The Insight–Adherence–Abstinence triad: An integrated treatment focus for cannabis-using first–episode schizophrenia patients

Insight–Adherence–Abstinence focused treatment for first episode of schizophrenia and schizoaffective patients is described using examples from clinical practice with 68 patients, 30 of whom have recent or active cannabis misuse. The treatment model is based on the unique characteristics of first–episode patients, who have little insight or experience with the relapses of chronic patients, demonstrate a great deal of denial, and frequently attribute their illness to cannabis. Treatment focuses on building adherence, abstinence, and insight during the first year of treatment in order to prevent repeated relapse and to optimize recovery. Interventions recognize the many needs of cannabis-using first–episode patients and therefore include supportive, cognitive-behavioral, behavioral, and motivational therapies, as well as skill building and psychoeducation.