Changes in cannabis use among psychotic clients without specialised substance use treatment

Abstract

The need to address substance use among people with psychosis has been well established. However, treatment studies targeting substance use in this population have reported mixed results. Substance users with psychosis in no or minimal treatment control groups achieve similar reductions in substance use compared to those in more active substance use treatment, suggesting a role for natural recovery from substance use. This meta-analysis aims to quantify the amount of natural recovery from substance use within control groups of treatment studies containing samples of psychotic substance users, with a particular focus on changes in cannabis use. A systematic search was conducted to identify substance use treatment studies. Meta-analyses were performed to quantify reductions in the frequency of substance use in the past 30days. Significant but modest reductions (mean reduction of 0.3-0.4 SD across the time points) in the frequency of substance use were found at 6 to 24months follow up. The current study is the first to quantify changes in substance use in samples enrolled in no treatment or minimal treatment control conditions. These findings highlight the potential role of natural recovery from substance use among individuals with psychosis, although they do not rule out effects of regression to the mean. Additionally, the results provide a baseline from which to estimate likely changes or needed effects sizes in intervention studies. Future research is required to identify the processes underpinning these changes, in order to identify strategies that may better support self-management of substance use in people with psychosis.

The needs of carers who support people living with schizophrenia and a substance use disorder: a multiperspective evaluation

“…Carers can have both positive and negative impacts on the evolution of a PLS-SUD. On the positive side, they can increase the PLS-SUD’s motivation to change their substance use practises (Maisto et al , 1999; Rebgetz et al , 2016; Tracy and Biegel, 2006), promote the satisfaction of their basic needs, which leads to a global improvement in health (Clark, 2001; Labrum, 2020; Townsend et al , 2006), facilitate access to care (Huguelet et al , 2012; Schofield et al , 2001; Tracy and Biegel, 2006) and, in the case of hospitalization, help with reintegration into the community (Smithnaraseth et al , 2020).…”

Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial

“…However, relatively few cannabis-specific interventions have been developed for and tested in people having FEP and those studied have mainly focused on achieving abstinence, showing overall limited efficacy [ 8 - 10 ]. A minority of individuals will recover from CUD without any cannabis-specific treatments [ 11 ], and only about half of people with FEP will recover from CUD within 2 years of regular EIS treatment [ 1 ]. For many individuals who continue to use cannabis, including those who do not wish to participate in cannabis cessation interventions, more research is needed to determine effective therapeutic options that can reduce potential cannabis use–related harms.…”

Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial (Preprint)

“…However, relatively few cannabis-specific interventions have been developed for and tested in people having FEP and those studied have mainly focused on achieving abstinence, showing overall limited efficacy [8][9][10]. A minority of individuals will recover from CUD without any cannabis-specific treatments [11], and only about half of people with FEP will recover from CUD within 2 years of regular EIS treatment [1]. For many individuals who continue to use cannabis, including those who do not wish to participate in cannabis cessation interventions, more research is needed to determine effective therapeutic options that can reduce potential cannabis use-related harms.…”