Communication Study
Online self-help forums on cannabis: A content assessment

https://doi.org/10.1016/j.pec.2017.06.001Get rights and content

Highlights

  • Cannabis online forums share similarities with other mental health-related forums.

  • Post contents differ according to the therapeutic orientation of the forum and user involvement.

  • Posts present a dissociation between emotional and information-related support.

  • Different forums attract individuals in different stages of readiness to change.

Abstract

Objective

To investigate online self-help forums related to cannabis users who were searching for help on the Internet.

Methods

We analyzed the content of 717 postings by 328 users in three online forums in terms of fields of interest and self-help mechanisms. Only English-language forums that were free of charge and without registration were investigated.

Results

The main self-help mechanisms were disclosure and symptoms, with relatively few posts concerning legal issues and social perceptions. The forums differed significantly in all fields of interest and self-help mechanisms except for social network and financial and vocational issues. Highly involved users more commonly posted on topics related to diagnosis, etiology/research, and provision of information and less commonly on those related to gratitude. Correlation analysis showed a moderate negative correlation between emotional support and illness-related aspects and between emotional support and exchange of information.

Conclusions

Cannabis forums share similarities with other mental health forums. Posts differ according to user involvement and the specific orientation of the forum.

Practice implications

The Internet offers a viable source of self-help and social support for cannabis users, which has potential clinical implications in terms of referring clients to specific forums.

Introduction

Cannabis is the most widely used addictive substance worldwide after tobacco and alcohol [1], [2]. Its use is associated with addiction, harms, and possible psychiatric disorders in some users, including young adults and adolescents [3], [4], [5], [6], [7], [8]. In the context of security issues and public health perspectives related to cannabis use, and the expanded use of medical marijuana, renewed discussions are being held in the United States, in some European countries (e.g. Switzerland), and in UN assemblies regarding early implementation of regulation policies, rather than criminalization [9], [10].

The number of users who seek help for cannabis addiction remains low [11], possibly because of perceived stigma and limited access to treatment [12], [13], [14], or to expectations that care will be ineffective [15]. At the same time, the Internet is becoming an important vector of health-related information and support for people with addiction and mental disorders [16], [17], [18], [19]. Almost two of every three Internet users have already looked for online health information, making the Internet one of the main sources of such information [20]. A number of studies have assessed structured Internet-based interventions adapted from psychotherapeutic treatments [21], [22], [23].

In parallel, web-based self-help forums are being developed for a wide range of psychiatric and somatic illnesses. Characteristics of these groups include an online environment, shared goals, media richness, access to a support network, and possible worldwide support independent of geographic location [24]. They also share core features of the recovery model, e.g. empowerment, peer support, and experiential knowledge [25], [26]. The theoretical and practical advantages of online self-help groups have been examined [27]. Possible benefits of these groups include positive changes in symptoms, enhanced recovery and adaptive responses to the diagnosis, improved quality of life, improved decision making [28], overcoming alienation and isolation, reduced stress levels, development of social networks [29], and increased self-determination [30]. A potential negative effect of online resources such as forums and blogs is that the quality of information for laypersons on health, mental health, and addiction websites is mostly poor [31]. Furthermore, information can be uncontrolled and sometimes poorly moderated, leading to the risk of spreading potentially harmful and stressful information that has a low level of reliability [32].

Although the number of online forums for patients with psychiatric illnesses continues to increase, few studies have evaluated the type of help offered, its possible effect on users, or the content of information shared among users [33]. Several studies were, however, conducted on online support for schizophrenia [34], [35], bipolar disorder [33], depression [36], [37], suicidality [38], eating disorders [29], and obsessive-compulsive disorder [39]. In his seminal paper, Finn paved the way for the current nomenclature, which was used in later studies with the same focus, by examining a single online disability group during a three-month period. The main finding was that the group was more than a forum for exchange of technical information, as about half of the messages fell into emotional categories.

Perron [40] specifically examined a mental health-related online forum, performing extensive discourse/content analysis during an 18-month period. The main result was that the online group participants appeared to write in order to achieve a sense of catharsis, as they were able to immediately share experiences following a difficult event. Haker et al. [35] investigated 11 online forums for people with schizophrenia. Their central finding, in contrast to that of previous studies, was that exchange of information was the main interest for those participating in the forums. Bauer et al. [33] examined two German-speaking online forums related to bipolar disorder by using the same assessment method as Haker et al. [35]. The main finding was related to the important level of sharing of emotional content and finding emotional support, with particular emphasis on social network issues.

These first studies did not describe posts according to user characteristics. They furthermore did not assess possible links between the different characteristics of the posts (e.g. between emotional support and exchange of information). In addition, studies that examined more than one forum did not consider differences between the assessed forums.

To our knowledge, only one study has examined online support in the area of substance use disorder, namely for alcohol use disorder [41]. The study assessed a web-based intervention that included access to a moderated peer-to-peer discussion forum. The focus of the study was, however, not related to the content of the forum. To date, and to the best of our knowledge, no study has considered cannabis and online self-help. The aim of the present study was therefore to target and investigate self-help online forums related to cannabis users who are searching for help on the Internet. The study furthermore aimed to assess differences between forums, possible links between user characteristics and posts, and associations between different kinds of posts.

Section snippets

Methods

The study adopted a “user journey” perspective in that we tried in our inclusion criteria to replicate the journey of a cannabis user who is seeking help on the web, i.e. a layperson cannabis user’s help-seeking web search. This search usually includes typing keywords into a general search engine such as the most popular one, Google [42], and then promptly checking the top-listed links, as people rarely search beyond the first 20 retrieved links [43].

Results

In total, 717 posts by 328 participants from the following three forums were included: cannabis addiction (CA, drugs-forum.com/forum/forumdisplay.php?f = 417), cannabis rehabilitation (CR, www.cannabisrehab.org), and Marijuana Anonymous (MA, www.marijuana-anonymous.org) (Fig. 1).

Discussion

We investigated the first three English online self-help forums, from our March 2015 search, that were centered on cannabis and were open, i.e. could be accessed free of charge and without registration. We analyzed the content with respect to fields of interest and self-help mechanisms from a “user journey” perspective. Further comparisons included assessment of posts according to the different cannabis forums included and user characteristics. Correlations between the assessed items were

Contributors

Christian Greiner and Yasser Khazaal conceived the study. Christian Greiner collected the data and wrote an initial draft of the manuscript. Anne Chatton conducted the statistical analyses. Yasser Khazaal reviewed versions of the manuscript. All authors have approved the final article.

Conflict of interest

Christian Greiner: no conflicts declared

Anne Chatton: no conflicts declared

Yasser Khazaal: no conflicts declared

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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