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

Strategy	Specific 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