Keep it Real: A web-based program for psychotic-like experiences and cannabis use

INTERVENTION: This study examines the efficacy and cost effectiveness of the Keep it Real website compared to an information‐only control website (ICW) in cannabis users with psychotic‐like experiences (PLEs). Keep it Real is a web program which consists of 7 modules that can be completed in 2‐3 x 30 minute sessions. PLEs are targeted first, given young people are more likely to be concerned about PLEs, than their cannabis use. The first 3 modules aim to increase the users’ ability to identify, understand and reduce distress associated with PLEs. Module 1 defines PLEs and provides detailed personal feedback on self‐reported PLEs based on age and gender‐specific norms. Module 2 provides information on risk factors for PLEs (including cannabis, trauma, stress, anxiety/depression), psychotic symptoms and disorders using fact sheets and videos. Module 3 provides information and normative data on different subtypes of PLEs and suggests a number of simple CBT techniques for their management. Modules 4 and 5 use motivational interviewing techniques to target cannabis, alcohol, methamphetamine and heroin use. Interactive quizzes aim to increase knowledge for all substances. Substance use and related problems are assessed and personal feedback is provided relative to age and gender‐specific norms. Normative feedback is also provided to increase awareness of the relationship between substance use and PLEs. Participants are then encouraged to set harm minimization or change goals and develop a plan for achieving them. Module 6 targets users’ coping skills by providing training in cognitive behavioural techniques including stress management, problem solving, behavioural activation, and attention control retraining (mindfulness). Module 7 encourages appropriate help seeking for PLEs and/or cannabis use and addresses any barriers to doing so. Written material is at Year 7 reading level or less, minimising rare words and words > 3 syllables, keeping sentence construction simple and paragraphs short. Entered data in the program is retained centrally for subsequent review and printing by participants. All website modules are unlocked and can be accessed by the user at any time. All participants have continuous access to a Get Help section of the website, which provides the contact details of mental health and AOD services (including crisis care). Links to the Keep it Real will be sent via SMS and email. Participants will be free to explore and utilise the website as much as they like, but SMS reminders will be sent to both groups 7, 14, and 21 days after access has been granted to remind them to access it. Participants will have indefinite access to the Keep it Real program once they create an account. ICW participants will be granted full access to the program after conclusion of the RCT. CONDITION: Cannabis use Cannabis use with psychotic‐like experiences amongst young people Psychosis PRIMARY OUTCOME: Composite primary outcome of frequency/quantity of cannabis use in the past month measured using the Opioid Treatment Index (OTI) Frequency of psychotic experiences and related distress, using the Community Assessment of Psychic Experiences (CAPE15) INCLUSION CRITERIA: 1. Aged 16‐25 years 2. Used cannabis at least once in the past month 3. CAPE15 >18 Outcomes from the intervention will be compared with outcomes of participants who have used an ICW. This program delivers the information sheets from the Keep it Real program including ; (i) What is psychosis?; (ii) Am I at risk of developing psychosis?; (iii) What is Schizophrenia?; (iv) What is Bipolar Disorder?; (v) Alcohol facts; (vi) Methamphetamine facts; (vii) Cannabis facts; (viii) Heroin facts. Limited, information‐only pages from four of the program’s modules have also been included in the ICW to increase the face validity of the program. These include: “What is a weird experience?”; “How does cannabis affect my mental health?”; “How does other substance use affect me?” and “Should I seek help?”. It does not provide personal feedback from assessments or normative feedback on cannabis, other substances, or PLEs at baseline or follow up. No information is given on how to manage PLEs; nor do the resources focus on building motivation to change cannabis use. SECONDARY OUTCOME: Anxiety severity, measured using the Generalized Anxiety Disorder scale (GAD‐7) Depression symptom severity, measured using the Patient Health Questionnaire (PHQ‐9) General functioning, measures using the Multidimentional Adolescent Functioning Scale (MAFS) Health related quality of life, measured using the 5 level version of EuroQoL (EQ‐5D‐5L) Smoking, alcohol and other drug use substance involvement scores on the Alcohol, Smoking and Substances Involvement Screening Test (ASSIST), reported through a composite score.