Disorders - Cannabis Use
D'Amico, E.J., Parast, L., Shadel, W.G., Meredith, L.S., Seelam, R., Stein, B.D.
Objective: The primary care (PC) setting provides a
unique opportunity to address adolescent alcohol and other drug (AOD) use. Method: We conducted a randomized controlled trial in 4 PC clinics from
April 2013 to November 2015 to determine whether a 15-min brief motivational interviewing (MI) AOD intervention, delivered in PC, reduced alcohol and
marijuana use and consequences. Adolescents ages 12-18 who came for an appointment during the 2.5-year study period were asked to be in the study and
screened using the National Institute of Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomized to the CHAT
intervention or usual care (UC). Adolescents completed 4 web-based surveys at baseline and 3, 6, and 12 months postbaseline. Results: The sample (n =
294) was 58% female and 66% Hispanic, 17% Black, 12% White, 5% multiethnic or other, with an average age of 16 years. Compared to UC adolescents,
CHAT adolescents reported significantly less perceived peer use of alcohol and marijuana at 3 months (alcohol: p < .0001; marijuana p = .01) and 6
months (alcohol: p = .04; marijuana p = .04). CHAT adolescents also reported marginally fewer negative alcohol consequences experienced at 6 months
(p = .08). At 12 months, compared to UC, CHAT adolescents reported less perceived peer alcohol (p = .04) and marijuana (p < .01) use and fewer
negative consequences from alcohol (p = .03) and marijuana (p = .04) use. Conclusions: A brief MI intervention delivered in PC reduced negative
consequences from alcohol and marijuana use 1 year later. Findings emphasize that adolescents can benefit from PC interventions that briefly and
effectively address both alcohol and marijuana use. (PsycINFO Database Record (c) 2018 APA, all rights reserved) Impact Statement What is the public
health significance of this article?-This study suggests that a brief motivational intervention in the primary care setting is an effective way to
reduce adolescents' perceptions of alcohol and marijuana use and consequences experienced one year later. Findings emphasize that adolescents can
benefit from interventions that briefly and effectively address both alcohol and marijuana use. (PsycINFO Database Record (c) 2018 APA, all rights
reserved)
Journal of Consulting and Clinical Psychology, 86(9) : 775-
786
- Year: 2018
- Problem: Alcohol
Use, Cannabis Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy
Mason, M. J., Zaharakis, N. M., Moore, M., Brown, A., Garcia, C., Seibers, A., Stephens, C.
Young adults ages 18 to 25 have the highest percentage (5%) of cannabis use disorder (CUD) among all age groups, and are the least likely
to receive treatment compared with other age groups. Because this population is in need of creative approaches for treatment engagement, we tested
Peer Network Counseling-txt (PNC-txt), a 4-week, automated text-delivered cannabis treatment that focuses on close peer relations with 96 treatment
seeking young adults.
Psychology of Addictive
Behaviors, 32(7) : 699-709
- 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)
Padovano, H.T., Miranda Jr, R.
Objective: The present study used youth's in vivo reports of subjective responses
to cannabis while smoking in their natural environments to identify real-world mechanisms of topiramate treatment for cannabis misuse. Method:
Participants were 40 cannabis users (>= twice weekly in past 30 days), ages 15-24 years (47.5% female), with at least one cannabis use episode during
the final 3 weeks of a 6-week, randomized clinical trial. Youth reported subjective \"high\" while smoking, stimulation, sedation, stress, craving,
and grams of marijuana used in the natural environment via wireless electronic devices. Bayesian multilevel structural equation modeling (MSEM)
evaluated mediation via indirect effect tests. Results: Significant within (daily) and between (person) variability and distinctive within and
between effects supported the MSEM approach. Subjective high while smoking was significantly reduced for youth in the topiramate condition, relative
to placebo, and the indirect effect of reduced subjective high on total grams of cannabis smoked that day was significant. Indirect effects through
other subjective responses were not significant. Conclusions: The results of this initial study suggest that altering subjective responses to
smoking, specifically subjective high, may be a key target for developing adjunctive pharmacotherapies for cannabis misuse. More generally, this work
provides an example for applying ecological momentary assessment and analytic techniques to evaluate mechanisms of behavior change in longitudinal
data. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Studies on Alcohol and
Drugs, 79(2) : 190-198
- 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, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy
Mason, M. J., Zaharakis, N. M., Moore, M., Brown, A., Garcia, C., Seibers, A., Stephens, C.
Young adults
ages 18 to 25 have the highest percentage (5%) of cannabis use disorder (CUD) among all age groups, and are the least likely to receive treatment
compared with other age groups. Because this population is in need of creative approaches for treatment engagement, we tested Peer Network
Counseling-txt (PNC-txt), a 4-week, automated text-delivered cannabis treatment that focuses on close peer relations with 96 treatment seeking young
adults.
Psychology of Addictive Behaviors, 32(7) : 699-
709
- 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)
Padovano, H.T., Miranda Jr, R.
Objective: The present study used youth's in vivo reports of subjective responses
to cannabis while smoking in their natural environments to identify real-world mechanisms of topiramate treatment for cannabis misuse. Method:
Participants were 40 cannabis users (>= twice weekly in past 30 days), ages 15-24 years (47.5% female), with at least one cannabis use episode during
the final 3 weeks of a 6-week, randomized clinical trial. Youth reported subjective \"high\" while smoking, stimulation, sedation, stress, craving,
and grams of marijuana used in the natural environment via wireless electronic devices. Bayesian multilevel structural equation modeling (MSEM)
evaluated mediation via indirect effect tests. Results: Significant within (daily) and between (person) variability and distinctive within and
between effects supported the MSEM approach. Subjective high while smoking was significantly reduced for youth in the topiramate condition, relative
to placebo, and the indirect effect of reduced subjective high on total grams of cannabis smoked that day was significant. Indirect effects through
other subjective responses were not significant. Conclusions: The results of this initial study suggest that altering subjective responses to
smoking, specifically subjective high, may be a key target for developing adjunctive pharmacotherapies for cannabis misuse. More generally, this work
provides an example for applying ecological momentary assessment and analytic techniques to evaluate mechanisms of behavior change in longitudinal
data. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Studies on Alcohol and
Drugs, 79(2) : 190-198
- 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, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy
Jacobus, J., Taylor, C.
T., Gray,
K. M., Meredith, L. R., Porter, A. M., Li, I., Castro, N., Squeglia, L. M.
BACKGROUND: Few effective
treatment options exist for cannabis-using youth. This pilot study aimed to test Approach-Avoidance Training to reduce cannabis use with non-
treatment-seeking adolescents.\rMETHODS: Eighty cannabis-using non-treatment-seeking adolescents (average age 19) were recruited from San Diego,
California and Charleston, South Carolina, and randomized to complete either six sessions of Cannabis Approach-Avoidance Task Training (CAAT-
training) designed to reduce automatic approach biases for cannabis cues or CAAT-sham training. Change in two primary outcome variables was examined:
1) cannabis approach bias and 2) percent cannabis use days over study enrollment. Change in percent alcohol use days over study enrollment was
explored as a secondary outcome.\rRESULTS: A mixed models repeated measures analysis confirmed the group by time interaction effect for approach bias
failed to reach statistical significance (p=.06). Significant group by time interaction effects (ps<0.05) predicted percent days of cannabis and
alcohol use over study enrollment. Participants randomized to the avoid cannabis condition (CAAT-training) reported 7% fewer days of cannabis use
compared to 0% change for sham; unexpectedly, those in the avoid cannabis condition reported 10% percent more alcohol use days compared to 3% more
for sham.\rCONCLUSIONS: Computerized cognitive bias modification paradigms may have utility in reducing adolescent cannabis use. Future work should
consider developing a paradigm that addresses both cannabis and alcohol, as well as alternative computerized approaches for coping with addictive
behavior in conjunction with bias modification.
Drug & Alcohol Dependence, 187 : 195-204
- Year: 2018
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Machielsen, M. W. J., Veltman, D.
J., van-den-Brink, W., de-Haan, L.
OBJECTIVE: Cannabis use disorders (CUDs) are highly comorbid in patients with schizophrenia and associated with poor outcome. Clozapine
has been put forward as the first choice antipsychotic in this patient group. However, little is known about the mechanisms underlying the assumed
superiority of clozapine.\rMETHODS: A total of 38 patients with DSM-IV schizophrenia (30 with and 8 without a DSM-IV CUD) and 20 healthy comparison
subjects were included between April 2009 and June 2012. Patients were randomized to antipsychotic treatment with clozapine or risperidone. At
baseline and after 4weeks of medication, brain response to cannabis-related, positive and neutral images was measured using functional MRI. Neural
correlates of cue reactivity were assessed in the following regions of interest: amygdala, ventral striatum, insula, thalamus, orbitofrontal cortex
and anterior cingulate cortex. Subjective craving was assessed using self-report questionnaires (OCDUS and MCQ).\rRESULTS: At baseline, patients with
a comorbid CUD showed higher subjective craving and greater activation in response to cannabis-related images compared to patients without a CUD and
healthy controls in most regions of interest. Clozapine treated patients reported a greater reduction in craving (F(1,28)=6.0, p=0.04) and showed a
larger decrease in amygdala activation during cannabis-related images compared to risperidone treated patients (T=3.94, pFWE=0.006). In addition,
significant correlations were found between subjective craving and thalamus and insula activation during cannabis-related images.\rCONCLUSION: These
findings provide evidence that clozapine is superior to risperidone in decreasing subjective craving and cue reactivity for cannabis-related images
probably due to a differential effect on dopaminergic neurotransmission.\rTRIAL REGISTRATION: 'Nederlands trial register'
(http://www.trialregister.nl), nr NTR1761, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1761.
Schizophrenia Research, 194 : 32-
38
- Year: 2018
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
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.\rMETHODS: 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.\rRESULTS:
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.\rCONCLUSIONS: 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