End User–Informed Mobile Health Intervention Development for Adolescent Cannabis Use Disorder: Qualitative Study

Abstract

BackgroundThe rates of cannabis use continue to increase among adolescents and the current interventions have modest effects and high rates of relapse following treatment. There is increasing evidence for the efficacy of mobile technology–based interventions for adults with substance use disorders, but there is limited study of this technology in adolescents who use cannabis.ObjectiveThe goal of our study was to elucidate elements of an app-based adjunctive intervention for cannabis cessation that resonate with adolescents who use cannabis.MethodsAdolescents, aged between 14 and 17 years, who used cannabis were recruited from San Diego County high schools. Semistructured focus groups (6 total; N=37) were conducted to examine the ways in which participants used smartphones, including the use of any health behavior change apps, as well as to elicit opinions about elements that would promote engagement with an app-based intervention for adolescent cannabis cessation. An iterative coding structure was used with first cycle structural coding, followed by pattern coding.ResultsThemes that emerged from the analysis included (1) youth valued rewards to incentivize the progressive reduction of cannabis use, which included both nontangible rewards that mimic those obtained on social media platforms and prosocial activity-related rewards, (2) having the ability to self-monitor progression, (3) peer social support, (4) privacy and confidentiality discrete logo and name and usernames within the app, and (5) individualizing frequency and content of notifications and reminders.ConclusionsIntegrating content, language, interfaces, delivery systems, and rewards with which adolescents who use cannabis are familiar, engage with on a day-to-day basis, and identify as relevant, may increase treatment engagement and retention for adolescents in substance use treatment. We may increase treatment effectiveness by adapting and individualizing current evidence-based interventions, so that they target the needs of adolescents and are more easily incorporated into their everyday routines.

Applications of technology in the assessment and treatment of cannabis use disorder

“…Engagement may be improved by integrating content, language, interfaces, delivery systems and rewards that are more salient and specific to the individual. For example, applications for adolescents should include elements that are more relevant to this age group ( 54 ). Design of these interventions must take into account key, qualitative differences in the experience of the patient and clinician ( 55 ).…”

The Digital Health Landscape in Addiction and Substance Use Research: Will Digital Health Exacerbate or Mitigate Health Inequities in Vulnerable Populations?

“…While digital heath strategies appear promising for addiction-and substance use-related research, specifically in vulnerable populations, the rates of acceptability, feasibility, and reliability for the use of digital health must be considered. This includes identifying the reliability and validity of using digital health tools in addiction and substance use related research, particularly in vulnerable populations [24]. A goal of this study was to better understand how digital health is used in substance use and addiction research with a focus on vulnerable populations.…”

Motivators for Cannabis Use Among Young Adults in Outpatient Psychiatric Care: A Qualitative Study

“…However, cannabis use negatively impacts brain functioning, particularly during the transitional and developmental period of young adulthood (National Academies of Sciences, Engineering, and Medicine, 2017). Tetrahydrocannabinol (THC) in cannabis triggers repeated activation of the endogenous mesolimbic dopaminergic system, which may sensitize this system and increase susceptibility to psychiatric illness (Bagot et al, 2019).…”

“…Psychiatric symptoms can lead to cannabis use as a form of self-medication. Furthermore, cannabis use can cause psychiatric symptoms to develop or worsen (Bagot et al, 2019). Epidemiologic data consistently show that major psychiatric and substance use disorders most commonly begin, and are most prevalent, in young adulthood (Gustavson et al, 2018).…”

“…Less qualitative work is available to guide the development of interventions to reduce cannabis among young adults, and there is no qualitative study that we could find to guide the development of cannabis cessation or reduction interventions for young adults in psychiatric treatment. Among a nonclinical sample of cannabis-using adolescents recruited from high schools, qualitative analyses uncovered that youth valued the following intervention strategies: (a) rewards to incentivize the progressive reduction of cannabis use, which included both nontangible rewards that mimic those obtained on social media platforms and prosocial activity-related rewards; (b) self-monitoring of progress; (c) peer social support; (d) privacy and confidentiality; and (e) individualizing frequency and content of intervention notifications and reminders (Bagot et al, 2019).…”