Attitudes and perceptions regarding tobacco, alcohol or cannabis use among people with and without mental disorders

Research Doctorate - Doctor of Philosophy (PhD)Co-occurring substance use and mental disorders are a major health problem. Substance use disorders are very common among people with mental disorders, cost health care systems large amounts of money and have been consistently linked to a number of adverse consequences among this population. It is clear therefore that effective intervention and preventative strategies are needed to address these co-occurring disorders and it is suggested that a clear understanding of people’s attitudes and perceptions regarding substances is needed to develop such strategies. Very little research investigating the substance related attitudes and perceptions among people with mental disorders exists. The broad aim of this thesis was to generate a greater understanding of attitudes and perceptions regarding tobacco, alcohol and cannabis among people with mental disorders. To address this aim the thesis presents five papers. Paper 1 describes a systematic review of current literature investigating attitudes and perceptions towards tobacco, alcohol and cannabis among people with mental disorders. The review aimed to identify the strengths, weaknesses and gaps in this literature. Paper 2 and Paper 3 describe a study of attitudes and perceptions regarding tobacco, alcohol and cannabis among people with psychotic disorders. This study elicited both quantitative and qualitative data and aimed to identify any similarities and differences between participants’ reasons for tobacco, alcohol and cannabis use. It also aimed to generate some initial insights regarding the perceived effectiveness of anti-tobacco public health campaigns among people with mental disorders. Paper 4 describes a study which investigated reasons for tobacco, alcohol and cannabis use among people with depression or a psychotic disorder. It aimed to identify similarities and differences in reasons for substance use between people with different mental disorders. Paper 5 describes a qualitative study of attitudes and perceptions regarding tobacco, alcohol and cannabis among people with a psychotic disorder, current symptoms of depression or without a mental disorder. The study aimed to generate insights regarding a range of substance related attitudes and perceptions by employing a flexible interview schedule that allowed issues important to the participants to be raised. The concluding chapter of this thesis reviews and synthesizes the main findings of these five papers and discusses their implications for future research and the development of effective intervention and prevention strategies. The findings of this thesis suggest that attitudes and perceptions regarding tobacco, alcohol and cannabis differ considerably. While all three substances were found to be used to cope with stress and to relax, this reason was particularly important for tobacco use among people with and without mental disorders. Social factors were found to play an important role in the alcohol use of people with and without mental disorders, while cannabis was often used as a source of pleasure by people with and without mental disorders. The type of harm these substances were perceived to cause was also found to differ considerably. Very few differences between the attitudes and perceptions of people with and without mental disorders, regarding tobacco, alcohol and cannabis, were found. However, among people with mental disorders specifically, mental health and substance use were perceived to interact. Anti-substance use campaigns were perceived to be ineffective by people both with and without mental disorders. Attitudes and perceptions towards tobacco, alcohol and cannabis were also found to differ between people with a psychotic disorder and people experiencing depression. The findings of this research add considerably to our understanding of the attitudes and perceptions regarding tobacco, alcohol and cannabis use held among people with mental disorders. The findings also suggest that it may be important to tailor intervention and prevention strategies regarding tobacco, alcohol and cannabis by substance type and perhaps type of mental disorder