Skip to main content Accessibility help
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 3
  • Print publication year: 2004
  • Online publication date: December 2009

12 - Addressing cannabis abuse in people with psychosis


As outlined in Chapter 8, cannabis use is common amongst people with schizophrenia and regular use, even at relatively low levels, can have a negative impact on illness course (Hall and Degenhardt, 2000). The effective management of this clinical problem is increasingly the focus of psychiatric practice and research. This chapter reviews a number of important areas that deserve consideration when developing an effective response. Aspects such as screening, assessment and models of service delivery are covered. The chapter concludes by outlining a number of psychosocial treatment interventions available for addressing cannabis use in schizophrenia and related disorders.

It must be acknowledged from the outset that there is a paucity of research evidence in terms of treatment interventions solely for cannabis use amongst people with schizophrenia. Thus, studies that have considered other drugs, and not just cannabis, are included in this review.


An awareness of any ongoing drug abuse is essential when determining psychiatric diagnosis, deciding on appropriate treatment interventions and planning future care (Zeidonis and Fisher, 1994). If undetected, drugs such as cannabis can confound the interpretation of important signs and symptoms of psychosis, possibly lead to overmanagement with psychotropic medications, as well as rendering other psychosocial treatments less effective for people with schizophrenia (Drake et al., 1993b).

Related content

Powered by UNSILO
Ananth, J., Vandewater, S., Kamal, M., et al. (1989). Missed diagnosis of substance abuse in psychiatric patients. Hosp. Commun. Psychiatry, 40, 297–299
Appleby, L., Dyson, V., Luchins, D. J. and Cohen, L. S. (1997). The impact of substance use screening on a public psychiatric inpatient population. Psychiatric Serv., 48, 1311–1316
Ashton, C. H. (2001). Pharmacology and effects of cannabis: a brief review. Br. J. Psychiatry, 178, 101–106
Barrowclough, C., Haddock, G. and Tarrier, N. (2001). Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am. J. Psychiatry, 158, 1706–1713
Bellack, A. S. and DiClemente, C. C. (1999). Treating substance abuse among patients with schizophrenia. Psychiatric Serv., 50, 75–80
Bellack, A. S. and Gearon, J. S. (1998). Substance abuse treatment for people with schizophrenia. Addict. Behav., 23, 749–766
Carey, K. B. and Correia, C. J. (1998). Severe mental illness and addictions: assessment considerations. Addict. Behav., 23, 735–748
Carey, K. B., Maisto, S. A., Carey, M. al. (2001) Readiness to change substance misuse among psychiatric outpatients: reliability and validity of self-report measures. J. Studies Alcohol, 62, 79–88
Castle, D., James, W. Koh, et al. (2002). Substance use in schizophrenia: why do people use, and what can be done about it?Schizophr. Res., 53, 223
Cooper, M. L., Frone, M. R., Russell, M. and Mudar, P. (1995). Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J. Personal. Soc. Psycho., 69, 990–1005
Department of Health (2002). Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide. London: Department of Health
Dixon, L., Haas, G., Weiden, P. J., Sweeney, J. and Frances, A. J. (1991). Drug abuse in schizophrenic patients: clinical correlates and reasons for use. Am. J. Psychiatry, 148, 224
Drake, R. and Meuser, K. (2000). Psychosocial approaches to dual diagnosis. Schizophr. Bull., 26, 105–118
Drake, R. E. and Wallach, M. A. (1989). Substance abuse among the chronic mentally ill. Hosp. Commun. Psychiatry, 40, 1041–1046
Drake, R. E., Bartels, S. J., Teague, G. B., Noordsy, D. L. and Clark, R. E. (1993a). Treatment of substance abuse in severely mentally ill patients. J. Nerv. Ment. Dis. 24, 589–608
Drake, R. E., Altereman, A. I. and Rosenberg, S. R. (1993b). Detection of substance use disorders in severely mentally ill patients. Commun. Ment. Health J., 29, 175–192
Drake, R. E., Essock, S. M., Shaner, al. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Serv., 52, 469–476
Hall, W. and Degenhardt, L. (2000). Cannabis use and psychosis: a review of clinical and epidemiological evidence. Aust. NZ J. Psychiatry, 34, 26–34
James, W., Koh, G., Spencer, C. et al. (2002). Managing Mental Health and Drug Use. Perth, Western Australia: Uniprint
James, W.Preston, N., Koh, al. (2004). A group intervention that assists patients with dual diagnosis reduce their drug and alcohol use: a randomised controlled trial. Psychol. Med. (in press)
Kavanagh, D. (1995). An intervention for substance abuse in schizophrenia. Behav. Change, 12, 20–30
Kavanagh, D. (2000). Treatment of Comorbidity. National Comorbidity Project–National Workshop Agenda Papers. Canberra. Available from Department of Psychiatry, University of Queensland
Kavanagh, D. J.Young, R., Boyce, al. (1998). Substance Treatment Options in Psychosis (STOP): a new intervention for dual diagnosis. J. Men. Health, 7, 135–143
Ley, A., McLaren, S. and Siegfried, N. (2001). Treatment programmes for people with both severe mental illness and substance misuse (Cochrane Review). Cochrane Library, Issue 1
Linszen, D. H., Dingemans, P. M. and Lenior, M. E. (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch. Gen. Psychiatry, 51, 273–279
Marlatt, G. and Gordon, J. (1985). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviours. New York: Guildford Press
Marsden, J., Gossop, M., Stewart, al. (1997). The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome. Addiction 93, 1857–1868
Mayfield, D., McLeod, G. and Hall, P. (1974). The CAGE questionnaire: validation of a new alcoholism instrument. Am. J. Psychiatry, 131, 1121–1123
McLellan, A. T., Kushner, H., Metzger, al. (1992). The fifth edition of the Addiction Severity Index. J. Substance Abuse Treatment, 9, 199–213
Miller, W. R. (1996). Motivational interviewing: research, practice and puzzles. Addict. Behav., 61, 835–842
Miller, W. and Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behaviour. New York: Guildford Press
Miller, W. R. and Tonigan, J. S. (1996). Assessing Drinker's motivation for change: the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychol. Addict. Behav., 10, 81–89
Milling, R. N., Faulkner, L. R. and Craig, J. M. (1994). Problems, in the recognition and treatment of patients with dual diagnosis. J. Substance Abuse Treatment, 11, 267–271
Osher, F. C. and Kofoed, L. L. (1989). Treatment of patients with psychiatric and psychoactive substance abuse disorders. Hosp. Commun. Psychiatry, 40, 1025–1030
Prochasca, J. and DiClemente, C. (1986). Toward a comprehensive model of change. In Treating Addictive Behaviours: Process of Change. ed. W. R. Miller and N. Heather. New York: Plenum
RachBeisel, J., Scott, J. and Dixon, L. (1999). Co-occurring severe mental illness and substance use disorders: a review of recent research. Psychiatric Serv., 50, 1427–1433
Rolfe, T. J., Kulkarni, J., Fitzgerald, al. (1999a). Cannabis use, symptom profile and quality of life in clients enrolled in the Schizophrenia Care and Assessment Program (SCAP). International Congress on Schizophrenia Research, Santa Fe, April 1999. Schizophr. Bull. (suppl.)
Rolfe, T. J. Williams, S., Fitzgerald, P. B. and Kulkarni, J.(1999b). Cannabis use in schizophrenia. R Aust NZ J Psychiatry, (supp.)
Rosenberg, S. D., Drake, R. E., Wolford, G. al (1998). Dartmouth assessment of lifestyle instrument (DALI): a substance use disorder screen for people with severe mental illness. Am. J. Psychiatry, 155, 232–238
Siegfried, N. (1998). A review of comorbidity: major mental illness and problematic substance use. Aust. NZ J. Psychiatry, 32, 707–717
Skinner, H. A. (1982). The drug abuse screening test. Addict. Behav. 7, 363–371
Spencer, C., Castle, D. J. and Michie, P. (2002). An examination of the validity of a motivational model for understanding substance use among individuals with psychotic disorders. Schizophr. Bull., 28, 233–247
Stephens, R. S., Roffman, R. A. and Simpson, E. E. (1994). Treating adult marijuana dependence: a test of the relapse prevention model. J. Consult. Clin. Psychol., 62, 92–99
Test, M. A., Wallisch, L. S. and Allness, D. J. (1989). Substance use in young adults with schizophrenic disorders. Schizophr. Bull., 15, 465–476
Weiss, R. D., Najavitis, L. M., Greenfield, S. al. (1998). Validity of substance use self-reports in dually diagnosed outpatients. Am. J. Psychiatry, 155, 127–128
Zeidonis, D. and Fisher, W. (1994). Assessment and treatment of comorbid substance abuse in individuals with schizophrenia. Psychiatric Ann., 24, 477–483