Disorders - Cannabis Use
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.\rMETHOD: 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).\rRESULTS: 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).\rCONCLUSION:
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
Copeland, J., Rooke, S., Rodriquez, D., Norberg, M.
M., Gibson, L.
Previous studies have shown brief online self-help interventions to be a useful method of treating cannabis use and related
problems; however, no studies have compared the effects of brief versus extended feedback for online brief intervention programs.\rOBJECTIVES: The
current study was a two arm randomised trial aimed at testing the short term effectiveness of a brief and extended feedback version of Grassessment,
a brief online intervention for cannabis users that provides individualised feedback regarding use, motives, and harms.\rMETHODS: Participants
(n=287) reporting at least one symptom of DSM IV cannabis abuse or dependence were recruited using online and offline advertising methods.
Participants were randomised to receive either a brief or extended feedback version of the Grassessment program and were required to complete a one
month follow up questionnaire.\rRESULTS: One hundred and ninety four participants completed the one month follow up. Wilcoxon analyses showed a
significant decrease in past month quantity and frequency of cannabis use (ps<0.001; r=-0.41 and -0.40 respectively) and lower severity of dependence
scores (p=0.002; r=-0.31) among those in the brief feedback condition. Participants in the extended feedback group also demonstrated significant
decreases in patterns of use (ps<0.002; r=-0.39 and -0.33) but not severity of dependence (p=0.09; r=0.18). A Generalized Estimating Equation (GEE)
analysis showed no significant interaction between length of feedback received and past month cannabis use frequency (p=0.78), quantity (p=0.73), or
severity of dependence (p=0.47).\rCONCLUSION: This study adds support for the use of brief online self-complete interventions to reduce cannabis use
and related problems in the short term. The findings suggest that in the case of the brief online screening and feedback program Grassessment,
extended feedback does not lead to superior outcomes over brief feedback.
Journal of Substance Abuse Treatment, 76 : 43-
48
- Year: 2017
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Personalised feedback, normative feedback, Technology, interventions delivered using technology (e.g. online, SMS)
Hill, K. P., Palastro, M.
D., Gruber, S. A., Fitzmaurice, G. M., Greenfield, S. F., Lukas, S. E., Weiss, R. D.
Background and Objectives: We assessed the safety, tolerability, and preliminary
efficacy of nabilone, a cannabinoid agonist, to treat cannabis dependence. Methods: Eighteen adults with DSM-IV cannabis dependence were randomized
to receive either 2 mg/day of nabilone (n = 10) or placebo (n = 8) for 10 weeks in addition to medication management. Twelve participants, six in
each group, completed treatment. The safety and tolerability of nabilone was assessed at each visit. Any side effects from nabilone or the placebo
were documented. Cannabis use outcomes were assessed via self-report of days of use and twice-weekly urine cannabinoid tests; secondary outcomes
included cannabis craving and anxiety. Results: We assessed safety and tolerability at each study visit. A total of eight adverse events, all mild or
moderate, were reported in two participants in the nabilone group, and six events were reported in four participants in the placebo group during
study treatment. A total of eight adverse events were reported in two participants in the nabilone group and six events were reported in four
participants in the placebo group during study treatment. All reported adverse events were rated mild-to-moderate. There were no side effects deemed
serious enough to be classified as an FDA-defined serious adverse event. In general, participants in both groups reported reduced cannabis use
according to self-report over the course of the study, although these reductions were not statistically discernible. Moreover, there was no
difference in cannabis use between the nabilone group and the placebo group as measured by self-report. Discussion and Conclusions: Nabilone
pharmacotherapy was safe and well-tolerated in participants with cannabis dependence. Future studies might evaluate a higher dose of nabilone to
determine its effects on cannabis use outcomes in participants with cannabis dependence. Scientific Significance: There remains a clear need for
additional pharmacotherapy trials for cannabis dependence, and nabilone remains a candidate for such trials. (PsycINFO Database Record (c) 2018 APA,
all rights reserved)
American Journal on Addictions, 26(8) : 795-
801
- Year: 2017
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse, Other biological interventions
Walther, L., Gantner, A., Heinz, A., Majic, T.
Background: Now that the
consumption of natural and synthetic cannabinoids is becoming more widespread, the specific treatment of cannabis-related disturbances is an
increasingly important matter. There are many therapeutic options, and it is not always clear which ones are evidence-based and appropriate for use
in a given clinical situation. Methods: This review is based on reports of pertinent randomized and controlled trials (RCTs) that were retrieved by a
selective search in the PubMed and Cochrane databases. Results: Cognitive behavior therapy (CBT) combined with other techniques has been found to
have a moderate to large effect (Cohen's d = 0.53-0.9) on the amount of cannabis consumed as well as on the level of psychosocial functioning or the
dependence syndrome. Systemic multidimensional family therapy (MDFT) has been found beneficial for younger adolescents who consume large amounts of
cannabis and have psychiatric comorbidities. Short-term interventions with motivational talk therapy have been found effective for patients with or
without an initial desire to achieve cannabis abstinence. All of these psychotherapeutic interventions are effective at evidence level Ia. The
administration of gabapentin had a weak effect (d = 0.26) on the quantity consumed and on abstinence (evidence level Ib). Withdrawal symptoms can be
alleviated with cannabinoid-receptor antagonists (d = 0.223 and 0.481) (evidence level Ib). On the other hand, there is evidence that serotonergic
antidepressants can worsen withdrawal manifestations and increase the likelihood of relapse. Conclusion: Psychotherapeutic techniques remain the
foundation of treatment for cannabis dependence. No drug has yet been approved for the treatment of cannabis dependence because of the lack of
scientific evidence. The rates of abstinence that are currently achieved, even with psychotherapy, are still only moderate. Further clinical studies
are needed for the evaluation of combinations of various treatments that can meet the needs of individual patients. (PsycINFO Database Record (c)
2017 APA, all rights reserved)
Deutsches Arzteblatt International, 113(39) : 653-
659
- Year: 2016
- Problem: Cannabis Use
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Motivational interviewing, includes Motivational Enhancing Therapy
Bentzley, J. P., Tomko, R. L., Gray, K. M.
Background: In light of recent progress toward pharmacologic interventions to treat adolescent cannabis use disorder, it is
important to consider which adolescent characteristics may be associated with a favorable response to treatment. This study presents secondary
analyses from a parent randomized controlled trial of N-acetylcysteine (NAC) in adolescents with cannabis use disorder. We hypothesized that high
pretreatment impulsivity and medication non-adherence would be associated with reduced abstinence rates. Methods: Participants were treatment-seeking
adolescents (N = 115) who met criteria for cannabis use disorder and were assessed for pretreatment impulsivity. They received 1200 mg NAC or placebo
orally twice daily for 8 weeks. An intent-to-treat analysis using a repeated-measures logistic regression model was used to relate pretreatment
impulsivity (Barratt Impulsiveness Scale) and treatment group to abstinence rates, measured by urine cannabinoid tests. To explore mechanisms by
which NAC may reduce cannabis use, relationships between impulsivity, adherence, and abstinence were assessed in a second statistical model using
data from participants with recorded adherence and urine cannabinoid test results (n = 54). Results: In the intent-to-treat analysis, low
pretreatment impulsivity, NAC treatment, and negative baseline urine cannabinoid test results independently increased the odds of having negative
urine cannabinoid tests during treatment (OR = 2.1, 2.3, and 5.3 respectively). In the sample of participants with adherence data (n = 54), adherence
tripled the odds of abstinence. Notably, the effect of adherence on abstinence was only observed in the NAC treatment group. Lastly, although the
highly impulsive participants had reduced rates of abstinence, highly impulsive individuals adherent to NAC treatment had increased abstinence rates
compared to non-adherent individuals. Conclusion: Low impulsivity, NAC treatment, medication adherence, and baseline negative cannabinoid testing
were associated with increased rates of abstinence in adolescents seeking treatment for cannabis use disorder. Efforts to optimize pharmacotherapy
adherence may be particularly crucial for highly impulsive individuals. Understanding and addressing factors, such as impulsivity and adherence,
which may affect outcomes, may aid in the successful evaluation and development of potentially promising pharmacotherapies. Copyright © 2016 Elsevier
Inc.
Journal of Substance Abuse Treatment, 63 : 72-
77
- Year: 2016
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Walker, D. D., Stephens, R. S., Blevins, C. E., Banes, K. E., Matthews, L., Roffman,
R. A.
OBJECTIVE: Brief interventions for adolescent marijuana users offered in schools reach users who would not
otherwise present for treatment. The current study builds on previous trials of a school-based, 2-session motivational enhancement therapy (MET)
intervention by adding periodic, brief motivational check-ins to reinforce gains and bolster motivation.\rMETHOD: Adolescent participants were
randomly assigned to a motivational check-in (MCI; n = 128) or assessment-only check-in (ACI; n = 124) comparison condition. Both conditions received
2 sessions of MET. Participants in the MCI condition then attended 3 MET-based check-in sessions at 4, 7, and 10 months after baseline, whereas the
ACI condition participants attended assessment-only check-ins at the same time points. Optional cognitive behavior therapy (CBT) sessions were
available as needed for 12 months from baseline in both conditions.\rRESULTS: Outcomes were assessed at 6, 9, 12, and 15 months after baseline.
Participants (59% Caucasian; 68% male; mean age = 15.84) reported using marijuana on an average of 37 of the last 60 days, and 70% met diagnostic
criteria for a marijuana use disorder. Both conditions were associated with reduced use and negative consequences that were sustained throughout the
15 months of follow-up. The MCI condition resulted in greater reductions at the 6 months follow-up, but differences between conditions were not found
at later follow-ups, and MCI participation did not increase engagement in CBT as predicted.\rCONCLUSIONS: Results replicated the efficacy of the
brief intervention for adolescent marijuana use and provided mixed evidence on the utility of adding repeated check-in sessions. (PsycINFO Database
Record
Journal of
Consulting & Clinical Psychology, 84(11) : 983-992
- Year: 2016
- Problem: Cannabis Use
- Type: Randomised controlled trials
-
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, Other service delivery and improvement
interventions