Individuals with psychosis have high rates of substance abuse, particularly cannabis use. This comorbidity leads to lower treatment adherence and higher rates of hospitalization in this segment of the population. Addressing cannabis use has been shown to be difficult and new and more effective methods of treatment need to be explored so that individuals with psychosis reduce the negative outcomes resulting from cannabis use.
To this end, C.R. Hjorthoj of the Copenhagen University Hospital’s Mental Health Centre in Denmark recently led a study comparing a motivational interviewing treatment combined with treatment at usual (TAU) to TAU alone in a sample of 103 people with cannabis use history and psychosis. The intervention participants received six months of TAU and CapOpus, a behavioral and motivation interviewing therapy, while the other group only received TAU. Cannabis use was measured by prior month’s use.
Hjorthoj found that although there were some slight reductions in frequency of use in the CapOpus group, the overall rate of cannabis consumption was similar for both groups. This suggests that even though the CapOpus addressed specific psychosis-related behaviors and beliefs, it was unsuccessful at reducing cannabis use in general. Hjorthoj did notice that certain participants benefitted more than others. Specifically, those participants who were not abstaining at study onset, those who were unemployed, and the youngest participants showed the largest reductions in cannabis use as a result of CapOpus.
Other benefits included higher reports of satisfaction with CapOpus/TAU than with TAU alone. This finding indicates that although the overall impact did not affect use, it did provide skills that benefited the participants and engaged them enough to perhaps keep them in treatment. Clinical improvement may take longer than the six months allotted for in this study. Many individuals who use cannabis believe the positive aspects of reducing anxiety and other self-medication outcomes far outweigh any negative consequences.
Although CapOpus was unsuccessful at reducing short-term use, longer periods of psychosocial treatment may help transform these beliefs about cannabis use and could impact use over time. Future trials should also look at how combined treatment of psychosocial and pharmacological interventions could help those with psychosis and cannabis use. Hjorthoj added, “Such trials may benefit from exploring ways to include group sessions and family-based interventions.”
Hjorthøj, ,C.R., et al. (2013). Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis: The CapOpus Randomized Trial. Psychological Medicine 43.7 (2013): 1499-510.ProQuest. Web.
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