Fischer, Benedikt, Dawe, Meghan, McGuire, Fraser, Shuper, Paul A., Capler, Rielle, Bilsker, Dan, Jones, Wayne, Taylor, Benjamin, Rudzinski, Katherine, Rehm, JUrgen

Feasibility and impact of brief interventions for frequent cannabis users in Canada

Cannabis use is prevalent among young people, and frequent users are at an elevated risk for health problems. Availability and effectiveness of conventional treatment are limited, and brief interventions (BIs) may present viable alternatives. One hundred thirty-four young high-frequency cannabis users from among university students were randomized to either an oral (C-O; n = 25) or a written experimental cannabis BI (C-W; n = 47) intervention group, or to either an oral (H-O; n = 25) or written health BI (H-W; n = 37) control group. Three-month follow-up assessments based on repeated measures analysis of variance techniques found a decrease in the mean number of cannabis use days in the total sample (p = 0.024), reduced deep inhalation/breathholding use in the C-O group (p = 0.003), reduced driving after cannabis use in the C-W group (p = 0.02), and a significant reduction in deep inhalation/breathholding in the C-O group (p = 0.011) compared with controls. Feasibility and short-term impact of the BIs were demonstrated, yet more research is needed.; Copyright © 2013 Elsevier Inc. All rights reserved.

Journal of Substance Abuse Treatment, 44(1) : 132-138

Hides, L., Carroll, S., Scott, R., Cotton, S., Baker, A., Lubman, D. I.

Quik fix: A randomized controlled trial of an enhanced brief motivational interviewing intervention for alcohol/cannabis and psychological distress in young people

Psychotherapy & Psychosomatics, 82(2) : 122- 124

Hjorthoj, C. R., Fohlmann, A., Larsen, A. M., Gluud, C., Arendt, M., Nordentoft, M.

Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis: The CapOpus randomized trial

Background: Cannabis abuse in psychotic patients is associated with rehospitalizations, reduced adherence and increased symptom severity. Previous psychosocial interventions have been ineffective in cannabis use, possibly because of low sample sizes and short interventions. We investigated whether adding CapOpus to treatment as usual (TAU) reduces cannabis use in patients with cannabis use disorder and psychosis. Method A total of 103 patients with psychosis and cannabis use disorder were centrally randomized to 6 months of CapOpus plus TAU (n = 52) or TAU (n = 51). CapOpus consisted mainly of motivational interviewing and cognitive behaviour therapy (CBT). TAU was targeted primarily at the psychotic disorder. The primary outcome was self-reported days with cannabis use in the preceding month.; Results: Pre-randomization cannabis use frequency was 14.9 [95% confidence interval (CI) 12.7-17.1] days/month. Post-treatment, the ratio of days/month with cannabis use in CapOpus versus TAU was 0.76 (95% CI 0.38-1.50) (p = 0.42), and 0.80 (95% CI 0.21-3.10) (p = 0.75) at the 4-month follow-up. From 46.4 (95% CI 36.4-56.3) monthly joints pre-randomization, consumption fell to 27.3 (95% CI 12.6-41.9) joints in CapOpus and 48.2 (95% CI 31.8-64.6) in TAU (p = 0.06). Follow-up amounts were 28.4 (95% CI 13.5-43.2) and 41.6 (95% CI 25.2-58.0) joints (p = 0.23). Several subgroup analyses suggested benefits of CapOpus.; Conclusions: CapOpus did not reduce the frequency, but possibly the amount, of cannabis use. This is similar to the findings of previous trials in this population. Implementation of CapOpus-type interventions is thus not warranted at present but subgroup analyses call for further trials.;

Psychological Medicine, 43(7) : 1499-1510

Hjorthoj, Carsten Rygaard, Orlovska, Sonja, Fohlmann, Allan, Nordentoft, Merete

Psychiatric treatment following participation in the CapOpus randomized trial for patients with comorbid cannabis use disorder and psychosis

Background: Randomized trials targeting cannabis use disorders in patients with psychosis have generally been unsuccessful. One of the largest such trials was the CapOpus trial, which had an impact on the number of monthly joints used, but not on the number of days with cannabis use or positive or negative symptoms.; Objective: To investigate the effects of CapOpus on psychiatric treatment.; Methods: Six-month randomized trial on participants meeting ICD-10 criteria for cannabis use disorder and schizophrenia-spectrum psychosis. Participants were randomized to treatment as usual (TAU, n=51) alone versus TAU plus CapOpus (n=52) consisting of motivational interviewing and cognitive behavior therapy. Data regarding psychiatric treatment was obtained from complete nationwide registers. Analyses were intention-to-treat. Cox and poisson regression were used as appropriate.; Results: Compared with treatment as usual, participants in the CapOpus group had an overall higher risk of having a psychiatric emergency room contact (hazard ratio 2.02, 95% confidence interval 1.22-3.34). Participants in CapOpus also had more contacts with psychiatric emergency rooms (incidence rate ratio 3.47 (2.64-4.57)) and more admissions to psychiatric hospitals (incidence rate ratio 2.24 (1.65-3.03)); conversely, CapOpus-participants spent fewer days admitted to psychiatric hospitals than treatment-as-usual participants (incidence rate ratio 0.72 (0.68-0.75)).; Conclusions: CapOpus led to earlier and more psychiatric emergency room contacts and admissions that, however, were of fewer days. This pattern could indicate that participants receiving treatment as usual were inadequately treated. However, it cannot be excluded that the differences might be an adverse reaction to the psychosocial intervention.; © 2013.

Schizophrenia Research, 151(1-3) : 191- 196

Madigan, K., Brennan, D., Lawlor, E., Turner, N., Kinsella, A., O'Connor, J. J., Russell, V., Waddington, J. L., O'Callaghan, E.

A multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness

Background: Patients who experience the onset of psychotic illness with a comorbid diagnosis of cannabis dependence experience poor clinical outcomes. Few studies have identified interventions that reduce cannabis use and improve clinical outcome in this population. Aims: We undertook a multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence to determine whether there was any impact on cannabis use symptoms, global functioning, insight, attitudes to treatment and subjective quality of life. Method: Across three centers, we compared a group psychological intervention, based on cognitive behavioral therapy and motivational interviewing, with treatment as usual among patients experiencing their first psychotic episode or early in the course of psychotic illness. Substance misuse and indices of clinical outcome were assessed at baseline, 3. months and 1. year. Results: At 3. month and 1. year follow-ups, there was no evidence for an intervention effect on cannabis use, symptoms, global functioning insight or attitude to treatment. However, the intervention improved subjective quality of life at 3. months and this effect was sustained at 1. year. Conclusions: Over the early phase of psychotic illness, group psychological interventions for those with comorbid cannabis dependence improved subjective quality of life. However, this was not associated with reduction in use of cannabis or improvement in clinical outcomes. (copyright) 2012 Elsevier B.V.

Schizophrenia Research, 143(1) : 138- 142

Lee, Christine M., Kilmer, Jason R., Neighbors, Clayton, Atkins, David C., Zheng, Cheng, Walker, Denise D., Larimer, Mary E.

Indicated prevention for college student marijuana use: A randomized controlled trial

Objective: Marijuana is the most frequently reported illicit substance used on college campuses. Despite the prevalence, few published intervention studies have focused specifically on addressing high-risk marijuana use on college campuses. The present study evaluated the efficacy of an in-person brief motivational enhancement intervention for reducing marijuana use and related consequences among frequently using college students. Method: Participants included 212 college students from 2 campuses who reported frequent marijuana use (i.e., using marijuana at least 5 times in the past month). Participants completed Web-based screening and baseline assessments and upon completion of the baseline survey were randomized to either an in-person brief intervention or an assessment control group. Follow-up assessments were completed approximately 3 and 6 months post-baseline. Marijuana use was measured by number of days used in the past 30 days, typical number of joints used in a typical week in the last 60 days, and marijuana-related consequences. Results: Results indicated significant intervention effects on number of joints smoked in a typical week and a trend toward fewer marijuana-related consequences compared with the control group at 3- month follow-up. Conclusion: This study provides preliminary data on short-term effects of a focused marijuana intervention for college students at reducing marijuana use during the academic quarter. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)

Journal of Consulting & Clinical Psychology, 81(4) : 702- 709

Champion, Katrina, Newton, Nicola, Barrett, Emma, Teesson, Maree

A systematic review of school-based alcohol and other drug prevention programs facilitated by computers or the internet

Issues: The use of alcohol and drugs amongst young people is a serious concern and the need for effective prevention is clear. This paper identifies and describes current school-based alcohol and other drug prevention programs facilitated by computers or the Internet.; Approach: The Cochrane Library, PsycINFO and PubMed databases were searched in March 2012. Additional materials were obtained from reference lists of papers. Studies were included if they described an Internet- or computer-based prevention program for alcohol or other drugs delivered in schools.; Key Findings: Twelve trials of 10 programs were identified. Seven trials evaluated Internet-based programs and five delivered an intervention via CD-ROM. The interventions targeted alcohol, cannabis and tobacco. Data to calculate effect size and odds ratios were unavailable for three programs. Of the seven programs with available data, six achieved reductions in alcohol, cannabis or tobacco use at post intervention and/or follow up. Two interventions were associated with decreased intentions to use tobacco, and two significantly increased alcohol and drug-related knowledge.; Conclusion: This is the first study to review the efficacy of school-based drug and alcohol prevention programs delivered online or via computers. Findings indicate that existing computer- and Internet-based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the Internet offer a promising delivery method for school-based prevention.; © 2012 Australasian Professional Society on Alcohol and other Drugs.

Drug & Alcohol Review, 32(2) : 115-123

Carroll, Kathleen M., Nich, Charla, LaPaglia, Donna M., Peters, Erica N., Easton, Caroline J., Petry, Nancy M.

Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: Less can be more, more or less

Aims: To evaluate reciprocal enhancement (combining treatments to offset their relative weaknesses) as a strategy to improve cannabis treatment outcomes. Contingency management (CM) with reinforcement for homework completion and session attendance was used as a strategy to enhance cognitive - behavioral therapy (CBT) via greater exposure to skills training; CBT was used as a strategy to enhance durability of CM with rewards for abstinence. Setting: Community-based out-patient treatment program in New Haven, Connecticut, USA. Design: Twelve-week randomized clinical trial of four treatment conditions: CM for abstinence alone or combined with CBT, CBT alone or combined with CM with rewards for CBT session attendance and homework completion. Participants: A total of 127 treatment-seeking young adults (84.3% male, 81.1% minority, 93.7% referred by criminal justice system, average age 25.7 years). Measurements: Weekly urine specimens testing positive for cannabis, days of cannabis use via the time-line follow-back method. Findings: Within treatment, reinforcing homework and attendance did not significantly improve CBT outcomes, and the addition of CBT worsened outcomes when added to CM for abstinence (75.5 versus 57.1% cannabis-free urine specimens, F = 2.25, P = 0.02). The CM for abstinence condition had the lowest percentage of cannabis-negative urine specimens and the highest mean number of consecutive cannabis-free urine specimens (3.3, F = 2.33, P = 0.02). Attrition was higher in the CBT alone condition, but random effect regression analyses indicated this condition was associated with the greatest rate of change overall. Cannabis use during the 1-year follow-up increased most rapidly for the two enhanced groups. Conclusions: Combining contingency management and cognitive - behavioural therapy does not appear to improve success rates of treatment for cannabis dependence in clients involved with the criminal justice system. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)

Addiction, 107(9) : 1650-1659

Lawlor, E., Madigan, K., Russell, V., O'Connor, J. J., Turner, N., Clarke, M., Waddington, J., O'Callaghan, E.

Engagement with a group-based psychological intervention for those with early phase psychosis and concurrent use of cannabis (Conference abstract)

Background: A Cochrane review of 25 randomized controlled trials of psychosis and comorbid substance use found little evidence of effective strategies to improve outcome amongst this cohort. Few studies have evaluated a group based intervention and none have utilized a group based cognitive behavioural therapy approach combined with motivational interviewing. Aim: We adapted the Cannabis and Psychosis (CAP) individual programme to a group-based format for those with early phase psychosis and cannabis abuse. The final intervention consisted of 12 weekly sessions and was based upon motivational interviewing, cognitive behavioural therapy and psychoeducation. The six phases included: (i) entry: gaining commitment to treatment; (ii) commitment: building commitment to a goal of nonproblematic substance misuse; (iii) goal setting: reinforcing commitment to change and development of goal achievement strategies; (iv) challenges: withdrawal counseling; (v) relapse prevention and lifestyle: early warning signs, healthy living; (vi) maintenance: coping skills. Results: In total 230 individuals were referred to the trial. Of those referred, 72 (31%) did not meet inclusion criteria and 70 (30.4%) refused. Of the remainder, 88 were randomized on a 2 : 1 ratio, 59 (26%) to intervention and 29 (13%) to treatment as usual. However 32 (14%) individuals allocated to the intervention declined to participate in the group based programme. Conclusion: It is difficult to engage participants with early phase psychosis and comorbid cannabis use with a group psychological intervention aimed at improving outcome in psychosis. Innovative engagement strategies are needed with this cohort.

Early Intervention in Psychiatry, 6 : 28

Hoch, E., Noack, R., Henker, J., Pixa, A., Hofler, M., Behrendt, S., Buhringer, G., et-al

Efficacy of a targeted cognitive- behavioral treatment program for cannabis use disorders (CANDIS)

Aims: To examine the efficacy, 3- and 6-month follow-up effects of a psychological treatment for older adolescents and adults with DSM-IV cannabis use disorders. The program was tailored to the needs of this patient population.; Experimental Procedures: A randomized controlled clinical trial of 122 patients aged 16 to 44 years with DSM-IV cannabis dependence as the main substance use diagnosis was conducted. Patients were randomly assigned to either Active Treatment (AT, n = 90) or a Delayed Treatment Control group (DTC, n = 32). Treatment consisted of 10 sessions of therapy, detailed in a strictly enforced manual. Assessments were conducted at baseline, during each therapy session, at post treatment and at follow-up assessments at 3 and 6 months.; Results: The treatment retention rate was 88%. Abstinence was achieved in 49% of AT patients and in 13% of those in DTC (p < 0.001; intend-to-treat (ITT) analysis). Further, AT patients improved significantly (p < = 0.001) in the frequency of cannabis use per week, addiction severity, number of disability days, and overall level of psychopathology. Program effects were maintained over a 3-month- (abstinence rate: 51%) and 6-month follow-up (45%) period.; Conclusion: The treatment program is effective in obtaining abstinence as well as reducing cannabis use and improves the associated social and mental health burden.; Copyright © 2011 Elsevier B.V. and ECNP. All rights reserved.

European Neuropsychopharmacology, 22(4) : 267- 280

De Dios, M. A., Herman, D. S., Britton, W. B., Hagerty, C. E., Anderson, B. J., Stein, M. D.

Motivational and mindfulness intervention for young adult female marijuana users

This pilot study tested the efficacy of a brief intervention using motivational interviewing (MI) plus mindfulness meditation (MM) to reduce marijuana use among young adult females. Thirty-four female marijuana users between the ages of 18 and 29 were randomized to either the intervention group (n = 22), consisting of two sessions of MI-MM, or an assessment-only control group (n = 12). The participants' marijuana use was assessed at baseline and at 1, 2, and 3 months posttreatment. Fixed-effects regression modeling was used to analyze treatment effects. Participants randomized to the intervention group were found to use marijuana on 6.15 (z = -2.42, p = .015), 7.81 (z = -2.78, p = .005), and 6.83 (z = -2.23, p = .026) fewer days at Months 1, 2, and 3, respectively, than controls. Findings from this pilot study provide preliminary evidence for the feasibility and effectiveness of a brief MI-MM for young adult female marijuana users. (copyright) 2012 Elsevier Inc.

Journal of Substance Abuse Treatment, 42(1) : 56-64

Killeen, T. K., McRae-Clark, A. L., Waldrop, A. E., Upadhyaya, H., Brady, K. T.

Contingency management in community programs treating adolescent substance abuse: a feasibility study

Adolescent substance abuse remains a public health problem, and more effective treatment approaches are needed. The study aims to determine the feasibility and preliminary effectiveness of implementing a cost-effective contingency management (CM) intervention in community substance abuse treatment for adolescents with marijuana use disorders. Thirty-one adolescents with primary marijuana use disorder enrolled in a community treatment were randomized into either a prize-based CM intervention contingent when submitting negative urine drug screens (UDS) or a noncontingent control group. There were no significant group differences in percent negative UDS, sustained negative UDS, or retention in treatment. CM was difficult to integrate into community treatment programs and did not seem to be an effective adjunct to standard community substance abuse treatment for adolescents with marijuana use disorders. Modifying the CM procedure for adolescents, changing staff attitudes toward CM, and/or combining CM with other evidence-based psychosocial treatment may improve outcomes. (copyright) 2012 Wiley Periodicals, Inc.

Journal of Child & Adolescent Psychiatric Nursing, 25(1) : 33-41