Cannabis is commonly characterized as the most normalized illicit drug. However, it remains a prohibited substance in most parts of the world, including Europe, and users can still be subject to stigmatization. The objective of this study is to assess to what extent and how cannabis users in different countries with different cannabis policies perceive, experience and respond to stigmatization. We conducted a survey in the Dutch coffeeshops among 1225 last year cannabis users from seven European countries, with national cannabis policies ranging from relatively liberal to punitive. Three dimensions of cannabis-related stigma were investigated (discrimination, perceived devaluation and alienation) and a sum score was used to reflect the general level of stigmatization. Perceived devaluation was the highest-scoring dimension of stigma and discrimination the lowest-scoring. The general level of stigmatization was lowest in the Netherlands and highest in Greece. This indicates that punitive cannabis policy is associated with stigma and liberal cannabis policy is associated with de-stigmatization. Besides country, daily cannabis use was also found to be a significant predictor of stigma, but gender, age, household type and employment status were not.
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This article examines to what extent and how cannabis users in different countries, with different cannabis legislation and policies practice normalization and self-regulation of cannabis use in everyday life. Data were collected in a survey among a convenience sample of 1,225 last-year cannabis users aged 18–40 from seven European countries, with cannabis policies ranging from relatively liberal to more punitive. Participants were recruited in or in the vicinity of Dutch coffeeshops. We assessed whether cannabis users experience and interpret formal control and informal social norms differently across countries with different cannabis policies. The findings suggest that many cannabis users set boundaries to control their use. Irrespective of national cannabis policy, using cannabis in private settings and setting risk avoidance rules were equally predominant in all countries. This illustrates that many cannabis users are concerned with responsible use, demonstrating the importance that they attach to discretion. Overall, self-regulation was highest in the most liberal country (the Netherlands). This indicates that liberalization does not automatically lead to chaotic or otherwise problematic use as critics of the policy have predicted, as the diminishing of formal control (law enforcement) is accompanied by increased importance of informal norms and stronger self-regulation. In understanding risk-management, societal tolerance of cannabis use seems more important than cross-national differences in cannabis policy. The setting of cannabis use and self-regulation rules were strongly associated with frequency of use. Daily users were less selective in choosing settings of use and less strict in self-regulation rules. Further differences in age, gender, and household status underline the relevance of a differentiated, more nuanced understanding of cannabis normalization.
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Background: There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Design: A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. Results: Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff’s motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. Conclusions: This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.
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