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The quote "two different sides to it" was taken from a participant describing both helpful and unhelpful aspects of cannabis use. However, the tension captured by this simple phrase appears as a thread throughout this thesis. For example, the tension between staff and service-user experiences; the ability of service involvement to empower or disempower individuals. Maybe what is less encapsulated by this phrase is the complexity of the experiences explored, and how they are made sense of through the lens of the wider context, personal history, and identity. Hopefully this thesis can begin to draw attention to some of these nuances. The first chapter explores how health workers experience working with patients with dual diagnosis, through a metasynthesis of qualitative studies. Themes were identified which describe working with this client group as often difficult and emotionally burdensome, which was related to services-related issues and the wider context. A third-order analysis aimed to interpret and explain findings through describing a vicious cycle of systemic issues, frustration, burnout, and stigma. How these themes fit in with the previous research and how they may inform service provision are explored. The second chapter explores the lived experiences of six young men who experience psychosis and use cannabis, using an interpretative phenomenological approach. Themes were identified regarding cannabis use and identity, the impact of cannabis on psychosis and wellbeing, and experiences of services. The overarching theme highlighted how these experiences can function to empower or disempower participants in their personal recovery. Themes were explored in relation to the current literature and how they may inform services. The third chapter details how both the literature review and empirical paper in this thesis may contribute to theory and clinical practice in the area of dual diagnosis, and psychosis and cannabis use in particular.

1.1 Background: Despite Cannabis being the most widely used recreational drug in the western world (Earlywine, 2002) little is known about its potential association with anxiety and panic pathology. 1.2 Literature Review: A systematic literature review was conducted with twenty-nine studies critically reviewed. Papers suggested contradictory and equivocal results across all research designs and anxiety disorders. Whilst a significant number of studies have observed an association between cannabis and anxiety/anxiety disorders, the nature and direction of that association is still a point of contention. 1.3 Research Report: No known British empirical research has focused on exploring relationships between cannabis and panic attacks. Also no known research has investigated the differential effects of consuming different types of cannabis on panic pathology. Inspired somewhat on established research (e.g. Zolvensky et al., 2006a) a cross-sectional study was undertaken to explore the potential relationship between cannabis and anxiety. A self-selecting opportunity sample of 306 students drawn from both of Leicester’s universities completed a battery of questionnaires concerning cannabis use, tobacco use, panic attack history, alcohol use, poly-substance use and various psychometrics. Significant levels of both cannabis use and panic attack history were reported among the sample. Survival analysis revealed cannabis users were of significant increased risk (OR 2.01) of experiencing a panic attack compared to non-users. Mann-Whitney analysis found cannabis users who use mainly high potency ‘sensimillia’ experienced significantly more lifetime panic attacks than those who used other types. Limitations are explored. 1.4 Implications: The research report concludes that cannabis use is a risk factor in experiencing panic attacks and experiencing more lifetime attacks. High potency cannabis further increases this risk. Education for substance misuse and mental health professionals is recommended along with cannabis use forming part of assessment for panic attacks/disorder. 1.5 Critical Appraisal: Reflective appraisal of the research process is presented alongside key learning points.