Cannabis-Induced Psychosis in Teenagers and Young Adults: Risk Factors, Detection, Management

Table 1: The CRAFFT Questionnaire24

Each “yes” answer scores 1 point; a total of 2 or higher indicates a need for additional assessment

C . Have you ever ridden in a car driven by someone (including yourself) who was high or had been using alcohol or drugs?
R . Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?
A . Do you ever use alcohol or drugs while you are by yourself, alone?
F . Do you ever forget things you did while using alcohol or drugs?
F . Do your family or friends ever tell you that you should cut down on your drinking or drug use?
T . Have you ever gotten into trouble while you were using alcohol or drugs?

Table 2: Severity of Dependence Scale for Cannabis25

During the past 3 months…                     
. Did you ever think your use of marijuana was out of control?                     
. Did the prospect of missing smoking or inhaling it make you anxious or worried?                     
. Did you worry about your use of marijuana?                     
. Did you wish you could stop?                     
. How difficult would you find it to stop or go without?

Table 3: Distinguishing Features Characteristic of Cannabis-Induced Psychosis26

· Close in time to last cannabis ingestion                    
. Possible recent sudden increase in cannabis potency or frequency                     
. Transient positive symptoms (paranoia, grandiosity, perceptual alterations)                    
. Mood symptoms (lability, anxiety)                  
. Cognitive deficits                     
. Fewer negative symptoms than schizophrenia
. Social phobia                     
. Hypomania                    
. Insight into condition

Table 4: Working With Adolescent Cannabis Users4

StrategySpecific Tips
Therapeutic relationship· Establish rapport                     
. Clarify confidentiality                    
. Encourage self-efficacy by asking about the adolescent’s goals, thoughts, and motivation for change                     
. Highlight the adolescent’s strengths and previous successes                     
. Do not lecture or judge                     
. Ask permission to address subject another time if the patient is not ready to change
Provide education about cannabis (examples of talking points)· Smoking marijuana may affect your sports performance                     
. Marijuana directly affects your brain and can hurt your school performance and your future
. Marijuana use can cause lifelong problems for some people                     
. Don’t ever get into a car with someone who has been drinking or using drugs                     
. Don’t drive a car after using marijuana, even if you don’t feel high
Set specific goals (examples)· This month: no more than 1 joint per weekend day, and up to 1 additional joint in social situations                     
. Next month: only 1 joint per weekend and up to 1 additional joint in social situations
Address barriers/triggers· Avoid high-risk situations/individuals                     
. Find substance-free ways to cope with stress (eg, recreational activities, exercise, talking with nonusing friends, finding a sponsor)
Minimize withdrawal symptoms· Taper use slowly                     
. Consider a detox facility for severe symptoms                     
. Consider use of oral cannabinoids
Follow-up· Providing ongoing monitoring/support                     
. Encourage patients who relapse to re-engage with treatment                     
. Emphasize that relapse is common and does not preclude long-term recovery                     
. Refer to addiction medicine specialists or facilities if necessary