared to <35 years and in males, but reduced in cannabis users. Overall five- (3.1% vs 7.5%) and ten-year mortality risk (5.5% vs. 13.6%) was lower in cannabis users than in non-users with psychotic disorders ( p  = 0.005) in a survival model. Alcohol use was not predictive of mortality. We observed a lower mortality risk in cannabis-using psychotic disorder patients compared to cannabis non-users despite subjects having similar symptoms and treatments. Future research is warranted to replicate these findings and to shed light on the anti-inflammatory properties of the endocannabinoid system and its role in decreased mortality in people with psychotic disorders.