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Implicit and explicit affective associations towards cannabis use in patients with recent-onset schizophrenia and healthy controls

  • N. Dekker (a1), A. M. Smeerdijk (a1), R. W. Wiers (a2), J. H. Duits (a1), G. van Gelder (a1), K. Houben (a3), G. Schippers (a1) (a4), D. H. Linszen (a1) and L. de Haan (a1)...



Cannabis use is common in patients with recent-onset schizophrenia and this is associated with poor disease outcome. More insight in the cognitive-motivational processes related to cannabis use in schizophrenia may inform treatment strategies. The present study is the first known to compare implicit and explicit cannabis associations in individuals with and without psychotic disorder.


Participants consisted of 70 patients with recent-onset psychotic disorder and 61 healthy controls with various levels of cannabis use. Three Single-Category Implicit Association Tests (SC-IAT) were used to assess ‘relaxed’, ‘active’ and ‘negative’ implicit associations towards cannabis use. Explicit expectancies of cannabis use were assessed with a questionnaire using the same words as the SC-IAT.


There were no differences in implicit associations between patients and controls; however, patients scored significantly higher on explicit negative affect expectancies than controls. Both groups demonstrated strong negative implicit associations towards cannabis use. Explicit relaxed expectancies were the strongest predictors of cannabis use and craving. There was a trend for implicit active associations to predict craving.


The findings indicate that patients suffering from schizophrenia have associations towards cannabis similar to controls, but they have stronger negative explicit cannabis associations. The strong negative implicit associations towards cannabis could imply that users of cannabis engage in a behaviour they do not implicitly like. Explicit relaxing expectancies of cannabis might be an important mediator in the continuation of cannabis use in patients and controls.


Corresponding author

*Address for correspondence: Dr N. Dekker, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. (Email:


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