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Abstract
Nearly two million people enter treatment to address substance use challenges each year in the United States. A large proportion of those entering treatment use marijuana and this use is likely to persist during treatment. This proportion of people entering treatment who use marijuana is likely to increase in conjunction with marijuana’s changing legal status. The purpose of this dissertation was to gain a comprehensive understanding of marijuana’s effects on formal treatment/recovery support attendance, alcohol use, crack/cocaine use, and opioid use as well as to describe perceptions, beliefs, and experiences with marijuana among people in treatment for substance use. Two studies were conducted to accomplish this purpose. Participants were recruited from two sites in Georgia and Connecticut. For the first study, participants completed daily surveys over a 90-day period. This study examined within-subject concurrent (same day) and prospective (next day) associations as well as the between-subject associations between marijuana use and formal treatment/recovery support attendance alcohol use, crack/cocaine use, and opioid use. This study found that 25.0% of participants used marijuana during the 90-day period. At the within-subjects level, using marijuana on a certain day was associated with using alcohol concurrently. At the between-subjects level, marijuana was associated with more alcohol use and more crack/cocaine use across days. Marijuana was not associated with formal treatment/recovery support attendance or opioid use both concurrently and prospectively. The second study described experiences, perceptions, and beliefs around marijuana among people in treatment for substance use challenges. This study found that although participants believed that marijuana use may be related to initiation and return to other substance use, many people in treatment for substance use have beliefs and experiences around marijuana as a beneficial medicine to address co-occurring mental health concerns and to relieve symptoms of other substance use disorders. These beliefs and experiences are often coupled with stigma and shame due to persistent marijuana use while identifying as sober or in treatment. Findings suggest that marijuana use during treatment is negatively related to other substance use outcomes and provides interventional points for which providers can dispel positive beliefs around marijuana as a beneficial/inconsequential substance.