Developing a theoretical framework for persistent cannabis use among young adults with first episode psychosis.

Abstract

Cannabis use is common among individuals with first episode psychosis (FEP) and persistent use is associated with worse outcomes. The purpose of this qualitative study is to identify factors pertaining to onset of cannabis use and persistent use among young adults with early psychosis receiving coordinated specialty care (CSC) in the United States and begin to develop a theoretical framework to drive further study and hypothesis testing and inform the approach to treatment of cannabis use disorder in this setting. Participants were ages 16-30 years with early psychosis attending a CSC program in New York State. Interviews were conducted in December 2018. Coding and analysis was conducted in Atlas.ti and themes were identified via a thematic analysis approach. Thirteen individuals completed the interview. The mean age in years was 20.7 and the majority were male (n=10). Almost half (46%) were Black, non-Hispanic and 39% were Hispanic. Seven participants indicated they were currently using cannabis and six participants indicated they had stopped for at least 6months at the time of the interview. Several themes emerged including the influence of family and social norms, motivating factors for persistent use and for reduced use or abstinence, and ambivalence regarding the impact of cannabis use on mental health. A theoretical framework emerged which may help identify future research in this area and inform the approach to treatment of cannabis use disorder in this setting.