A relapse prevention model for comorbid schizophrenia and cannabis use disorder in South Africa

Abstract

Incidents of users with comorbid schizophrenia and cannabis use disorder experiencing a relapse have been a cyclic phenomenon for decades in most psychiatric health care facilities admitting users with such diagnosis. Rehabilitation programmes play a pivotal role in reducing and preventing relapses and are receiving more attention of late. Cannabis use and non-adherence to treatment contribute to a relapse for comorbid schizophrenia and cannabis use disorder users. The purpose of this study was to develop and describe a relapse prevention model for MHCPs to support users with comorbid schizophrenia and cannabis use disorder and their caregivers in the prevention of a relapse. The study was conducted in two phases, namely empirical and theory generating. Data was collected by means of semi-structured interviews with fourteen users and their thirteen caregivers. A caregiver for the fourteenth user declined to participate. The data was analysed using Van Kaam’s (1984) data analysis method. The users with comorbid schizophrenia and cannabis use disorder experienced effects of cannabis that led to a relapse, and identified factors maintaining cannabis use and factors discouraging cannabis use. In terms of effects of cannabis that led to a relapse, the caregivers were burdened by objective cognitive relapse symptoms of psychosis by the users. In respect of factors maintaining cannabis use, the caregivers experienced the burden of social effects due to illness. Factors discouraging cannabis use, included institutional factors, e.g. psychiatric treatment, rehabilitation, support, as well as spiritual and traditional help. In phase 2 the researcher developed a relapse prevention model for use in nursing practice, education and research by MHCPs to support users with comorbid schizophrenia and cannabis use disorder and their caregivers. The findings suggest that help, support, guidance and mental health education, coping skills, cognitive behaviour therapy and lifestyle modification are intervention strategies that are crucial in relapse prevention. The model would enable MHCPs to support users with comorbid schizophrenia and cannabis use disorder, including measures to support their caregivers in South Africa.