Mobile Application-Based Interventions for Cannabis Use in Young Adults With First Episode Psychosis

To determine whether adding CHAMPS (an intervention aimed at developing safer consumption behaviors) to standard EIS is superior to standard EIS alone in reducing cannabis-related problems in young adults with FEP who are not seeking to cease or reduce their use. Total score of the Marijuana Problems Scale (MPS, 19 items, 0-38) at Week 8 post-randomization (also assessed at Week 12 post-randomization). Minimum clinically important difference (MCID): 2 points. For each MPS item, the participant rates a cannabis-related problem over the past month on a three-point scale: 0 = not a problem, 1 = a minor problem, 2 = a serious problem. Total scores range from 0 to 38; higher scores indicate more serious problems.

To determine whether adding iCC to standard services offered in EIS clinics is superior to standard EIS alone in reducing the frequency of cannabis use in individuals with FEP and CUD (moderate to severe) who are seeking to reduce or cease their use. Number of days of cannabis use in the past 14 days (Timeline Follow Back, TLFB) at Week 12 (also assessed at Weeks 6 and 24 post-randomization).

Number of days of cannabis use in the past 14 days - Timeline Follow Back (TFLB) The TLFB will assess self-reported days of cannabis use over the past 14 days , as well as type of cannabis products, provenance, form, and quantity . The main endpoint for this outcome is the number of days per week of cannabis use. Days per week is the preferred manner of reporting cannabis use frequency in the field, and use of cannabis once per week or more is an established threshold for increased risk of adverse psychosis-related outcomes.

Protective behavioral strategies: PBSM total score (17 items, 15-73) The PBSM is a 17-item, self-report measure including various evidence-based strategies that cannabis users can adopt to reduce harms or use more safely. For each item, participants rate the degree to which they engage in a specific protective behavior on a scale of 1 = Never to 6 = Always. Individual item responses are summed for a total score, which is then converted to an item-response theory scaled score (possible range: 15-73). Higher scaled scores indicate greater use of PBS.

The proportion of participants in each State of Change Designation (i.e., precontemplation, contemplation, and action) Readiness to change Questionnaire (RCQ) Motivation to change cannabis use practices will be assessed using the adapted 12-item Readiness-to-Change Questionnaire (RCQ), modified for cannabis use. The RCQ is based on Prochaska and DiClemente's stages-of-change model and assesses three stages: pre-contemplation, contemplation, and action. For each scale, 4 items are summed (range: -8 to +8); the scale with the highest score represents the participant's Stage of Change Designation. The internal consistency of the three subscales is acceptable. The tool is designed for cannabis users not seeking treatment who may be unaware of a problem.

Quality of life: WHOQOL-BREF (26 items, 4 domains, 0-100) Quality of life will be measured using the WHOQOL-BREF, which assesses four domains: physical health, psychological health, social relationships, and environment, plus two overall items. The WHOQOL-BREF consists of 26 items; each item is rated on a 5-point Likert scale ranging from very poor to very good. Domain scores are calculated according to WHOQOL-BREF guidelines and converted to a 0-100 scale; an overall total score will also be calculated .

Cannabis dependence severity will be assessed using the Severity of Dependence Scale (SDS), a 5-item self-report questionnaire validated in people with early psychosis. Items are scored 0-3; total scores range from 0-15 (higher = greater dependence severity).

Motivation to reduce cannabis use will be assessed using the Precaution Adoption Process Model (PAPM), a theoretical stage-based model that classifies individuals into 6 nominal stages: (1) unaware, (2) unengaged, (3) undecided, (4) decided not to act, (5) decided to act, (6) acting. Stages will be dichotomized for inter-group comparison (e.g., pre-action vs. action stages).

In addition to frequency (primary endpoint), the timeline follow back (TLFB) will capture continuous abstinence (proportion of participants with 0 days of cannabis use in past 14 days) and estimated quantity of cannabis used per session.

Quality of life will be measured using the WHOQOL-BREF, which has been validated in individuals with psychotic disorders and consists of 26 items across 4 domains: physical health, psychological health, social relationships, and environment. Each item is rated on a 5-point Likert scale ranging from very poor to very good. For each domain, scores are calculated according to WHOQOL-BREF guidelines and converted to a 0-100 scale.