Adaptation and Pilot of a Cannabis Reduction Intervention for Young Adults with Early Psychosis

Background and Purpose: Young adults with early psychosis (EP) are more likely than peers without psychosis to use cannabis and develop cannabis use disorder (CUD). Cannabis use negatively impacts clinical and functional outcomes, such as increased re-hospitalization and psychotic symptoms; however, reduction or cessation after EP contributes to improved long-term outcomes. No evidence-based practice has been identified to effectively treat CUD for people with EP. This project adapted and piloted a motivational-enhancement therapy cannabis-reduction intervention and assessed feasibility and acceptability.

Methods: A stakeholder advisory board was developed (n=9), comprised of one person with psychosis, family members (n=5), and FEP providers (n=3). The research team presented to them an adapted intervention protocol, solicited feedback, and developed a revised, manualized intervention (“The Check-Up”) to pilot.

The Check-Up consists of two individual sessions (45-90 minutes each) delivered via Zoom. Session 1 focuses on engagement and eliciting participants’ use patterns and perceived benefits, consequences of use, and motivation for change. A personalized feedback report (PFR) is generated from baseline assessment data and reviewed in session two. PFR topics include normative data about cannabis use, CUD symptoms, life goals, social support, and cannabis and psychosis harm reduction psychoeducation.

Pilot: Baseline data were collected at study enrollment, with both sessions conducted within a three-week timeframe. Final data collection and semi-structured interviews (T2) were scheduled two weeks after session two. Pilot participants (N=12) were recruited nationally, through the Psychosis-risk and Early Psychosis Program Network, and all were receiving EP services. Participants were primarily men (n=10; women=1, non-binary=1) and White (n=8; Black n=2, Native Hawaiian / Pacific Islander n=1; Latinx n=1), with a mean age of 22.4 (SD=2.84) and average use of 18.3 days (SD=8.82) of the previous 30. Cannabis use and intentions to change were measured at baseline and T2. Interviews collected feedback about the intervention, with questions like, “Tell me about your experience with The Check-Up” and prompts for things they liked / disliked, and most / least favorite parts. Interviews were recorded and analyzed using “rapid identification of themes from audio recordings” (RITA), using 3-minute intervals to track themes directly related to interview questions: minimal interpretation was employed to keep findings data-near.

Results: The first 12 eligible candidates enrolled and attended their first session; 11 completed both sessions and T2 measures / interview, for an attrition rate below 10%. The intervention was rated as moderately-extremely helpful, averaging 4.36/5 (SD=1.21). Three participants reported reduced cannabis use days and amount. All 11 participants interviewed reported they would recommend the intervention, with a ratio of positive to negative comments within each three-minute interview segment of 8:1. Participants particularly praised PFR data about cannabis-psychosis interactions, opportunities to reflect on the impact of cannabis on life goals, “red flags” for CUD, and harm-reduction strategies for cannabis use.

Conclusions and Implications: The Check-Up demonstrated high feasibility, retention rates, and participant satisfaction – particularly the psychosis-specific adaptations. It can be delivered by social workers and promotes self-determination of behavior change. Further, large-scale study is warranted to investigate efficacy for this population.