Feasibility and acceptability of culturally adapted cognitive behavioural therapy for patients with Cannabis use disorder in tertiary care hospitals in Peshawar, Pakistan: A multi-methods study protocol

<ns3:p>Background Cannabis use is associated with an increased risk of Cannabis Use Disorder (CUD). Cognitive Behavioral Therapy (CBT) has been shown as an effective intervention for CUD in High-Income Countries, but its implementation may be limited in Low- and Middle-Income Countries due to cultural differences. Cultural adaptation of CBT may enhance its appropriateness, acceptability, and feasibility in diverse populations where cannabis use is prevalent with limited treatment options. Methods and Analysis This study follows a multi-method approach. The first phase will involve focus group discussions and In-depth Interviews to explore cultural beliefs, treatment preferences, and contextual barriers. Findings will inform three co-adaptation workshops with patients, caregivers, clinicians, and community stakeholders. These workshops will guide the development of a culturally adapted CBT (CA-CBT) manual. The manual will be piloted in a pre-post feasibility study. The study will assess acceptability, appropriateness, and feasibility of the intervention using indicators such as recruitment, retention, adherence, and patient engagement. Preliminary outcomes on cannabis use frequency and dependence severity will also be examined. Qualitative data will be analyzed through framework and thematic analysis, whereas quantitative data will be evaluated using descriptive and inferential statistical methods. Ethical approval has been obtained from institutional review boards in Khyber Medical University, Pakistan and the Keele University, United Kingdom. Significance of the Study The study contributes to the literature by documenting a systematic process for adapting CBT for CUD in Pakistan, where access to structured psychological treatments is limited and treatment needs remain unmet. It explains how interviews, focus groups, stakeholder involvement, and feasibility testing will shape the adaptation. The study offers practical guidance for researchers and practitioners developing culturally relevant interventions for substance use in low-resource contexts.</ns3:p>