Family Member Perceptions of Substance Use in Loved Ones with Psychosis

Julie M. McCarthy (1,2), M. Grace Shinners (1), Edoardo N. Bianchi (1), Kim Mueser (3), Roger Weiss (1,4), Dost Öngür (1,2)

1. Division of Psychotic Disorders, McLean Hospital, Belmont, MA
2. Department of Psychiatry, Harvard Medical School, Boston, MA
3. Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA
4. Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA

Abstract

Background: The impact of substance use affects people living with psychosis and their families. Family members may have concerns about their loved one’s substance use given that such use increases the risk for treatment dropout and rehospitalization. However, limited data exist on how families of people with early psychosis and substance use perceive their loved one’s substance use.

Methods: Participants were 20 family members of a loved one with a history of substance use in the past 90 days and psychosis first onset in the past 6 years. Family members completed a functional analysis with a research study coach as part of a pilot feasibility clinical trial on Community Reinforcement and Family Training for Early Psychosis (CRAFT-EP). Functional analysis qualitative data were analyzed using a thematic analysis approach to identify patterns of substance use, internal and external triggers, as well as short-term positive consequences, and long-term negative consequences of substance use.

Results: Family members reported that cannabis was the most commonly used substance among loved ones with psychosis. Self-medicating or relieving negative emotions, such as anxiety and stress, were key internal triggers for substance use. The most frequent external triggers included evening/nighttime use at home. Short-term positive consequences often involved experiencing positive emotions, relaxation, and a sense of freedom. Long-term negative consequences of greatest concern to families were tensions with friends/acquaintances, damage to their loved one’s brain, and fear of future job consequences.

Conclusions: Family members can identify concerns and empathize with reasons their loved ones may continue using substances despite the risks associated with psychosis. Developing healthy behaviors as alternatives to promote positive emotions, relaxation, and a sense of freedom may important targets when addressing substance use among people living with early psychosis.