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Nguyen N, Bold KW, McClure EA. Urgent need for treatment addressing co-use of tobacco and cannabis: An updated review and considerations for future interventions. Addict Behav 2024; 158:108118. [PMID: 39089194 DOI: 10.1016/j.addbeh.2024.108118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 07/10/2024] [Accepted: 07/19/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND There are no clinical practice guidelines addressing the treatment of tobacco-cannabis co-use and a dearth of studies to inform treatment for co-use. This narrative review aims to (1) summarize promising intervention components used in published co-use treatment studies, (2) describe key gaps and emerging issues in co-use, and (3) provide recommendations and considerations in the development and evaluation of co-use interventions. METHODS We conducted a literature search in June 2024 across several databases to update previous reviews on tobacco-cannabis co-use treatment. We found 9 published intervention studies that specifically addressed treatment for both substances. Data from these studies were manually extracted and summarized. RESULTS Most of the 9 included studies (1) focused on acceptability and/or feasibility, (2) provided both psychosocial/behavioral and pharmacotherapy intervention components, (3) were conducted in adults, and (4) were delivered in-person, with some having digital asynchronous components, for a 5-to-12-week duration. The most common psychosocial/behavioral strategies used were Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management; while the most common pharmacotherapy was Nicotine Replacement Therapy. There was no evidence of compensatory use of tobacco or cannabis when providing simultaneous treatment for both substances. CONCLUSIONS The literature to date provides support for well-integrated multi-component interventions of psychosocial/behavioral and pharmacotherapy strategies for co-use treatment. This review reinforces an urgent need for treatments targeting tobacco and cannabis co-use. Future interventions should address key gaps, including co-use of vaporized products among youth and young adults, tailored interventions for priority populations, and digital applications to increase reach and advance health equity.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California San Francisco, CA, USA.
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, CT, USA; Yale Cancer Center, CT, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, SC, USA; Hollings Cancer Center, Medical University of South Carolina, SC, USA
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Ferron JC, Brunette MF, Aschbrenner KA, ElSayed MW, Pratt SI. Tobacco, Alcohol, and Drug Use Among Young Adults with Serious Mental Illness. Community Ment Health J 2024; 60:945-954. [PMID: 38427276 DOI: 10.1007/s10597-024-01246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
To inform early intervention, this study describes correlates of substance use among young people with serious mental illness (SMI) enrolled in integrated care in community mental health settings. 227 adults ages 18-35 were assessed for clinical characteristics and substance use. Logistic regressions were used to describe relationships between substance use and participant characteristics. Over a third (38.9%) reported daily cannabis, 15.9% past month other illicit drug, 13.5% frequent/heavy alcohol and 47.4% any of these; 50.2% reported daily tobacco smoking and 23.3% current vaping. Daily cannabis and tobacco were the most common combination. Alcohol, drug, and cannabis with tobacco were associated with higher mental health symptoms but not with emergency room or hospital utilization. Cannabis and other substance use was common and associated with higher symptoms but not with greater hospital utilization, suggesting that early intervention could prevent long-term negative consequences.
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Affiliation(s)
- Joelle C Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA.
- The Dartmouth Institute, Dartmouth College, Hanover, USA.
- Dartmouth Hitchcock Health System, Lebanon, USA.
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Department of Family Medicine, Geisel School of Medicine at Dartmouth College, Concord, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Mohamed W ElSayed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
- New Hampshire Hospital, Concord, USA
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
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Gex KS, Leone RM, Aungst J, Branson K, Gray KM, Tomko RL. Identifying brief intervention factors to improve cannabis related outcomes in adolescents and young adults: A systematic review of sample characteristics and intervention components. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209335. [PMID: 38490335 PMCID: PMC11090745 DOI: 10.1016/j.josat.2024.209335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/19/2023] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Prior systematic and meta-analytic reviews observed mixed evidence for the efficacy of cannabis brief interventions (BIs). Inconsistent support for cannabis BIs may be the result of intersecting methodological factors, including intervention structure and content, participant eligibility criteria, and outcome assessment measures. The current systematic review of cannabis BI studies narratively synthesizes these data to guide intervention development decision-making in future cannabis BI studies (PROSPERO CRD42022285990). METHODS We searched PubMed/MEDLINE, PsycINFO, and CINAHL databases in January 2022 and again in June 2023 to capture newly published studies. Studies were included if they were a randomized trial, enrolled adolescents (13-17) and/or young adults (18-30), specified cannabis use and/or problems inclusion criteria, and evaluated a cannabis BI (defined as ≤4 sessions). We extracted and synthesized data on intervention characteristics (e.g., components, length/duration, modality), cannabis inclusion criteria and recruitment setting, baseline cannabis use descriptives and treatment-seeking status, and outcome assessment measures to discern if/how they may intersect to determine intervention efficacy. The Cochrane Risk of Bias Tool 2 assessed study quality. RESULTS Our search resulted in a final sample of 25 study records including 4094 participants. Recruitment setting seemed to provide an influential backdrop for how well inclusion criteria determined baseline cannabis use level, as well as for the type/length of the BI evaluated. Motivational interviewing (MI) and personalized feedback (PF) were the most frequently used BI components overall; however, some differences were observed in the proportion of BIs with reported intervention effects using MI vs. PF. Frequency of use days was the most commonly used outcome measure, although this may not be the most sensitive measure for assessing cannabis BI efficacy. CONCLUSIONS Our systematic review indicates that cannabis BI studies require greater precision in their design, giving special attention to matching the content and structure of the BI to the needs of the target population and selecting outcomes commensurate to the goals of the BI and the target population to more accurately reflect the efficacy of the BI. However, consistent with prior reviews, all included studies demonstrated at least some concerns for risk of bias, and most were at high risk.
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Affiliation(s)
- Kathryn S Gex
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Jenna Aungst
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, United States
| | - Kevin Branson
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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Borodovsky JT, Struble CA, Habib MI, Hasin DS, Shmulewitz D, Walsh C, Livne O, Aharonovich E, Budney AJ. Exploring survey methods for measuring consumption quantities of cannabis flower and concentrate products. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:733-745. [PMID: 37774316 PMCID: PMC10795727 DOI: 10.1080/00952990.2023.2246635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/06/2023] [Indexed: 10/01/2023]
Abstract
Background: Researchers need accurate measurements of cannabis consumption quantities to assess risks and benefits. Survey methods for measuring cannabis flower and concentrate quantities remain underdeveloped.Objective: We examined "grams" and "hits" units for measuring flower and concentrate quantities, and calculating milligrams of THC (mgTHC).Methods: Online survey participants (n = 2,381) reported preferred unit (hits or grams), past-week hits and grams for each product, and product %THC. Quantile regression compared mgTHC between unit-preference subgroups. Hits-based mgTHC calculations assumed a universal grams-per-hit ratio (GPHR). To examine individualized GPHRs, we tested a "two-item approach," which divided total grams by total hits, and "one-item approach," which divided 0.5 grams by responses to the question: "How many total hits would it take you to finish 1/2 g of your [product] by [administration method]?"Results: Participants were primarily daily consumers (77%), 50% female sex, mean age 39.0 (SD 16.4), 85% White, 49% employed full-time. Compared to those who preferred the hits unit, those who preferred the grams unit reported consuming more hits and grams, higher %THC products, and consequently, larger median mgTHC (flower-hits mgTHC: 32 vs. 91 (95%CI: 52-67); flower-grams mgTHC: 27 vs. 113 (95%CI: 73-95); concentrate-hits mgTHC: 29 vs. 59 (95%CI: 15-43); concentrate-grams mgTHC: 61 vs. 129 (95%CI: 43-94)). "Two-item" and "one-item" approach GPHRs were similar and frequently 50% larger or smaller than the universal GPHR.Conclusion: Allowing respondents to choose "hits" or "grams" when reporting cannabis quantities does not compromise mgTHC estimates. A low-burden, one-item approach yields individualized "hit sizes" that may improve mgTHC estimates.
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Affiliation(s)
- Jacob T. Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Cara A. Struble
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Mohammad I. Habib
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 St, New York, NY 10032, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Claire Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Alan J. Budney
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
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Trick L, Butler K, Bourgault Z, Vandervoort J, Le Foll B. Implementation and Preliminary Evaluation of a 12-Week Cognitive Behavioural and Motivational Enhancement Group Therapy for Cannabis Use Disorder. Subst Abuse 2023; 17:11782218231205840. [PMID: 37904747 PMCID: PMC10613350 DOI: 10.1177/11782218231205840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/19/2023] [Indexed: 11/01/2023]
Abstract
Background The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored.
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Affiliation(s)
- Leanne Trick
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, ON, Canada
- Department of Psychology, Durham University, Durham, UK
| | - Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, ON, Canada
- School of Psychology, College of Health and Science, University of Lincoln, Lincoln, UK
| | - Zoe Bourgault
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Julianne Vandervoort
- Concurrent Outpatient Medical & Psychosocial Addiction Support Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Concurrent Outpatient Medical & Psychosocial Addiction Support Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Division of Brain and Therapeutics, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Trends in the use of cannabis products in Canada and the USA, 2018 – 2020: Findings from the International Cannabis Policy Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103716. [DOI: 10.1016/j.drugpo.2022.103716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
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Schluter MG, Hodgins DC. Measuring recent cannabis use across modes of delivery: Development and validation of the Cannabis Engagement Assessment. Addict Behav Rep 2022; 15:100413. [PMID: 35434244 PMCID: PMC9006737 DOI: 10.1016/j.abrep.2022.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 02/06/2022] [Indexed: 11/25/2022] Open
Abstract
The CEA is consistent with expert-recommended guidelines for quantifying cannabis use. The CEA is representative of current patterns of recreational cannabis engagement. Estimates of cannabis use show strong associations with the timeline followback method. The CEA shows good test–retest reliability over a one-week period.
Introduction Methods of cannabis engagement have proliferated in recent years, which many self-report measures do not adequately capture. There is a clear need for self-report measures that capture current patterns of cannabis use across a range of methods, and that can be used to track changes over time. The current study developed the Cannabis Engagement Assessment (CEA), a self-report measure of past month cannabis use across dry flower, concentrate, and edible products. Methods A sample of 349 participants from the undergraduate student population and broader community were recruited. To examine convergent validity of the CEA, participants completed measures of cannabis engagement, cannabis misuse, and use-related problems. To assess divergent validity, participants also completed measures of depression and alcohol use problems. Criterion and test–retest reliability were examined in a subset of 65 participants who re-completed the CEA and a timeline follow-back interview (TLFB). Results Indicators of cannabis use frequency and quantity showed good convergence with measures of cannabis use patterns, problematic engagement, and cannabis use-related problems. Divergent validity of the CEA was supported by lower associations with alcohol use problems and depression symptoms. The CEA also showed good test–retest reliability and convergence with estimates of frequency and quantity of cannabis use from the TLFB. Conclusions The CEA is a viable self-report measure of cannabis use that is representative of current patterns of recreational cannabis engagement. Its focus on cannabis use in the preceding 30 days also lends itself to measuring changes in use over time.
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Affiliation(s)
- Magdalen G. Schluter
- Corresponding Author at: Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
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McClure EA, Rabin RA, Lee DC, Hindocha C. Treatment Implications Associated with Cannabis and Tobacco Co-Use. CURRENT ADDICTION REPORTS 2020; 7:533-544. [PMID: 33777645 PMCID: PMC7992053 DOI: 10.1007/s40429-020-00334-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE OF THE REVIEW The goal of this article is to summarize the treatment-focused literature on cannabis and tobacco co-use and the treatment implications of co-use. This review will focus on: 1) the impact of co-use on cessation outcomes, 2) compensatory use/substitution of the non-treated substance among co-users, and 3) treatment interventions to address co-use. This article will highlight the limitations to co-use captured in the literature and offer considerations and directives for co-use research and treatment moving forward. RECENT FINDINGS The degree to which co-use affects cessation for a single, targeted substance remains in question, as the literature is largely mixed. Cannabis treatment trials are better equipped to answer these questions given that they do not typically exclude tobacco users. While the relationship between tobacco use and poorer cannabis outcomes appears to have some evidence, the reverse relationship (cannabis use affecting tobacco outcomes) is not consistently supported. SUMMARY The co-use of cannabis and tobacco and its impact on single substance cessation and/or compensatory substance use during cessation is generally overlooked in treatment trials, while interventions to address both substances are rare. Capturing co-use adds burden for researchers, clinicians, and participants, but is warranted given the prevalence of co-use and a rapidly changing cannabis and tobacco regulatory environment, which may further complicate co-occurring substance use. Co-users are a heterogeneous population; trials focused on co-users, in addition to better data capture and consistent terminology, will aid in an understanding of nuanced patterns of co-use critical to inform treatment interventions.
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Affiliation(s)
- Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel A. Rabin
- Department of Psychiatry, McGill University and The Douglas Mental Health Institute, Montreal, Canada
| | - Dustin C. Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Department of Clinical, Educational & Health Psychology, University College London, Faculty of Brain Sciences, University College London
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre
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