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Author ORCID Identifier
https://orcid.org/0000-0002-5233-7073
Date Available
11-7-2026
Year of Publication
2026
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Nursing
Department/School/Program
Nursing
Faculty
Chizimuzo Okoli
Faculty
Jean Edward
Abstract
Substance use is prevalent among adults living with mental illness and is associated with adverse cognitive, clinical, and health service outcomes. Important gaps remain in understanding how substance use relates to metacognitive functioning, how dependence severity is measured in psychiatric populations, and how substance use patterns influence short-term psychiatric outcomes. This dissertation addresses these gaps through a three-study investigation integrating a broad synthesis across substances with focused empirical analyses of cannabis and tobacco use among adults living with mental illness.
The first study is a systematic review examining the effects of psychoactive substances on metacognition among adults. Findings indicate that several substances are associated with impairments across metacognitive domains. Specifically, cannabis use was associated with deficits in metacognitive monitoring, confidence calibration, and decision-related self-evaluation, whereas tobacco/nicotine use was associated with impairments in attention-related monitoring and mixed effects on regulatory processes. Building on this evidence base, the second study evaluates the psychometric properties of cannabis and tobacco dependence measures in a psychiatric sample, and the third examines associations with 30- and 60-day psychiatric rehospitalization. Collectively, findings highlight substance use, particularly cannabis and tobacco, as clinically relevant and modifiable factors that shape behavioral health outcomes among adults living with mental illness.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2026.110
Archival?
Archival
Funding Information
This dissertation was supported by the University of Kentucky, College of Nursing Dissertation Award (2024).
Recommended Citation
Seng, Sarret, "SUBSTANCE USE IN MENTAL ILLNESS: A SYSTEMATIC REVIEW OF METACOGNITION AND EMPIRICAL STUDIES OF CANNABIS, TOBACCO, AND PSYCHIATRIC REHOSPITALIZATION" (2026). Theses and Dissertations--Nursing. 77.
https://uknowledge.uky.edu/nursing_etds/77
Included in
Psychiatric and Mental Health Nursing Commons, Public Health and Community Nursing Commons
