Intentions for Cannabis Reduction and Cessation for Young Adults with Psychosis: Critical Inquiry Guided By Theory of Planned Behavior

Background and Purpose: Young adults experiencing a first episode of psychosis (FEP) are more likely than peers without psychosis to use cannabis and develop a cannabis use disorder (CUD). Use is associated with negative clinical and functional outcomes; however, there is evidence to suggest that cessation after FEP contributes to improved long-term outcomes. Unfortunately, no evidence-based practice (EBP) has been identified to effectively treat CUD for people with FEP. Moreover, there is a paucity of research about what impacts a person’s intentions to reduce or stop using. This paper attempts to fill that gap and reports on a critical inquiry about intentions of young adults with FEP to reduce or discontinue cannabis use, guided by Theory of Planned Behavior (TPB).

Methods: Online focus groups (n=3) and individual interviews (n=3) were conducted via Zoom with 16 young adults with FEP and historical cannabis use: most were men (75%; 25% women) and White (87.5%, 12.5% Black), with a mean age of 23.7 years. Most were current students (56.2%), employed (62.5%), and enrolled in an FEP program for 13.7 months. All reported a lifetime history of cannabis use and used cannabis an average of 11.8 of the past 30 days. Participants were recruited from two local FEP teams and nationally through the Psychosis-risk and Early Psychosis Program Network and National Alliance on Mental Illness.

Group and individual interviews were semi-structured with questions about patterns and modalities of cannabis use, salient factors contributing to intentions to reduce or discontinue use based on TPB, and norms about discussing cannabis use with family and providers. All were recorded, transcribed verbatim, and entered into NVivo for analysis. Data were initially analyzed independently by two researchers using deductive content analysis guided by constructs of TPB. After resolving discrepancies by consensus, coded data within each TPB construct were analyzed again thematically to identify and describe the breadth of themes from each TBP construct. Researchers created an audit trail and analytical memos to enhance rigor and trustworthiness of findings.

Findings: Four topics were present across TPB’s attitude, normative, and control belief constructs to explain and predict intentions for cannabis reduction and cessation: social support, enjoyable activities, mental health, and pursuit of life goals. While participants identified many potential benefits of cannabis reduction and cessation, particularly for pursuing meaningful life goals, most maintained regular use. Participants perceived cannabis as a facilitator of social interactions, enjoyable activities, and improved mental health (and reduced dysthymia). Because cannabis conferred benefits, many were concerned about reducing or discontinuing cannabis without requisite replacement strategies to compensate for the benefits of cannabis.

Conclusions and Implications: In spite of life goals incompatible with cannabis use, the decisional balance did not favor cessation given its perceived benefits and participants’ lack of replacement strategies to facilitate social interactions, enjoyable activities, and euthymia. Interventions may be improved by directly addressing the decisional balance of use, including data about negative functional and clinical impacts of cannabis, and by teaching skills to build positive social support, schedule enjoyable activities, and ameliorate dysthymia.