Hearing voices: How do substances affect the relationship with voices, coping and compliance?

Objectives: The cognitive model offers a useful framework to understand the emotional and behavioural consequences of voice-hearing experience. Substance use can be viewed as a way of coping with these emotional and behavioural consequences. This research explores how substance use as a coping strategy may affect voice-hearers‟ beliefs about their relationships with the voices, how they cope with the voices and compliance with command hallucinations. Design: This research used a qualitative design to analyse the experiences of participants that have used substances as a way of coping with hearing voices giving commands. Participants were recruited from early intervention services and community mental health services within a local NHS Trust. Methods: Semi-structured interviews were held with nine participants and analysed using a thematic analysis to identify themes amongst the accounts of their experiences. Participants also completed a Beliefs About Voices Questionnaire (BAVQ-R) as a triangulation measure of the appraisals of the voices. Results: Six themes in total were identified during the analysis and a theme of control was interpreted as central to the research question. These themes were: Control; emotional moderation; relationships; self-concept; understanding of psychosis and function of the substance use. Many participants viewed themselves as passively using substances which took control of themselves and their voices. Participants also used substances to disengage from the emotional effect of hearing voices Conclusions: The research suggests that people who hear voices may use substances to lessen the control of the voice. For some this may mean remaining passive and attributing substances (including anti-psychotic medication) as having control over the voice. This has implications for how services can successfully engage individuals in treatment. The effect of substance use on compliance with commands remains unclear