Disorders - cannabis use
Mason, M. J., Zaharakis, N. M., Russell, M., Childress, V.
Approximately 1.8 million young adults aged 18 to 25 had a Cannabis Use Disorder (CUD) in the past year. Unfortunately, engaging young adults in treatment is very challenging. Creative approaches to treat cannabis disorders such as integrating mobile technology with evidence-based treatments are warranted. In light of these challenges, we developed a text message-delivered version of Peer Network Counseling (PNC-txt), which is a substance use intervention that focuses on peer relations. PNC-txt engages participants in 16 automated, personalized text interactions over 4 weeks. We conducted a randomized controlled trial to test the efficacy of PNC-txt against a waitlist control group with 30 treatment seeking young adults (ages 18-25) who met DSM-5 criteria for CUD. Self-report and urine analyses were used to test outcomes at the three-month follow-up. The PNC-txt group significantly reduced their cannabis use related problems as well as cannabis cravings, compared to the control group. PNC-txt participants also had a significantly greater percentage with urines negative for cannabis metabolites compared to controls. Moderation analysis showed that CUD severity level moderated treatment, suggesting that PNC-txt is more effective for participants with medium and high levels of CUD severity. All effect sizes ranged from medium to large. Results from this pilot trial are promising and warrant further research on PNC-txt for addressing cannabis use disorder. Copyright © 2018 Elsevier Inc.
Journal of Substance Abuse Treatment, 89 : 1-10
- Year: 2018
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Sahlem, G. L., Baker, N. L., George, M. S., Malcolm, R. J., McRae-Clark, A. L.
Background: Cannabis use disorder (CUD) is a common condition with few treatments. Several studies in other substance use disorders have found that applying repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) decreases cue-elicited craving and possibly decreases use. To date, there have been no studies attempting to use rTMS in CUD. Objective(s): This study was conducted to determine if rTMS could be feasibly delivered to a group of non-treatment seeking CUD participants. Secondarily, the study aimed to estimate the effect of rTMS on craving. Method(s): In a double-blind, sham-controlled, crossover design, a single session of active or sham rTMS (Left DLPFC, 10 Hz, 110% rMT, 4000 pulses) was delivered during a validated cannabis cue paradigm. Participants crossed over to complete the other condition one week later. The feasibility and tolerability were measured by the rate of retention, and the percentage of participants able to tolerate full dose rTMS, respectively. Craving was measured using the Marijuana Craving Questionnaire (MCQ). Result(s): Eighteen non-treatment seeking CUD participants were recruited from the community; 16 (three women) completed the trial (89% retained for the three study visits). All of the treatment completers tolerated rTMS at full dose without adverse effects. There was not a significant reduction in the total MCQ when participants received active rTMS as compared to sham rTMS. Conclusion(s): rTMS can be safely and feasibly delivered to CUD participants, and treatment is well tolerated. A single session of rTMS applied to the DLPFC may not reduce cue-elicited craving in heavy cannabis users. Copyright © 2018 Taylor & Francis.
American Journal of Drug and Alcohol Abuse, 44(1) : 47-55
- Year: 2018
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Transcranial magnetic stimulation (TMS)
Schlienz, N. J., Lee, D. C., Stitzer, M. L., Vandrey, R.
BACKGROUND: There is a clear need for advancing the treatment of cannabis use disorders. Prior research has demonstrated that dronabinol (oral THC) can dose-dependently suppress cannabis withdrawal and reduce the acute effects of smoked cannabis. The present study was conducted to evaluate whether high-dose dronabinol could reduce cannabis self-administration among daily users.
METHODS: Non-treatment seeking daily cannabis users (N=13) completed a residential within-subjects crossover study and were administered placebo, low-dose dronabinol (120mg/day; 40mg tid), or high-dose dronabinol (180-240mg/day; 60-80mg tid) for 12 consecutive days (order counterbalanced). During each 12-day dronabinol maintenance phase, participants were allowed to self-administer smoked cannabis containing <1% THC (placebo) or 5.7% THC (active) under forced-choice (drug vs. money) or progressive ratio conditions.
RESULTS: Participants self-administered significantly more active cannabis compared with placebo in all conditions. When active cannabis was available, self-administration was significantly reduced during periods of dronabinol maintenance compared with placebo maintenance. There was no difference in self-administration between the low- and high-dose dronabinol conditions.
CONCLUSIONS: Chronic dronabinol dosing can reduce cannabis self-administration in daily cannabis users and suppress withdrawal symptoms. Cannabinoid agonist medications should continue to be explored for therapeutic utility in the treatment of cannabis use disorders.
Drug & Alcohol Dependence, 187 : 254-260
- Year: 2018
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse, Other biological interventions
Sherman, B. J., Baker, N. L., Squeglia, L. M., McRae-Clark, A. L.
Background: More effective treatments for cannabis use disorder (CUD) are needed. Evidence suggests that biases in cognitive processing of drug-related stimuli are central to the development and maintenance of addiction. The current study examined the feasibility and effect of a novel intervention - approach bias modification (ApBM) - on cannabis approach bias and cue-reactivity. Method(s): A randomized, double-blind, sham-controlled proof-of-principle laboratory experiment investigated the effect of a four-session computerized ApBM training protocol on cannabis approach bias and cue-reactivity in non-treatment seeking adults age 18-65 with CUD (N = 33). ApBM procedures involved responding to cannabis or neutral stimuli using a computer joystick to model approach or avoidance behavior. Reactivity to tactile, olfactory, and auditory cue sets was assessed with physiological (blood pressure and heart rate) and subjective (cannabis craving) measures. Cannabis use was assessed via self-report. Result(s): Participants receiving ApBM showed blunted cannabis cue-induced craving at the end of training compared to those in the sham-ApBM condition (p =.05). A preliminary gender effect on cannabis use was also found; men receiving ApBM reported fewer cannabis use sessions per day at the end of training compared to women (p =.02), while there were no differences between men and women in the sham condition. ApBM did not attenuate cannabis approach bias following training. Conclusion(s): Preliminary results indicate that ApBM may be efficacious in reducing cannabis cue-reactivity and improving cannabis use outcomes. While encouraging, the results should be interpreted with caution. Investigation of ApBM as an adjunct to psychosocial treatments for treatment-seeking adults with CUD is warranted. Copyright © 2018 Elsevier Inc.
Journal of Substance Abuse Treatment, 87 : 16-22
- Year: 2018
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Treloar-Padovano, H., Miranda, R.
Despite clinical demand for effective substance-use interventions for youth, less than one-third experience sustained benefit from the best available psychosocial treatments. In addition, adolescents and young adults oftenmisusemultiple substances, namely alcohol and cannabis, which requires treatment approaches that yield cross-drug beneficial effects. The major objective of this study was to address the urgent need for empirical data on medications that may advance treatment options for youth. Specifically, we randomized 82 youth, ages 14 to 24 to topiramate (up to 200 mg/day) or placebo, combined with biweekly motivational enhancement and cognitive behavioral therapy, for 8 weeks using a two-group, double-blind design. Topiramate is an anticonvulsant medication shown to be efficacious for reducing alcohol use among adults, and recent preliminary data suggest it also may reduce cannabis use (Miranda, Treloar, Blanchard, et al., 2017). It is the only medication that reduces drinking in adults that has approval from the Food and Drug Administration for use with adolescents, albeit for other indications. Although youth were recruited from the community specifically for alcohol misuse, 64.6%also reported cannabis use during the trial. Of this subset, half (52.8%) were randomized to topiramate. These youth were primarily White (66.0%) or Black (20.8%); 17% Hispanic or Latino ethnicity; 39.6%were female; average age was 20.3 years (SD = 2.2). Results showed youth assigned to topiramate reported 12.0 fewer cannabis use days and smoked 7.3 fewer grams of cannabis than youth assigned to placebo, during the 28-day period at target dose. In a regression including participant baseline demographics, topiramate treatment predicted reduced use days, beta = -0.38, p = 0.004, and reduced total grams smoked, beta = -0.38, p = 0.022. Indeed, topiramate accounted for an additional 10%of the variance in cannabis-use outcomes over and above the influences of gender, age, race, and ethnicity, R2 = 0.28 and 0.22 for use days and grams smoked, respectively; DELTA R2 = 0.14 and 0.10, respectively. This study provides much needed data on the tolerability and efficacy of topiramate for treating substance misuse among adolescents and young adults while adding important new information about its potential for reducing cannabis use among youth who also misuse alcohol.
Alcoholism: Clinical and Experimental Research, 42 (Supplement 1) : 277A
- Year: 2018
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Anticonvulsants/mood stabilisers (excl. lithium), Medications used to treat substance abuse
Squeglia, L. M., Schacht, J. P., Jacobus, J., Meredith, L. R., Tapert, S. F., Gray, K. M.
Background: Approach Avoidance Training (AAT) is a computerized intervention that aims to retrain approach biases toward harmful cues and has been effective in treating a number of psychological disorders, including alcohol use disorder. The effects of AAT have not been examined in marijuana users and its neural mechanism of action is unclear. Methods: Forty-one non-treatment-seeking regular marijuana users (46% female; average age=18.8 years; using ~5 days per week) were randomized to complete either six sessions of Marijuana AAT (MAAT) or sham training. No other treatment was provided within the study. Marijuana cue reactivity was measured via functional magnetic resonance imaging (fMRI) before and after training. Thirty-eight participants (93%) completed all 6 sessions of MAAT and both fMRI sessions. Results: Self-reported marijuana use, creatinine-adjusted cannabinoid levels, and marijuana cue reactivity in the medial prefrontal cortex and amygdala decreased in both groups post-treatment. No significant between-group differences were found. Conclusions: Using MAAT as an intervention with marijuana-using youth was feasible. Despite its success in treating adult alcohol dependence, AAT was not found to reduce marijuana use or marijuana cue reactivity in this non-treatment-seeking sample. Future studies should evaluate MAAT in motivated treatment seekers or as an adjunctive treatment, to parallel promising alcohol AAT findings.
Alcoholism: Clinical and Experimental Research, 41 (Supplement 1) : 337A
- Year: 2017
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Stanger, C., Scherer, E. A., Babbin, S. F., Ryan, S. R., Budney, A. J.
The purpose of this study was to conduct a randomized test of clinic- and home-based incentives plus parent training for adolescent problem alcohol use. Adolescents (N = 75) with alcohol misuse, with or without other substance misuse, were enrolled. All youth received individual Motivational Enhancement Therapy/Cognitive Behavior Therapy and weekly urine drug testing. The experimental condition (EXP) included Abstinence Incentives (clinic-based incentives for abstinence from all substances) plus weekly behavioral parent training that included a parent-delivered, abstinence-based, substance monitoring contract. The comparison condition (CONTROL) included Attendance Incentives (ATTI). All adolescents met DSM-IV criteria for alcohol abuse or dependence or reported recent binge drinking, and 77% (N = 58) met criteria for a cannabis use disorder or had recent cannabis use at baseline. Alcohol and cannabis use outcomes were compared across treatment conditions. A similar percentage of youth maintained complete alcohol abstinence across the 36-week follow-up in both conditions. However, among youth not entirely abstinent from alcohol, EXP resulted in a lower percentage of days using alcohol during the 36 weeks after the end of treatment than CONTROL. Among youth who also used cannabis at baseline, results showed similar benefits of EXP on cannabis use days. Combined individual and family based treatment, plus abstinence based incentives can reduce substance use days during and after treatment over and above individual evidence-based psychosocial treatment plus attendance incentives. Future research should focus on identifying cost-effective components and incentive levels and delivery via technology to facilitate dissemination. (PsycINFO Database Record
Psychology of Addictive Behaviors, 31(4) : 385-392
- Year: 2017
- Problem: Alcohol Use, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Case management
Lize, S. E., Iachini, A. L., Tang, W., Tucker, J., Seay, K. D., Clone, S., DeHart, D., Browne, T.
This meta-analysis examines the effectiveness of interactive middle school-based drug prevention programs on adolescent cannabis use in North America, as well as program characteristics that could moderate these effects. Interactive programs, compared to more didactic, lecture style programs, involve participants in skill-building activities and focus on interaction among participants. A systematic literature search was conducted for English-language studies from January 1998 to March 2014. Studies included evaluations using random assignment or a quasi-experimental design of interactive school-based substance use prevention programs delivered to adolescents (aged 12-14) in North American middle schools (grades 6-8). Data were extracted using a coding protocol. The outcomes of interest were post-treatment cannabis use, intent to use, and refusal skills compared across intervention and control groups. Effect sizes (Cohen's d) were calculated from continuous measures, and dichotomous measures were converted to the d index. A total of 30 studies yielding 23 independent samples were included. The random effects pooled effect size for cannabis use (k = 21) was small (d = -0.07, p < 0.01) and favorable for the prevention programs. The pooled effect sizes for intention to use (k = 3) and refusal skills (k = 3) were not significant. Moderator analyses indicated significant differences in program effectiveness between instructor types, with teachers found to be most effective (d = -0.08, p = 0.02). The findings provide further support for the use of interactive school-based programs to prevent cannabis use among middle school students in North America. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Prevention Science, 18(1) : 50-60
- Year: 2017
- Problem: Cannabis Use
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Parmar, A., Sarkar, S.
Background: Cannabis use and abuse is an important health hazard which has several harmful consequences on person's physical and psychological well-being. Although cannabis use disorder is a common problem across various countries, the effective medications for treatment are still limited. Because of this, the major focus of interventions for cannabis use disorder has been on psychological modalities. One such intervention is a brief intervention, which targets mainly those persons with less severe cannabis use problems. The current narrative review aims at providing an overview of the role and relevance of brief intervention in cannabis use disorders and discusses the relevant methodological issues. Subjects and Methods: We reviewed multiple scientific search engines including Google Scholar, PubMed, and PubMed Central. Search terms used includes but are not limited to, "brief intervention," "cannabis use disorders treatment," "cannabis abuse treatment," "brief interventions for cannabis," etc. Studies assessing efficacy/effectiveness of brief intervention in cannabis use disorders were included in this review. Results: The majority of studies points toward the effectiveness of brief intervention in reducing the cannabis use and/or associated consequences in cannabis use disorders. However, the studies should be interpreted cautiously given the variation in the type, theoretical construct, duration, and outcome measures for brief intervention and the therapist attributes. Conclusions: Brief interventions might be useful for mild to moderate cannabis users for reducing cannabis use and/or associated consequences. Future studies, especially in developing countries are required to look for applicability of such interventions in different populations. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Addictive Disorders and their Treatment, 16(2) : 80-93
- Year: 2017
- Problem: Cannabis Use
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Personalised feedback, normative feedback
Sherman, B. J., Baker, N. L., McRae-Clark, A. L.
Motivational enhancement therapy (MET) is efficacious in reducing cannabis use, yet benefits are generally short-lived. Oxytocin is a hypothalamic neuropeptide that promotes prosocial behaviors and plays a role in drug-related neuroadaptations; as such, oxytocin may enhance the effect of MET on cannabis outcomes. Cannabis dependent adults were randomized to receive MET plus oxytocin (n =8) or placebo (n =8).
Psychiatry Research, 249 : 318-320
- Year: 2017
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions, Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy
Miranda, R., Jr., Treloar, H., Blanchard, A., Justus, A., Monti, P. M., Chun, T., Swift, R., Tidey, J. W., Gwaltney, C. J.
Cannabis misuse accounts for nearly all of the substance abuse treatment admissions among youth in the United States. Most youth do not experience sustained benefit from existing psychosocial treatments; however, medication development research for treating adolescent cannabis misuse is almost nonexistent. We conducted a double-blind, placebo-controlled, pilot study to test the potential efficacy of topiramate plus motivational enhancement therapy (MET) for treating cannabis use among adolescents. Sixty-six heavy cannabis users, ages 15 to 24 years, were randomized to one of two 6-week treatment conditions: topiramate plus MET or placebo plus MET. Topiramate was titrated over 4 weeks then stabilized at 200 mg/day for 2 weeks. MET was delivered biweekly for a total of three sessions. Only 48 percent of youths randomized to topiramate completed the 6-week trial (n = 19), compared with 77 percent of youths in the placebo condition (n = 20). Adverse medication side effects were the most common reason for withdrawal among participants in the topiramate group. Latent growth models showed that topiramate was superior to placebo for reducing the number of grams smoked per use day, but it did not improve abstinence rates. The same pattern of results was found when values for missing outcomes were imputed. We show that topiramate combined with MET demonstrated efficacy for reducing how much cannabis adolescents smoked when they used but did not affect abstinence rates. The magnitude of this effect was modest, however, and topiramate was poorly tolerated by youths, which calls into question the clinical importance of these findings.
Addiction Biology, 22(3) : 779-790
- Year: 2017
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Anticonvulsants/mood stabilisers (excl. lithium), Medications used to treat substance abuse, Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy
Kaminer, Y., Ohannessian, C. M., Burke, R. H.
OBJECTIVE: Treatment response as measured by both retention and abstinence attainment rates for adolescents with cannabis use disorders (CUD) has been unsatisfactory. This study tested the hypothesis that adaptive treatment (AT) will improve outcomes for poor responders (PR) to evidence-based practice interventions.
METHOD: A total of 161 adolescents, 13-18years of age, diagnosed with DSM-IV CUD, enrolled in this outpatient, randomized, AT study. Following a 7-session weekly motivational enhancement and cognitive behavioral therapy intervention (MET/CBT-7) only poor responders (defined as failing to achieve abstinence at week seven for any reason) were randomized into a 10-week AT phase of either an individualized enhanced CBT or an Adolescent Community Reinforcement Approach (ACRA) intervention. Good responders (GR) enrolled only in follow-up assessments starting at the completion of the AT phase (week 17).
RESULTS: Eighty adolescents (50%) met the criterion for poor response to treatment. Thirty seven percent of poor responders completed the AT phase and 27% of them achieved abstinence. There was no significant difference in retention and abstinence rates between the AT conditions. Although the majority of GR relapsed by week 17, they significantly differed from PR both for drug use (71% vs. 91%, respectively; p<0.05) and reporting to scheduled assessment on that week (78% vs. 54%, respectively; p<0.01).
CONCLUSION: Continuity of care to achieve abstinence among poor responders remains a therapeutic necessity and a research challenge. Examining innovative AT designed interventions including potential integrative approaches should be further studied in order to improve treatment outcomes.
Addictive Behaviors, 70 : 102-106
- Year: 2017
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions