A Scoping Review of Substance Use Treatment in Early Intervention Programs for Psychosis
Leo Bernstein (1), Delbee M Martin (1), Whitney Sourey (1), Dave Flynn MS(LIS) (2), Amy Yule M.D. (1)
1. Psychiatry Department at Boston Medical Center
2. BU Chobanian & Avedisian School of Medicine
Background: Co-occurring substance use and substance use disorders are common in first episode psychosis (FEP) patients, yet integration of substance use treatment into early intervention services (EIS) is not well established or researched. We therefore aimed to conduct a scoping review to describe substance use interventions within EIS, and barriers and facilitators to integrating substance use treatment into these programs.
Methods: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, and PsycINFO were searched from 1996 to 2025. Eligibility criteria included manuscripts written in English that discussed substance use treatment in EIS for individuals at clinical high-risk (CHR) and FEP. At least two reviewers independently screened abstracts and full texts and extracted data. Any conflicts were discussed as a group with the PI.
Results: A total of 1273 publications were identified and 35 met inclusion criteria. One publication focused on CHR and 34 focused on FEP. All publications discussed cannabis and alcohol as the two most used substances within these populations, with 13 focusing only on cannabis use. Ten of the studies evaluating substance use treatment were randomized controlled trials, 4 of which demonstrated significant reductions in substance use. Motivational interviewing (MI) was a common substance use intervention described in 17studies. Barriers to integrating substance use treatment included differing training and funding streams for substance use professionals and EIS providers, clinician time and familiarity with integrated substance use and mental health care models, and patient and family acceptability of as well as access to substance use treatment.
Conclusions: In the limited studies focusing on substance use interventions within EIS, MI was the most frequently used intervention. Given the high prevalence of substance use in CHR/FEP populations, additional research on substance use interventions for this population is needed.