Intentions to Engage in Motivational Interviewing Around Cannabis Reduction and Cessasion with Young Adult Family Members with Psychosis: Critical Inquiry Guided By Theory of Planned Behavior

Background and Purpose: Cannabis use in young adults experiencing first episode psychosis (FEP) is associated with negative clinical and functional outcomes. While there is currently no evidence based practice to treat cannabis use disorder for people with FEP, previous research has shown that family training in motivational interviewing (MI) is associated with reduced cannabis use in young adults with FEP as well as reduced caregiver burden and distress. Guided by the theory of planned behavior (TPB), this paper reports on a critical inquiry about intentions for individuals to utilize motivational interviewing to address cannabis use with their young adult family members (YAFM) with FEP, which we describe as “strategic conversations”.

Methods: Online focus groups (n=3) were conducted via Zoom with 8 individuals with YAFM with FEP and historical cannabis use: almost all were parents (82.5%; 12.5% sibling) with a mean age of 52.3 years, most were women (75%; 25% men), and all reported being White. All participants reported completing 2 years of college or more. Half reported being employed, and half reported annual household incomes of $100,000 or greater. Recent cannabis use of YAFM was estimated by participants and averaged 12.0 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 interviews were semi-structured with questions about intentions to engage in strategic conversations about cannabis use with their YAFM. All were recorded, transcribed verbatim, and entered into NVivo for analysis. Initial analysis was completed 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: Several tensions were raised across TPB’s attitude, normative, and control belief constructs to explain and predict intentions to engage in strategic conversations with YAFM. Participants reported vested interests in supporting their YAFM, understanding reasons for use, and reducing conflict. However, participants also reported concerns that the MI approach would be ineffective, compete with existing caregiver/parental roles, or imply approval of cannabis use. Finally, while participants reported wanting to provide factual information about cannabis use and psychosis to their YAFM, some wanted the information for persuasion rather than to help collaboratively elicit the YAFM’s own reasons for cannabis reduction.

Conclusions and Implications: Participants reported interest in supporting the reduction of cannabis use in YAFM with FEP, reducing conflict, and reducing caregiver burnout. However, participants also reported skepticism about their ability to reduce extant conflict, concerns over competing caregiver roles, and hesitancy to adopt a less persuasion-focused approach. These findings suggest that family members themselves may benefit from MI to increase intention to engage in strategic conversations with YAFM. Finally, families may be more receptive to an approach that includes both strategic conversations and a feedback component such as motivational enhancement therapy.