FOCUS-FEP: Facilitating Open Communication about Substance Use in First Episode Psychosis

Substance use increases the risk of developing psychosis and is known to worsen the long-term illness course of people living with psychotic disorders. However, people who develop the first episode of psychosis (FEP) secondary to substance use (i.e., substance-induced psychosis) are less likely to develop a long-term psychotic illness (e.g., schizophrenia) if they can achieve abstinence from drugs like cannabis and amphetamines. Despite this knowledge, some mental health services can find it challenging to effectively identify and intervene to help people experiencing substance use disorders concurrently with the FEP. The cause of this challenge is likely multifactorial, including whether relevant questions are asked, the process through which relevant questions are asked, and consumers' willingness to share this information. FOCUS-FEP is part of the SURE-STEP (Substance Use Recovery: Supporting the Transition to Remission in Early Psychosis) program of work supported by the Project Lead’s Metro North Clinician Research Fellowship (2024-2027). This study will build directly on the findings of the SUNRISE study (Substance Use Needs: Revealing unmet ISsues in Early psychosis) that is currently in progress. FOCUS-EP is an exploratory qualitative study that considers stakeholder perspectives on how best to facilitate communication about substance use in the context of FEP. It is expected that the findings of FOCUS-FEP (in combination with SUNRISE) will inform the collaborative development of a focused care pathway for people experiencing substance use issues concurrently with the FEP. This qualitative research project has an explanatory focus on understanding the potential forces (e.g., beliefs, attitudes, events, policies) shaping the non-disclosure of substance use phenomena (including under- and selective-reporting) in the context of early psychosis. The stakeholders being considered are consumers and staff (both clinical and lived-experience staff).