A Quarter Of Adults Entering SUD Treatment Screen Positive For Psychosis

The percentage of adults entering substance use disorder (SUD) treatment who screened positive for probable-to-extreme psychosis symptoms increased from 19.4% during the January 2019 through June 2021 period to 23.9% during the January 2024 through June 2026 period. During the intervening period from July 2021 through December 2023, 22.1% screened positive for psychosis symptoms.

The increase occurred across all three psychosis severity categories measured by the Yale PRIME Screen Revised. Between the first and most recent periods, the percentage screening in the probable range increased from 9.5% to 11.6%, the percentage with severe symptoms increased from 7.0% to 8.4%, and the percentage with extreme symptoms increased from 2.9% to 3.9%.

Psychosis symptoms also varied substantially by the primary substance for which individuals entered treatment. Across the study period, the percentage screening positive for psychosis symptoms ranged from 15% among those entering treatment for alcohol use disorder to 42% among those entering treatment for methamphetamine use.

Psychosis severity was also associated with treatment completion. Across the entire review period, the average treatment completion rate was 63.0%. The rate was 63.8% among adults whose screening results indicated psychosis was unlikely, compared with 55.9% among those screening in the extreme psychosis range.

For many individuals, the symptoms diminished after entering treatment. Psychosis symptoms resolved within two weeks of treatment entry for 57% of adults. However, 26% continued to show probable-to-severe psychosis symptoms at their last assessment or, for those receiving longer-term treatment, 90 days after treatment entry. The median treatment length of stay was 28 days. Unresolved psychosis symptoms were most common among adults whose primary substance was marijuana, hallucinogens, or club drugs.

The researchers analyzed admission and treatment-completion data for 45,287 adults who entered SUD treatment between January 1, 2019, and June 30, 2026. The data came from the Vista Research Group database. The report did not describe the types of treatment centers in the database or present regional differences.

The findings were reported in You’re Not Imagining It – You Are Seeing More Psychosis by Joanna Conti of Vista Research Group. The analysis was intended to assess the prevalence and potential impact of psychosis symptoms among adults entering addiction treatment.

The researchers concluded that psychosis symptoms among adults entering SUD treatment warrant screening and coordinated follow-up, particularly when symptoms persist during treatment. They recommended screening at intake, access to experienced health care professionals, interventions to reduce premature treatment departure, and psychiatric follow-up for individuals who leave treatment with unresolved symptoms.

The full text of You’re Not Imagining It – You Are Seeing More Psychosis was posted on August 21, 2026 (accessed August 31, 2026).

For more information, contact: Joanna Conti, Founder & Chief Executive Officer, Vista Research Group, Inc., Post Office Box 9002, Port Saint Lucie, Florida 34952; 800-215-3201, ext. 701; Email: jconti@vista-research-group.net; Website: https://vista-research-group.com/