Delusions incorporating cannabis use in dually diagnosed patients with a primary psychotic disorder.

OBJECTIVE

To describe and discuss the implications for treatment of 3 cases of dually diagnosed patients with a primary psychotic disorder who have developed persisting, cannabis-oriented delusional systems.

METHOD

Psychiatric assessment and daily observation on an acute inpatient psychiatric unit.

RESULTS

Abstinence appears to be particularly difficult to attain for a patient with psychosis who hold delusional beliefs that cannabis is a conduit for supernormal experiences with positive affective content, grandiose themes and a sense of enhanced self-efficacy.

CONCLUSION

This phenomenon poses special challenges in the treatment of dual diagnosis patients. Modifications to existing CBT protocols for the treatment of substance abuse in psychosis might be useful in such patients.