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Halladay J, Freibott CE, Lipson SK, Zhou S, Eisenberg D. Trends in the co-occurrence of substance use and mental health symptomatology in a national sample of US post-secondary students from 2009 to 2019. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1911-1924. [PMID: 35834773 DOI: 10.1080/07448481.2022.2098030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/20/2022] [Accepted: 06/27/2022] [Indexed: 05/18/2023]
Abstract
Objective: This study examined joint trends over time in associations between substance use (heavy drinking, cannabis, and cigarette smoking) and mental health concerns (depression, anxiety, and suicidal ideation) among US post-secondary students. Participants: Data came from 323,896 students participating in the Healthy Minds Study from 2009 to 2019, a national cross-sectional survey of US post-secondary students. Weighted two-level logistic regression models with a time by substance interaction term were used to predict mental health status. Results: Use of each substance was associated with a greater odds of students endorsing depression, anxiety, and suicidal ideation. Over time, the association with mental health concerns strengthened substantially for cannabis, modestly for heavy drinking, and remained stable for smoking. Conclusion: Given co-occurrence is common and increasing among post-secondary students, college and university health systems should prioritize early identification, psychoeducation, harm-reduction, and brief interventions to support students at risk.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Christina E Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sarah K Lipson
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sasha Zhou
- Department of Public Health, Wayne State University, Detroit, Michigan, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA
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Weitzman ER, Minegishi M, Dedeoglu F, Fishman LN, Garvey KC, Wisk LE, Levy S. Disease-Tailored Brief Intervention for Alcohol Use Among Youths With Chronic Medical Conditions: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2419858. [PMID: 38985475 PMCID: PMC11238030 DOI: 10.1001/jamanetworkopen.2024.19858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/21/2024] [Indexed: 07/11/2024] Open
Abstract
Importance In the US, 25% of youths have a chronic medical condition (CMC). Alcohol use is prevalent among youths with a CMC and is associated with treatment nonadherence, simultaneous exposure to contraindicated medications, poor self-care, and elevated rates of progression to heavy and problem use by young adulthood. Preventive interventions targeting these youths are scarce and lack evidence about longer-term risk-stratified effects. Objective To evaluate the 12-month effects of a preventive intervention for alcohol use among youths with a CMC reporting baseline no or low-risk alcohol use vs high-risk alcohol use, testing the hypothesis of no difference. Design, Setting, and Participants This presepecified secondary analysis used data from a 2-group, parallel randomized clinical trial of the Take Good Care (TGC) intervention. Convenience samples of youths (aged 14-18 years) with a CMC, such as type 1 diabetes, juvenile idiopathic arthritis, or inflammatory bowel disease, were randomly assigned to the intervention or treatment as usual (TAU) between May 11, 2017, and November 20, 2018, and were followed up for up to 12 months. High-risk alcohol use was defined as heavy episodic (binge) alcohol use in the past 3 months and alcohol-related blackouts, injuries, vomiting, or emergency department visits in the past 12 months. Data were analyzed from September 21, 2023, to February 3, 2024. Interventions The self-administered, tablet computer-based TGC intervention was developed with patient and expert input, and it delivers disease-tailored psychoeducational content about the effects of alcohol use on overall health, disease processes, and treatment safety and efficacy. Main Outcomes and Measures The main outcome was self-reported frequency of alcohol use (in days) over the past 3 months, measured by a single validated question. Maximum likelihood methods incorporating all available data were used assuming data missing at random. Results The trial included 451 participants (229 female youths [50.8%]), with a mean (SD) age of 16.0 (1.4) years. Of these youths, 410 (90.9%) participated in the 12-month follow-up. At baseline, 52 youths (11.5%) reported high-risk alcohol use. Among participants with high-risk alcohol use, the observed mean (SD) frequency of alcohol use from baseline to the 12-month follow-up decreased in the intervention group (from 6.3 [4.6] to 4.9 [4.3] days) and increased in the TAU group (from 5.5 [4.9] to 9.0 [5.8] days), with an adjusted relative rate ratio of 0.60 (95% CI, 0.38 to 0.94). There were no group differences among youths reporting no or low-risk alcohol use. Conclusions and Relevance In this trial of a brief chronic illness-tailored preventive intervention, medically vulnerable youths with a high risk of alcohol use and harm decreased alcohol use. These findings support the use of a personalized preventive intervention with this group. Trial Registration ClinicalTrials.gov Identifier: NCT02803567.
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Affiliation(s)
- Elissa R. Weitzman
- Division of Addiction Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Machiko Minegishi
- Division of Addiction Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Rheumatology Program, Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
| | - Laurie N. Fishman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Boston Children’s Hospital, Boston, Massachusetts
| | - Katharine C. Garvey
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Lauren E. Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles
| | - Sharon Levy
- Division of Addiction Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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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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Connor JP, Manthey J, Hall W, Stjepanović D. Effectiveness of cannabis use and cannabis use disorder interventions: a European and international data synthesis. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01829-5. [PMID: 38780801 DOI: 10.1007/s00406-024-01829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
This data synthesis examined the effectiveness of behavioural and pharmacological approaches for cannabis treatment. We integrated findings from high level evidence studies and prioritised data from Europe when available. The synthesis found that only a relatively small number of published behavioural and pharmacological studies on cannabis interventions have been conducted in Europe. Applying both European and non-European data, it was found that Cognitive Behavioural Therapy (CBT) and/or Motivational Enhancement Therapy (MET) improved short-term outcomes in the frequency of cannabis use and dependency severity, although abstinence outcomes were less consistent. These improvements were typically not maintained nine months after treatment. CBT and MET (or combined CBT + MET) treatments that extend beyond four sessions were more effective than fewer sessions over a shorter duration. Combining CBT or MET (or combined CBT + MET) with adjunctive Contingency Management (CM) improved therapeutic outcomes. No pharmacotherapies have been approved for the management of cannabis use, cannabis use disorders or cannabis withdrawal. Despite only weak evidence to support the use of pharmacological agents, some are used 'off-label' to manage withdrawal symptoms outside clinical trials.
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Affiliation(s)
- Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.
- School of Psychology, The University of Queensland, St Lucia, Australia.
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Côté J, Chicoine G, Vinette B, Auger P, Rouleau G, Fontaine G, Jutras-Aswad D. Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies. J Med Internet Res 2024; 26:e55031. [PMID: 38630515 PMCID: PMC11063887 DOI: 10.2196/55031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/09/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. OBJECTIVE We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. METHODS We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. RESULTS Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001). CONCLUSIONS Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. TRIAL REGISTRATION PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.
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Affiliation(s)
- José Côté
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Gabrielle Chicoine
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Billy Vinette
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Patricia Auger
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Guillaume Fontaine
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Didier Jutras-Aswad
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Blair AL, Clawson AH, Keirns NG, Mullins LL, Chaney JM, Cole AB. The Moderating Role of Health Status on the Association Between Depressive Symptoms and Cannabis Vaping. CANNABIS (ALBUQUERQUE, N.M.) 2024; 6:127-145. [PMID: 38883281 PMCID: PMC11178062 DOI: 10.26828/cannabis/2023/000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Objective Cannabis vaping is increasing among college students. There is little information on risk factors for vaping cannabis. Consistent with the self-medication hypothesis, experiencing depressive symptoms and having a chronic medical condition (CMC) are associated with cannabis use among young adults. Individuals who experience both risk factors may be at higher risk for cannabis vaping. This study examined cross-sectional associations between depressive symptoms, CMC status, and cannabis vaping, and identified the moderating role of CMC status on depressive symptoms and cannabis vaping. Method College students (N = 3,742) self-reported on depressive symptoms, CMC status, and lifetime and current cannabis vaping (i.e., cannabis vaporizers; electronic nicotine devices to use cannabis). Data were collected Fall 2017 until Spring 2021. The sample was predominantly female (70.9%) and White (75.4%). Regression analyses were used. Results Greater depressive symptoms were related to increased likelihood of cannabis vaping across outcomes. Having a CMC was related to lifetime history of cannabis vaporizing. CMC status moderated the associations between depressive symptoms and lifetime cannabis vaporizing. Depressive symptoms were only a risk factor for cannabis vaporizing among college students without a CMC, not those with a CMC. Conclusions Interventions that teach adaptive ways of coping with depressive symptoms and the potential demands of managing a CMC in college are needed. Comprehensive programs for college students, with and without CMCs, are needed to support those with comorbid depression and cannabis vaping use.
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Affiliation(s)
- Alexandra L Blair
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
- Department of Psychology, Oklahoma State University
| | - Ashley H Clawson
- Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences
| | - Natalie G Keirns
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, RI
- Department of Medicine, Warren Alpert Medical School of Brown University
| | - Larry L Mullins
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
- Department of Psychology, Oklahoma State University
| | - John M Chaney
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
- Department of Psychology, Oklahoma State University
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Shipley JL, Braitman AL. Assessment of simultaneous alcohol and cannabis use and its related consequences and cognitions in college students: A narrative review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:230-240. [PMID: 38212143 DOI: 10.1111/acer.15258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
As rates of students using cannabis continue to rise, simultaneous use of alcohol and cannabis (such that their effects overlap; commonly referred to as simultaneous alcohol and marijuana [SAM] use) is prevalent among college students who use both substances. Although research focusing on SAM use and related cognitions and consequences continues to grow, there are no common established measures, as approaches vary across studies. This narrative review identifies current methods for assessing SAM use and measures of SAM-related consequences and cognitions (motives and expectancies) among college students, evaluates how they were developed, identifies gaps in the literature, and provides recommendations for future directions of assessment. We conclude that the assessment of SAM use is limited by difficulties in the assessment of cannabis quantity and potency. However, and the lack of a psychometrically validated measure of SAM consequences. However, measures of SAM motives and expectancies have been published with support from psychometric examinations such as exploratory factor analysis, confirmatory factor analysis, and measurement invariance. Research is needed that incorporates qualitative approaches in the development of SAM use measures so that unique items specific to SAM use rather than single-substance use can be identified. Additionally, validation of these measures is needed across different samples that vary demographically, such as by race and gender or sex. Future research should consider the development of a measure of protective behavioral strategies specific to SAM use to inform interventions that target the reduction of negative consequences of SAM use.
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Affiliation(s)
- Jennifer L Shipley
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Abby L Braitman
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
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8
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Affiliation(s)
- David A Gorelick
- From the Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore
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9
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Calihan JB, Levy S. Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics. Psychiatr Clin North Am 2023; 46:749-760. [PMID: 37879836 DOI: 10.1016/j.psc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.
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Affiliation(s)
- Jessica B Calihan
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sharon Levy
- Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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Bonar EE, Goldstick JE, Tan CY, Bourque C, Carter PM, Duval ER, McAfee J, Walton MA. A remote brief intervention plus social media messaging for cannabis use among emerging adults: A pilot randomized controlled trial in emergency department patients. Addict Behav 2023; 147:107829. [PMID: 37598642 DOI: 10.1016/j.addbeh.2023.107829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Interventions addressing cannabis use among emerging adults (ages 18-25) are currently needed to prevent negative outcomes. Emergency Department (ED) visits provide an opportunity to initiate interventions. In this pilot study, we created a brief intervention (BI), extended with private social media messaging for emerging adult ED patients who use cannabis regularly. Study aims were to examine intervention feasibility, acceptability, and descriptive outcomes. METHODS We recruited and randomized N = 58 emerging adults (M age 21.5 years, 65.5% female) who used cannabis from an ED in-person and remotely after their ED visit (given COVID-19 restrictions). Participants randomized to the intervention (N = 30) received a Motivational Interviewing-based BI and 4 weeks of health coaching via private social media; control participants received a resource brochure and entertaining social media messaging. Follow-ups occurred at 1-month and 3-months. RESULTS Most intervention participants liked the BI (95.8%), found it helpful to discuss cannabis use in the BI (91.7%), and liked interacting with coaches on social media (86.3%). Social media content (e.g., video clips, images/still pictures/memes) were highly rated. Descriptively, the intervention group showed theory-consistent changes in importance of and intentions to change cannabis (increases vs. decrease/stability in control group), whereas findings for cannabis consumption/consequences were mixed. CONCLUSIONS This BI paired with social media messaging was acceptable in a sample of emerging adults from an ED who used cannabis regularly. Despite feasibility challenges due to COVID-19, this intervention warrants future investigation with a larger sample and longer follow-up period, with attention to the changing cannabis landscape when measuring outcomes.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA.
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Burlington Building, 325 E. Eisenhower Parkway, Ann Arbor, MI 48108, USA.
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
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Langwerden RJ, Morris SL, Fernandez SB, Contreras-Pérez ME, Hospital MM, Wagner EF. Preliminary Effects of a Guided Self-Change Intervention on Perceived Risk and Self-Efficacy in University Students Engaging in Cannabis or Alcohol Misuse. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:127-138. [PMID: 38035169 PMCID: PMC10683752 DOI: 10.26828/cannabis/2023/000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Guided Self-Change (GSC) is a Motivational Interviewing (MI)-based early intervention program, infused with Cognitive Behavioral Therapy (CBT), for individuals with substance use problems. In this study, we implemented a 4-session GSC program with the innovative addition of mindfulness-based techniques at a minority-serving institution to reduce substance use and negative consequences among self-referred university students. We investigated processes that may be associated with behavior change, including perceived risk of use and self-efficacy ratings among university students who reported their primary substance of choice was cannabis (n = 18) or alcohol (n = 18). The sample of 36 participants (Mage = 24.4, SDage = 5, range 18-37) mostly identified as female (58.3%), then male (41.7%); 52.8% identified as Hispanic/Latine, 22.2% as Black or African American, and 19.5% as a sexual minority. Among cannabis primary using students, results indicated that the perceived risk of weekly cannabis use, confidence to change, and readiness to change showed statistically significant increases from pre- to post-assessment. Among alcohol primary using students, confidence to change and readiness to change showed statistically significant increases from pre- to post-assessments. All results yielded large effect sizes, which may be inflated due to the small sample size. Findings suggest that over the course of participation in a brief, 4-session targeted GSC program, there were significant increases in perceived risk and self-efficacy among minority university students who engage in primary cannabis or primary alcohol use.
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Affiliation(s)
- Robbert J Langwerden
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - Staci L Morris
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
| | - Sofia B Fernandez
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
| | - María Eugenia Contreras-Pérez
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
| | - Michelle M Hospital
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Eric F Wagner
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
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12
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Davis AK, Arterberry BJ, Xin Y, Hubbard SM, Schwarting CM, Bonar EE. Incremental Predictive Validity of the Dualistic Model of Passion for Cannabis Use Among College Undergraduate Students With and Without a Cannabis Use Disorder. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:105-126. [PMID: 38035170 PMCID: PMC10683744 DOI: 10.26828/cannabis/2023/000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Introduction We examined whether the Dualistic Model of Passion (DMP; i.e., obsessive passion [OP] and harmonious passion [HP]) for cannabis use was prospectively associated with cannabis use and use-related outcomes, and with academic performance, relationship attachment style, and social connectedness among college students. We also explored whether the DMP was associated with outcomes when included in a model using established constructs (e.g., coping motives, refusal self-efficacy, cannabis use disorder [CUD] symptoms) as predictors of cannabis use and outcomes. Methods Using a longitudinal cohort design (baseline, 5-month, 10-month [timepoints chosen to better correspond to 9-month academic year]), 513 undergraduate students from two universities who reported using cannabis at least four times in the past month completed a baseline survey (308 meeting criteria for CUD). We used Generalized Estimating Equations to assess longitudinal associations between OP/HP and cannabis use and academic/social outcomes at 5-month and 10-month. Results At baseline, participants were young adults (Mean age = 20.57, SD = 2.51), 78.8% non-Hispanic, 83.8% White, 55.0% female, and 72.3% heterosexual. Greater HP was not associated with greater past month cannabis use or cannabis-related problems. Greater OP was associated with greater past month cannabis use and more cannabis-related problems. There were no significant passion by time interactions. Greater HP was associated with more anxious attachment. OP was associated with less social connection. Conclusion This research suggests that the DMP provides novel information about factors associated with cannabis use and use-related consequences, which can aid in our understanding of cannabis use, misuse, and CUD among college students.
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Affiliation(s)
- Alan K Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University. Columbus, OH USA
- Institute for Population Research, University of Michigan, Ann Arbor, MI USA
| | - Brooke J Arterberry
- Institute for Population Research, University of Michigan, Ann Arbor, MI USA
- Department of Psychology, Iowa State University, Ames, IA USA
| | - Yitong Xin
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University. Columbus, OH USA
| | | | | | - Erin E Bonar
- University of Michigan - Department of Psychiatry; Ann Arbor, MI, USA
- University of Michigan - Addiction Center; Ann Arbor, MI, USA
- University of Michigan - Injury Prevention Center; Ann Arbor, MI, USA
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13
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Shekhawat AS, Mathur R, Sarkar S, Kaloiya GS, Balhara YPS. A randomized controlled trial of brief intervention for patients with cannabis use disorder. J Neurosci Rural Pract 2023; 14:710-716. [PMID: 38059244 PMCID: PMC10696312 DOI: 10.25259/jnrp_79_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/29/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Effective interventions for cannabis use disorders are fairly limited. The present randomized controlled trial (RCT) aimed to compare the reduction in cannabis use (number of days cannabis used) with brief intervention and simple advice in patients with cannabis use disorder. Materials and Methods This non-blinded and parallel two-group RCT included 100 male patients with cannabis use disorder. A semi-structured pro forma and severity of dependence scale (SDS) were used. Participants were then randomized to either of the two arms (brief intervention and simple advice) in a 1:1 ratio. Cannabis use patterns and SDS scores were assessed over the phone at week 4, week 8, and week 12. Results The two groups were comparable in sociodemographics and cannabis use characteristics. Participants in both groups were using cannabis for 30 days in the past month before enrolment. The brief intervention group had a lesser number of days of cannabis use vis-a-vis the simple advice group at 4, 8, and 12 weeks. There was a significant time effect for change in SDS scores (F = 30.629, P < 0.001), but the group effect was not significant (F = 0.379, P = 0.541). Conclusion In this population of regular cannabis users, brief intervention may be useful in reducing cannabis usage. It can be integrated into routine assessments and management of those with regular use of cannabis.
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Affiliation(s)
- Anil Singh Shekhawat
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rahul Mathur
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Gauri Shanker Kaloiya
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, Delhi, India
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14
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Wilkinson ML, Linden-Carmichael AN. Reasons for not drinking among young adults with simultaneous alcohol and cannabis use: A latent class analysis applied to daily diary data. Addict Behav 2023; 145:107780. [PMID: 37354848 PMCID: PMC10350901 DOI: 10.1016/j.addbeh.2023.107780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
Simultaneous alcohol and cannabis use (i.e., simultaneous use) is prevalent among young adults and often associated with negative consequences. Understanding reasons for not drinking (RND) may provide insight into a key intervention target for reducing negative consequences associated with simultaneous use. RND may vary on a day-to-day level, and multiple RND may be endorsed on a given day. Latent class analysis (LCA) of daily diary data is a nuanced approach that can identify complex patterns of daily RND as well as its day- and person-level covariates. The current study was a secondary data analysis of daily diary data from young adults who engaged in heavy drinking and recent simultaneous use (n = 154). We aimed to: (1) characterize daily RND, (2) use LCA to classify day-level patterns of RND, and (3) compare latent classes on same-day variables (i.e., positive and negative affect, day of the week), previous-day variables (i.e., substance use, intoxication level, consequences), and person-level characteristics (i.e., age, sex, baseline substance use frequency, simultaneous use motives). Participants completed up to 14 consecutive diaries. Multilevel LCA identified four classes of heterogeneous daily RND profiles. Daily RND classes significantly differed in terms of day of the week, previous day quantity of cannabis use, and several baseline variables (age, typical substance use, simultaneous use motives). Study findings offer preliminary support for heterogeneous RND classes among young adults engaging in simultaneous use and suggest multiple avenues for future research.
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Affiliation(s)
- M L Wilkinson
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA; Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA.
| | - A N Linden-Carmichael
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
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15
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Vidal C, Alvarez P, Hammond CJ, Lilly FRW. Cannabis Use Associations with Adverse Psychosocial Functioning among North American College Students. Subst Use Misuse 2023; 58:1771-1779. [PMID: 37584421 DOI: 10.1080/10826084.2023.2247075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Introduction: Adolescent-onset cannabis use (CU) (before age 18) is associated with multiple adverse psychosocial outcomes, but rates of CU peak between the ages of 18 and 22, coinciding with college matriculation. Whether CU among college-enrolled young adults is associated with similar psychosocial outcomes is poorly understood. In the present study, we examined relationships between CU and multiple psychosocial outcomes in North American college students. Methods: Data for this report come from N = 40,250 North American college students ages 18-to-25 years (mean age = 20.7 years, 69% female, 66% Caucasian) who participated in the Healthy Minds Study (HMS) 2016-17. HMS is a web-based annual survey querying multiple mental health, substance use, and psychosocial variables in representative student populations from 53 universities across North America. Student respondents were stratified in two groups based upon their self-report of past 30-day CU and compared on psychosocial variables. Results: Approximately 20% (n = 8,327) of student respondents reported past 30-day CU. After adjusting for socio-demographics, knowledge of campus services, and use of other drugs, the odds of depression (aOR = 1.3), suicidal thoughts and behaviors (aORs ∼1.4-1.7), anxiety (aOR = 1.2), eating disorders (aOR = 1.2), and violence victimization (aOR = 1.4) were all higher for CU students. Additionally, CU students had higher rates of other drug use and lower rates of perceived supportive relationships. Conclusion: Our results indicated that CU is common among North American college students and associated with adverse psychosocial consequences across multiple domains. Based upon these findings, colleges should consider expanding educational, prevention, and early-intervention programs for students who use cannabis.
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Affiliation(s)
- Carol Vidal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patty Alvarez
- University of Maryland Graduate School, Baltimore, MD, USA
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16
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Bou Nassif Y, Rahioui H, Varescon I. Psychological Interventions for Cannabis Use among Adolescents and Young Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6346. [PMID: 37510578 PMCID: PMC10380066 DOI: 10.3390/ijerph20146346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
Regular cannabis use during adolescence can lead to cognitive, psychological, and social consequences, causing significant distress. Although psychological interventions are the mainstay type of treatment for cannabis use disorder, the results remain mixed among youths. The objective of this review is twofold: to identify the existing psychological interventions for cannabis use among youths, and to assess the evidence regarding the effectiveness of those interventions. Randomized controlled trials focused exclusively on cannabis use among adolescents and young adults were included. Three databases-Embase, PsycInfo, and PubMed-were searched to identify relevant peer-reviewed manuscripts published before February 2022 in English and French. The risk of bias was assessed using the Cochrane Collaboration's tool. Twenty-five randomized controlled trials were included. Fourteen studies reported a significant outcome related to cannabis use. These were mainly non-intensive, online interventions that aimed to improve the patients' relationships and emotion regulation. This review highlights the need to conduct additional randomized control trials that target cannabis use disorder specifically among adolescents. These randomized control trials should also aim to reduce the risk of bias related to psychiatric comorbidities as well as detection and attrition problems.
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Affiliation(s)
- Yara Bou Nassif
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 92100 Boulogne Billancourt, France
- Consultations en Addictologie pour Adolescent, Centre des Troubles de Neuro-Développement chez l'Adulte, Groupe Hospitalier Universitaire, Site Sainte-Anne, 75014 Paris, France
| | - Hassan Rahioui
- Consultations en Addictologie pour Adolescent, Centre des Troubles de Neuro-Développement chez l'Adulte, Groupe Hospitalier Universitaire, Site Sainte-Anne, 75014 Paris, France
| | - Isabelle Varescon
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 92100 Boulogne Billancourt, France
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17
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Coughlin LN, Bonar EE, Wieringa J, Zhang L, Rostker MJ, Augustiniak AN, Goodman GJ, Lin LA. Pilot trial of a telehealth-delivered behavioral economic intervention promoting cannabis-free activities among adults with cannabis use disorder. J Psychiatr Res 2023; 163:202-210. [PMID: 37224772 DOI: 10.1016/j.jpsychires.2023.05.012] [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: 01/16/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cannabis is increasingly consumed and increasingly perceived as harmless. Among those whose use develops into a cannabis use disorder (CUD), <5% initiate and engage in treatment. Thus, novel options for low-barrier, appealing treatments are needed to foster engagement in care. METHODS We conducted an open trial of a telehealth-delivered multicomponent behavioral economic intervention for non-treatment-engaged adults with CUD. Participants with CUD were recruited from a health system and screened for eligibility. Participants completed behavioral economic indices (cannabis demand, proportionate cannabis-free reinforcement), measures of cannabis use and mental health symptoms, and provided open-ended feedback on the intervention experience. RESULTS Of the 20 participants who enrolled and engaged in the initial intervention session, 70% (14 out of 20) completed all intervention components. All participants were satisfied/very satisfied with the intervention and 85.7% reported the telehealth delivery made it at least slightly easier/more likely for them to receive substance use care. Baseline to immediate post-treatment, behavioral economic cannabis demand decreased (intensity: Hedges' g = 0.14, maximum total expenditure: Hedges' g = 0.53, maximum expenditure for a single hit: Hedges' g = 0.10) and proportionate cannabis-free reinforcement (Hedges' g = 0.12) increased. Past-month total cannabis use decreased by 8.9% from baseline to post-treatment (Hedges' g = 0.39), along with decreases in recent depression (Hedges' g = 0.50) and anxiety symptoms (Hedges' g = 0.29). DISCUSSION These preliminary findings suggest that this behavioral economic intervention was highly acceptable and feasible for adults with untreated CUD. Changes in potential mechanisms of behavior change (cannabis demand, proportionate cannabis-free reinforcement) were consistent with reduced frequency of cannabis use and improved mental health outcomes.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joshua Wieringa
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lan Zhang
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Matthew J Rostker
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Alyssa N Augustiniak
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Grant J Goodman
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, 48109, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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18
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Crocker CE, Emsley J, Tibbo PG. Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate? Front Psychiatry 2023; 14:1093081. [PMID: 37304435 PMCID: PMC10247977 DOI: 10.3389/fpsyt.2023.1093081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have previously reviewed the types and numbers of cannabis-associated adverse events that have mental health presentations that are encountered in the Emergency Department. A particular challenge in examining these events is disentangling cannabis use adverse events from adverse events associated with use of multiple recreational substances. Since that review was published, cannabis legalization for recreational use has greatly expanded world-wide and with these changes in the legal climate has come clearer information around the frequency of adverse events seen in the Emergency Department. However, as we examined the current state of the literature, we also examined some of research designs and the biases that may be impacting the validity of the data in this field. The biases both of clinicians and researchers as well as research approaches to studying these events may be impacting our ability to assess the interaction between cannabis and mental health. For example, many of the studies performed examining cannabis-related admissions to the Emergency Department were administrative studies that relied on front line clinicians to identify and attribute that cannabis use was associated with any particular admission. This narrative review provides an overview on what we currently know about mental health adverse events in the Emergency Department with a focus on the mental health impacts both for those with and without a history of mental illness. The evidence that cannabis use can adversely impact genders and sexes differently is also discussed. This review outlines what the most common adverse events related to mental health with cannabis use are; as well as noting the most concerning but much rarer events that have been reported. Additionally, this review suggests a framework for critical evaluation of this field of study going forward.
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Affiliation(s)
- Candice E. Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Jason Emsley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- IWK Children’s Health Centre, Halifax, NS, Canada
| | - Philip G. Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Nova Scotia Health, Halifax, NS, Canada
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19
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Elam KK, Mun CJ, Connell A, Ha T. Coping strategies as mediating mechanisms between adolescent polysubstance use classes and adult alcohol and substance use disorders. Addict Behav 2023; 139:107586. [PMID: 36610287 PMCID: PMC10075236 DOI: 10.1016/j.addbeh.2022.107586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Adolescent polysubstance use is a robust predictor of substance use in adulthood and can be exacerbated by poor coping with stress over time. We examined whether latent classes of adolescents' polysubstance use predicted alcohol use disorder and substance use disorder diagnoses in adulthood via multiple stress coping strategies. Self-reported frequency of past 3-month alcohol, tobacco, and marijuana use in 792 adolescents (aged 16/17) were used to form latent classes of polysubstance use. Self-reported aggressive, reactive, substance use and cognitive coping strategies (ages 18/19, 22/23, 23/24) were examined as multiple mediators of polysubstance use classes and alcohol use disorder and substance use disorder in adulthood (age 26/27) controlling for demographic covariates. Latent class analysis resulted in High, Experimental, and Low polysubstance use classes. Those in high and experimental polysubstance use classes, compared to those in the low polysubstance use class, had greater use of aggressive and reactive coping strategies, which respectively predicted greater substance use disorder and alcohol use disorder in adulthood. Across all comparisons (high vs low, experimental vs low, and high vs experimental), higher polysubstance use was associated with greater substance use coping, which predicted both alcohol and substance use disorder. Greater polysubstance use, even experimental use, in adolescence is a significant risk factor for developing alcohol use disorder and substance use disorder in adulthood and this occurs, in part, via maladaptive stress coping strategies.
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Affiliation(s)
- Kit K Elam
- Department of Applied Health Science, Indiana University, 1025 E. 7(th) St., Suite 116, Bloomington, IN 47405, United States.
| | - Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States
| | - Arin Connell
- Department of Psychological Sciences, Case Western Reserve University, United States
| | - Thao Ha
- Department of Psychology, Arizona State University, United States
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20
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Gutkind S, Shmulewitz D, Hasin D. Sex differences in Cannabis use disorder and associated psychosocial problems among US adults, 2012-2013. Prev Med 2023; 168:107422. [PMID: 36641126 PMCID: PMC9974921 DOI: 10.1016/j.ypmed.2023.107422] [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: 08/01/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
While men show greater prevalence of cannabis use disorder (CUD) than women, whether cannabis use frequency drives this difference is unknown, and little is known about sex differences in problems associated with CUD. We therefore assessed the association of CUD with sex, adjusted for frequency of use, and compared the association of psychosocial and health-related problems with CUD between men and women. We included US adults age ≥ 18 who reported past-year cannabis use in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3701). Cannabis use frequency, DSM-5 CUD and problems (interpersonal, financial, legal, health-related) were assessed. Associations between psychosocial problems, sex and DSM-5 CUD were assessed using prevalence differences (PD) and 95% confidence intervals (CI) from logistic regression models, controlling for demographics and cannabis use frequency, and effect modification by sex was assessed. We found that the prevalence of CUD among men versus women was not significantly greater after adjusting for use frequency. Women had significantly higher prevalence of interpersonal, financial and health-related problems than men, adjusting for frequency of use. Women showed significantly greater association of CUD with interpersonal problems with a boss or co-workers (p < 0.05) and a neighbor, relative or friend (p < 0.05) compared to men. Lack of sex differences in CUD after adjusting for frequency of use suggests use frequency may be an important target of CUD prevention efforts. CUD showed stronger associations for interpersonal problems among women than men, suggesting the need for particular emphasis on treating interpersonal problems related to cannabis use among women.
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Affiliation(s)
- Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Dvora Shmulewitz
- Columbia University, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
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21
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Gette JA, Regan T, Schumacher JA. Screening, brief intervention, and referral to treatment (SBIRT) for cannabis: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208957. [PMID: 36880902 DOI: 10.1016/j.josat.2023.208957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/04/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Screening, brief intervention, and referral to treatment (SBIRT) has been used to change substance use behavior. Despite cannabis being the most prevalent federally illicit substance, we have limited understanding of use of SBIRT for managing cannabis use. This review aimed to summarize the literature on SBIRT for cannabis use across age groups and contexts over the last two decades. METHODS This scoping review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Scoping Reviews and Meta-Analyses) statement. We gathered articles from PsycINFO, PubMed, Sage Journals Online, ScienceDirect, and SpringerLink. RESULTS The final analysis includes forty-four articles. Results indicate inconsistent implementation of universal screens and suggest screens assessing cannabis-specific consequences and utilizing normative data may increase patient engagement. Broadly, SBIRT for cannabis demonstrates high acceptability. However, the impact of SBIRT on behavior change across various modifications to intervention content and modality has been inconsistent. In adults, patients with primary cannabis use are not engaging in recommended treatment at similar rates to other substances. Results also suggest a lack of research addressing referral to treatment in adolescents and emerging adults. DISCUSSION Based on this review, we offer several to improve each component of SBRIT that may increase implementation of screens, effectiveness of brief interventions, and engagement in follow-up treatment.
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Affiliation(s)
- J A Gette
- Center for Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, Piscataway, NJ, United States of America.
| | - T Regan
- Department of Psychiatry, the University of Mississippi Medical Center, Jackson, MS, United States of America
| | - J A Schumacher
- Department of Psychiatry, the University of Mississippi Medical Center, Jackson, MS, United States of America
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22
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Fontana TJK, Schulz JA, Budney AJ, Villanti AC. Feasibility and utility of a structured guide for cannabis tolerance breaks in young adults. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-5. [PMID: 36595624 PMCID: PMC10315416 DOI: 10.1080/07448481.2022.2155061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/02/2022] [Accepted: 10/07/2022] [Indexed: 06/17/2023]
Abstract
Objective: To explore the feasibility and utility of a tolerance break (T-Break) guide on young adults' cannabis use. Participants: Young adults aged 18-29 (n = 125) who were current cannabis users. Methods: Participants recruited through posters and listservs at various universities were offered the T-Break Guide-daily activities, advice, and encouragement-to help complete a 21-day cannabis break. Bivariate analyses examined associations between Guide use and follow-up measures. Results: Compared to non-Guide users, participants who used the Guide "a lot" were more likely to complete the 21-day abstinence break (84% vs. 57%), revise their personal definition of balance to mean less cannabis (84% vs. 62%), and plan a future break (32% vs. 11%). Conclusion: Use of this self-directed T-Break Guide may help young adults take a break from cannabis use and reduce future use. Further research using more rigorous designs to test the Guide's efficacy and assess longer-term maintenance of effects is needed.
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Affiliation(s)
- Thomas J K Fontana
- Center for Health & Wellbeing, University of Vermont, Burlington, VT, USA
| | - Jonathan A Schulz
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health and Rutgers Center for Tobacco Studies, New Brunswick, NJ, USA
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23
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Calihan JB, Levy S. Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics. Child Adolesc Psychiatr Clin N Am 2023; 32:115-126. [PMID: 36410898 DOI: 10.1016/j.chc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.
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Affiliation(s)
- Jessica B Calihan
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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Bonar EE, Chapman L, Pagoto S, Tan CY, Duval ER, McAfee J, Collins RL, Walton MA. Social media interventions addressing physical activity among emerging adults who use cannabis: A pilot trial of feasibility and acceptability. Drug Alcohol Depend 2023; 242:109693. [PMID: 36442441 DOI: 10.1016/j.drugalcdep.2022.109693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Cannabis use is common among emerging adults (ages 18-25), yet few prevention interventions have targeted this unique developmental period. Physical activity (PA) is an under-utilized intervention target for cannabis use, despite research showing its potential utility. Based on prior promising social media-delivered interventions targeting cannabis and PA separately, we developed and piloted, in a randomized controlled feasibility trial (NCT04901910), interventions for emerging adults who use cannabis that focused on PA. PROCEDURES Using social media, we recruited 60 emerging adults (Mean age=21.7 years; 63.3% female sex) who used cannabis (>=3 times/week for the past month) and could engage in PA. We randomized participants into one of 3 conditions (PA-Only; PA+Cannabis, Attention-Control) that each lasted 8 weeks and were delivered in secret Facebook groups by health coaches. We collected follow-up data at 3- and 6-months post-group start. Outcomes are presented descriptively given the pilot nature and limited sample size. RESULTS The interventions were rated favorably, with ratings of the content in each condition averaging around 3 on a 5-point scale. Both intervention groups demonstrated larger reductions in cannabis consequences and cannabis-impaired driving over time than the control condition. Findings were mixed regarding patterns of change in cannabis use in the intervention conditions. Proportions of group members reporting increased PA ranged from 38.9% to 80.0% across time. CONCLUSIONS Interventions targeting PA and delivered via social media to emerging adults who regularly use cannabis offer a novel intervention target. These interventions warrant future investigation in larger trials over a longer follow-up period.
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Affiliation(s)
- Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.
| | - Lyndsay Chapman
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06268, USA
| | - Chiu Yi Tan
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Back and Pain Center, 325. E. Eisenhower Parkway, Building 1, Ann Arbor, MI 48108, USA
| | - R Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Chazal C, Roux C, Kinouani S, Schuers M, Fortin F, Pereira B, Blanc O, Piñol-Domenech N, Brousse G, Vorilhon P, Laporte C. Effectiveness of brief interventions in primary care for cannabis users aged from 12 to 25 years old: a systematic review. Fam Pract 2022; 39:1156-1168. [PMID: 35696124 DOI: 10.1093/fampra/cmac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of this systematic review was to assess the effectiveness of brief interventions realized in primary care in reducing cannabis use for adolescents and emerging adults. METHODS PubMed, CINAHL, Embase, PsycInfo, and Central (Cochrane Library) were searched until December 2020. Randomized controlled trials conducted in primary care, concerning in-person brief interventions for non-medical cannabis users aged from 12 to 25 years old were eligible for inclusion. Brief interventions had to last 30 min or less. Patients with comorbid mental health disorder or very specific populations were not included. RESULTS One thousand eighty hundred and fifty-five studies were identified through database searching; only 8 studies involving 2,199 patients were included for qualitative synthesis after double reading and data extraction. Randomized controlled trials selected were heterogeneous regarding screening tools, initial levels of cannabis use and cannabis outcomes measures. Brief interventions were all based on motivational interviewing techniques or personalized feedback. Seven studies consisted in a single session of brief intervention. Six studies involved also other substance users. No significant reduction of cannabis use after brief intervention was found for most studies, especially in the long term. A trend of decreased cannabis consequences, such as negative psychosocial repercussions, perception of cannabis use by peers, or driving under the influence of cannabis, was reported. CONCLUSION The current state of knowledge does not allow us to say that the brief intervention is effective in reducing cannabis use among adolescents in primary care. We found a mild positive effect on cannabis consequences after brief intervention. Mixed qualitative and quantitative studies are need to better evaluate the impact of brief intervention and his faisability. PROSPERO (International Prospective Register of Systematic Reviews): n° CRD42016033080.
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Affiliation(s)
- Camille Chazal
- Department of General Practice, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Charline Roux
- Department of General Practice, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Shérazade Kinouani
- Department of General Practice, University of Bordeaux, Bordeaux F-33000, France.,University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team HEALTHY, UMR 1219, Bordeaux, France
| | - Matthieu Schuers
- Department of General Practice, Normandie Univ, UNIROUEN, Rouen, France.,Department of Biomedical Informatics, CHU Rouen, Rouen, France.,Sorbonne Université, LIMICS U1142, Paris, France
| | - Frédéric Fortin
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics Unit, Direction de la Recherche Clinique, Clermont-Ferrand, France
| | - Olivier Blanc
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
| | | | - Georges Brousse
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Service of Psychiatry B, Clermont-Ferrand, France
| | | | - Catherine Laporte
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
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Teeters JB, Armstrong NM, King SA, Hubbard SM. A randomized pilot trial of a mobile phone-based brief intervention with personalized feedback and interactive text messaging to reduce driving after cannabis use and riding with a cannabis impaired driver. J Subst Abuse Treat 2022; 142:108867. [PMID: 36007434 PMCID: PMC10810297 DOI: 10.1016/j.jsat.2022.108867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 07/27/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Driving after cannabis use (DACU) and riding with a cannabis-impaired driver (RWCD) are national public health concerns. Though driving impairments and increased crash risk make DACU and RWCD two of the riskiest cannabis-related behaviors, many continue to drive after use and ride with others who are under the influence and do not view DACU or RWCD as dangerous. The current study examined the efficacy of an accessible, low-cost, mobile phone-based brief intervention aimed at reducing DACU and RWCD among college cannabis users in the context of a randomized three-group pilot trial. METHOD Participants were 97 college cannabis users (67.4 % women; average age = 21.34; 80.4 % Caucasian) who endorsed DACU at least three times in the past three months. After completing baseline measures, the study randomly assigned participants to one of three conditions: a) a substance impaired-driving personalized feedback plus MI-style interactive text messaging intervention (PF + MIT); b) a substance impaired-driving personalized feedback only intervention (PF); and c) a substance information control condition (IC). All conditions completed outcome measures three months postintervention. RESULTS Generalized linear mixed models (GLMM) analyses indicated that after controlling for sex, cannabis users in the PF + MIT condition significantly reduced DACU and RWCD over time compared to those in the IC condition. CONCLUSIONS These findings provide preliminary support for the short-term efficacy of a mobile phone-based intervention in decreasing DACU and RWCD among college cannabis users. Future research should determine whether these reductions in driving behaviors persist past three months.
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Affiliation(s)
- Jenni B Teeters
- Psychological Sciences Department, Western Kentucky University, United States of America.
| | - Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States of America
| | - Shelby A King
- Psychology Department, East Tennessee State University, United States of America
| | - Sterling M Hubbard
- Counseling Psychology Department, Iowa State University, United States of America
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Kreski NT, Cerdá M, Chen Q, Hasin DS, Martins SS, Mauro PM, Olfson M, Keyes KM. Adolescents' Use of Free Time and Associations with Substance Use from 1991 to 2019. Subst Use Misuse 2022; 57:1893-1903. [PMID: 36127772 PMCID: PMC9746067 DOI: 10.1080/10826084.2022.2115849] [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] [Indexed: 12/15/2022]
Abstract
Background: Understanding time trends in risk factors for substance use may contextualize and explain differing time trends in substance use. Methods: We examined data (N = 536,291; grades 8/10/12) from Monitoring the Future, years 1991-2019. Using Latent Profile Analyses, we identified six time use patterns: one for those working at a paid job and the other five defined by levels of socialization (low/high) and engagement in structured activities like sports (engaged/disengaged), with the high social/engaged group split further by levels of unsupervised social activities. We tested associations between time use profiles and past two-week binge drinking as well as past-month alcohol use, cigarette use, cannabis use, other substance use, and vaping. We examined trends and group differences overall and by decade (or for vaping outcomes, year). Results: Prevalence of most substance use outcomes decreased over time among all groups. Cannabis use increased, with the largest increase in the group engaged in paid employment. Vaping substantially increased, with the highest nicotine vaping increase in the high social/engaged group with less supervision and the highest cannabis vaping increase in the highly social but otherwise disengaged group. Substance use was lowest in the low social groups, highest in the high social and employed groups. Conclusions: While alcohol, cigarette, and other substance use have declined for all groups, use remained elevated given high levels of social time, especially with low engagement in structured activities or low supervision, or paid employment. Cannabis use and vaping are increasing across groups, suggesting the need for enhanced public health measures.
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Affiliation(s)
- Noah T Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Identifying risk-thresholds for the association between frequency of cannabis use and development of cannabis use disorder: A systematic review and meta-analysis. Drug Alcohol Depend 2022; 238:109582. [PMID: 35932748 DOI: 10.1016/j.drugalcdep.2022.109582] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cannabis use disorder (CUD) affects one-in-five cannabis users, presenting a major contributor to cannabis-associated disease burden. Epidemiological data identify the frequency of cannabis use as a risk factor for CUD. This review aimed to determine quantifiable risk-thresholds of the frequency of cannabis use for developing CUD. METHODS Systematic search of Medline, EMBASE, PsycInfo, CINAHL, and Web of Science for cohort/case-control studies that assessed the association between frequency of cannabis use and CUD from 2000 to 2022. Effect estimates were converted to risk ratios (RR). A random-effects multi-level multivariate meta-analytic approach was utilized, and sensitivity analyses conducted. Quality of included studies was assessed with the Newcastle Ottawa Scale. RESULTS Six prospective cohort studies were included in this review, drawn from two main source studies. Random-effect modeling showed a significant log-linear dose-response association between the frequency of cannabis use and CUD risk (p < 0.0001). The risk of CUD increased from RR:2.03 (95% CI:1.85-2.22) for 'yearly' use, to RR:4.12 (95% CI:3.44-4.95) for 'monthly" use, RR:8.37 (95% CI:6.37-11.00) for 'weekly' use, and RR:16.99 (95% CI:11.80-24.46) for 'daily' use. Multi-level modeling showed an absolute risk increase (ARI) from 3.5% (95% CI:2.6-4.7) for 'yearly' use, to 8.0% (95% CI:5.3-12.1) for 'monthly' use, to 16.8% (95% CI:8.8-32.0) for 'weekly' use, and 36% (95% CI:27.047.9) for 'daily' use. CONCLUSION A limited risk of CUD as a potential outcome of cannabis use exists even at infrequent levels of use, but significantly increases as frequency of use increases. Corresponding information should be conveyed to cannabis users as part of targeted prevention messaging to promote safer cannabis use.
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Seabra P, Sequeira A, Filipe F, Amaral P, Simões A, Sequeira R. Substance Addiction Consequences: Outpatients Severity Indicators in a Medication-Based Program. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Carr M, Reddy V, Anderson JM, Weaver M, Hartwell M, Vassar M. Evaluating the relationship between industry sponsorship and conflicts of interest among systematic review authors on treatments for cannabis use disorder. Subst Abus 2022; 43:1180-1189. [PMID: 35617607 DOI: 10.1080/08897077.2022.2074598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Cannabis is the most commonly used illicit drug worldwide. In addition to potential adverse effects, an estimated 9% consistent cannabis users are likely to become dependent and may develop a cannabis use disorder (CUD). Methods: This cross-sectional study developed a search strategy using Ovid, MEDLINE, and Ovid Embase for systematic reviews and meta-analyses focused on CUD treatment in June 2020. These reviews were evaluated for conflicts of interest (COIs) per previously developed classification scheme. Our primary objectives were to (1) evaluate the presence of disclosed or undisclosed COI of systematic review authors, regarding treatment of CUD; and (2) determine whether overall summary effect estimates, narrative results and conclusions were influenced by the presence of disclosed or undisclosed COIs among systematic review authors. Results: Our systematic search returned 560 articles which 9 systematic reviews were eligible for data extraction. We found 77.8% (7/9) contained at least one author with a COI. From the 51 authors included, 29.4% (15/51) were found to have a COI. Forty-four percent (4/9) were funded, 22.2% (2/9) were not funded, and 33.3% (3/9) had no funding statements. Out of the 7 systematic reviews with one or more authors containing COI, 14.2% (1/7) included results favoring the treatment group and 28.6% (2/7) included conclusions favoring the treatment group. Our results showed no significance between funding source and results (p = 0.429) or conclusions. Additionally, we found no significance between the presence of COIs with the favorability of results (p = 0.56) or conclusions. Conclusion: Multiple studies favored the treatment of cannabis-containing products, even though COIs were found in the majority of the systematic reviews. COIs have the ability to sway results of a study, which can affect clinical decision-making. Stricter guidelines should be enforced among authors displaying COIs in systematic reviews studying CUD treatment.
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Affiliation(s)
- Marvin Carr
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Vaishnavi Reddy
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Office of Research, University of Tulsa, Tulsa, OK, USA
| | - J Michael Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Michael Weaver
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine, Joplin, MO, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Tanner-Smith EE, Parr NJ, Schweer-Collins M, Saitz R. Effects of brief substance use interventions delivered in general medical settings: a systematic review and meta-analysis. Addiction 2022; 117:877-889. [PMID: 34647649 PMCID: PMC8904275 DOI: 10.1111/add.15674] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/11/2021] [Indexed: 01/17/2023]
Abstract
AIMS To estimate effects of brief substance use interventions delivered in general medical settings. METHODS A systematic review and meta-analysis of randomized trials conducted since 1990 of brief substance use interventions in patients of any age or severity level recruited in general medical settings. Primary outcomes were any measure of substance use or substance-related consequences (indexed with Hedges' g and risk ratios). Mixed-effects meta-regressions were used to estimate overall effects and predictors of effect variability. Analyses were conducted separately by brief intervention (BI) target substance: alcohol only or drugs. FINDINGS A total of 116 trials (64 439 participants) were identified; 111 (62 263 participants) provided effect size data and were included in the meta-analysis. Drug-targeted BIs yielded significant small improvements in multiple drug/mixed substance use (Hedges' g (g¯ ) = 0.08; 95% CI = 0.002, 0.15), but after adjusting for multiple comparisons, they did not produce significant effects on cannabis use ( g¯ = 0.06; 95% CI = 0.001, 0.12), alcohol use ( g¯ = 0.08; 95% CI = -0.0003, 0.17), or consequences ( g¯ = 0.05; 95% CI = 0.01, 0.10). Drug-targeted BIs yielded larger improvements in multiple drug/mixed substance use when delivered by a general practitioner ( g¯ = 0.19; 95% CI = 0.187, 0.193). Alcohol-targeted BIs yielded small beneficial effects on alcohol use ( g¯ = 0.12; 95% CI 0.08, 0.16), but no evidence of an effect on consequences ( g¯ = 0.05; 95% CI = -0.04, 0.13). However, alcohol-targeted BIs only had beneficial effects on alcohol use when delivered in general medical settings (g¯ = 0.17; 95% CI = 0.10, 0.24); the findings were inconclusive for those delivered in emergency department/trauma centers ( g¯ = 0.05; 95% CI = 0.00, 0.10). CONCLUSIONS When delivered in general medical settings, alcohol-targeted brief interventions may produce small beneficial reductions in drinking (equivalent to a reduction in 1 drinking day per month). There is limited evidence regarding the effects of drug-targeted brief interventions on drug use.
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Affiliation(s)
- Emily E. Tanner-Smith
- University of Oregon, Counseling Psychology and Human Services Department, College of Education, 1215 University of Oregon, Eugene, OR, 97403-1215
| | - Nicholas J. Parr
- University of Oregon, Counseling Psychology and Human Services Department, College of Education, 1215 University of Oregon, Eugene, OR, 97403-1215,U.S. Department of Veterans Affairs Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239
| | - Maria Schweer-Collins
- University of Oregon, Counseling Psychology and Human Services Department, College of Education, 1215 University of Oregon, Eugene, OR, 97403-1215
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4 Floor, Boston, MA 02118,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine; Grayken Center for Addiction, Boston Medical Center
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Bonar EE, Goldstick JE, Chapman L, Bauermeister JA, Young SD, McAfee J, Walton MA. A social media intervention for cannabis use among emerging adults: Randomized controlled trial. Drug Alcohol Depend 2022; 232:109345. [PMID: 35144238 PMCID: PMC9549699 DOI: 10.1016/j.drugalcdep.2022.109345] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Cannabis use is increasing among emerging adults (ages 18-25), necessitating the need for prevention interventions. Using a novel platform - social media - we developed an 8-week motivational interviewing and cognitive-behavioral intervention targeting cannabis use among emerging adults. Herein, we report on the feasibility and acceptability of the intervention in a pilot trial. PROCEDURES For NCT04187989 we recruited N = 149 emerging adults who used cannabis (at least 3 times/week for the past month) using social media advertising. Their mean age was 21.0 years (SD = 2.2); 55.7% were female. Most were White (70.5%; 20.1% Black/African American, 9.4% Other races), with 20.1% identifying as Hispanic/Latinx. Participants were randomized to the 8-week intervention or an 8-week attention-placebo control condition, both delivered in secret Facebook groups by electronic health coaches (e-coaches). Follow-up assessments occurred at 3- and 6-months. RESULTS The intervention was well-received and follow-up rates were high; fidelity was good. Intervention participants rated e-coaches significantly higher in terms of helpfulness, warmth, etc., compared to control participants. Intervention participants were more likely to engage with and recommend the group. In terms of percentage reductions in cannabis outcomes, the intervention group evidenced absolute reductions over time in several measures of cannabis consumption across modalities. In an adjusted model, reductions in vaping days in the intervention group, relative to attention-control, reached statistical significance (p = .020, D =.40). CONCLUSIONS This social media intervention for emerging adults' cannabis use was feasible and acceptable in the target population warranting future testing in a fully powered trial.
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Affiliation(s)
- Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA
| | - Jason E. Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Lyndsay Chapman
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA 92697
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Lee CM, Calhoun BH, Abdallah DA, Blayney JA, Schultz NR, Brunner M, Patrick ME. Simultaneous Alcohol and Marijuana Use Among Young Adults: A Scoping Review of Prevalence, Patterns, Psychosocial Correlates, and Consequences. Alcohol Res 2022; 42:08. [PMID: 35548267 PMCID: PMC9059839 DOI: 10.35946/arcr.v42.1.08] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Alcohol and marijuana are commonly used by young adults, and use of both substances, particularly at the same time, is prevalent among this population. Understanding the prevalence, patterns, correlates, and consequences of simultaneous alcohol and marijuana (SAM) use is important to inform interventions. However, this literature is complicated by myriad terms used to describe SAM use, including use with overlapping effects and same-day co-use. OBJECTIVES This scoping review identifies and describes the peer-reviewed literature focused on SAM use by young adults and distinguishes simultaneous use from same-day co-use of alcohol and marijuana. This review also provides a narrative summary of the prevalence of SAM use, patterns of SAM and other substance use, psychosocial correlates, and consequences of SAM use. ELIGIBILITY CRITERIA This review is limited to papers written in English and published in peer-reviewed journals between January 2000 and August 2021. It includes papers assessing simultaneous use or same-day co-use of alcohol and marijuana among young adults ages 18 to 30. Review papers, qualitative interviews, experimental lab studies, policy work, toxicology or medical reports, and papers focused on neurological outcomes are excluded. SOURCES OF EVIDENCE PubMed, PsycINFO, and Web of Science databases were searched. Databases were selected and the search strategy developed in consultation with an information specialist. CHARTING METHODS A data charting form was utilized to specify which information would be extracted from included papers. Eight categories of data were extracted: (1) research questions and hypotheses; (2) sample characteristics; (3) study procedures; (4) definition of SAM use; (5) prevalence of SAM use; (6) patterns of SAM and other substance use; (7) psychosocial correlates of SAM use; and (8) consequences of SAM use. RESULTS A total of 1,282 papers were identified through initial search terms. Through double-blind title/abstract screening and full-text review, the review was narrowed to 74 papers that met review inclusion criteria. Review of these papers demonstrated that SAM use was prevalent among young adults, particularly among those who reported heavier quantities and more frequent use of alcohol and marijuana. Enhancement-related motives for use were consistently positively associated with SAM use. SAM use was associated with greater perceived positive and negative consequences of alcohol and/or marijuana use. Inconsistencies in prevalence, patterns, correlates, and consequences were found between studies, which may be due to large variations in measurement of SAM use, populations studied, methodological design (e.g., cross-sectional vs. intensive longitudinal), and the covariates included in models. CONCLUSIONS The literature on simultaneous use and same-day co-use of alcohol and marijuana has expanded rapidly. Of the 74 included papers (61 on SAM use; 13 on same-day co-use), 60 papers (47 on SAM use; 13 on same-day co-use) were published within the last 5 years. Future research focusing on the ways in which SAM use confers acute risk, above and beyond the risks associated with separate consumption of alcohol and marijuana, is needed for understanding potential targets for intervention.
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Affiliation(s)
- Christine M. Lee
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Brian H. Calhoun
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Devon Alisa Abdallah
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Jessica A. Blayney
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Nicole R. Schultz
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Meg Brunner
- Addictions, Drug, and Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Megan E. Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Schulte MH, Boumparis N, Huizink AC, Riper H. Technological Interventions for the Treatment of Substance Use Disorders. COMPREHENSIVE CLINICAL PSYCHOLOGY 2022. [PMCID: PMC7500918 DOI: 10.1016/b978-0-12-818697-8.00010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Substance use disorders (SUDs) pose a major public health concern. In recent years, technological (i.e., e-health) interventions have emerged and are increasingly offered in a variety of settings, including substance use treatment. E-health interventions encompass a wide variety of advantages depending on the chosen delivery format. This chapter discusses existing interventions and the effectiveness of delivering them as an e-health intervention, with a focus on randomized controlled trials, for the treatment of alcohol, cannabis, opioid, psychostimulant, or poly-substance use, as well as in transdiagnostic interventions. Based on the literature, suggestions for future research and clinical implications are discussed.
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Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, van den Brink W, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103381. [PMID: 34465496 DOI: 10.1016/j.drugpo.2021.103381] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Bullen
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand
| | - Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Maria Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom
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Pouliquen M, Auriacombe M. Psychotherapeutic interventions for cannabis use disorder. What do we know and what should we do? Encephale 2021; 48:70-77. [PMID: 34625215 DOI: 10.1016/j.encep.2021.05.009] [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: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cannabis use disorder is the most commonly reported illegal substance use disorder and demand for treatment is growing worldwide. OBJECTIVES Our aim was to compare the two last Cochrane systematic reviews of the literature concerning psychotherapeutic and psychosocial interventions for cannabis use disorder to determine what new evidence emerged and how craving was considered as a treatment mediator. METHOD We extracted raw data from both reviews regarding their titles, objectives, methods and results. This information was analyzed by face validity to distinguish apparent differences from real differences. It enabled us to describe similarities and differences between reviews. We also screened both reviews looking for craving or related words. RESULTS The objective and methods of both reviews were mostly similar. Although the second review covered a wider range of psychotherapies, including drug counseling and mindfulness-based meditation as an intervention group and minimal treatment as a control group. Five of the six studies included in the first review were also included in the second review. One study excluded from the first review was included in the last review that included an additional 17 studies published after the first review. The 2016 review performed a meta-analysis whereas the first review was descriptive. Both reviews supported the efficacy of motivational enhancement therapy and cognitive and behavioral therapy interventions with adjunction of contingency management for abstinence when possible. There was no relevant mention of craving in the 2006 review and very few in the 2016 review. CONCLUSION The methods and results of the last two Cochrane reviews on psychosocial interventions for cannabis use disorder were mostly similar. Consistent with other reviews on the same subject and reviews of psychotherapies for other substance use disorders, the 2016 review confirmed evidence already available in the 2006 review. Instead of confirming already confirmed evidence, future research is needed to determine if craving focused treatment would increase efficiency and how to maintain initial treatment outcomes long-term.
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Affiliation(s)
- M Pouliquen
- University of Bordeaux, 33000 Bordeaux, France; Équipe phénoménologie et déterminants des comportements appétitifs, Sanpsy CNRS USR 3413, University of Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France
| | - M Auriacombe
- University of Bordeaux, 33000 Bordeaux, France; Équipe phénoménologie et déterminants des comportements appétitifs, Sanpsy CNRS USR 3413, University of Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France.
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Baumgartner C, Schaub MP, Wenger A, Malischnig D, Augsburger M, Walter M, Berger T, Stark L, Ebert DD, Keough MT, Haug S. CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial. J Med Internet Res 2021; 23:e27463. [PMID: 33929333 PMCID: PMC8122293 DOI: 10.2196/27463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/18/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Despite increasing demand for treatment among cannabis users in many countries, most users are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low effectiveness and adherence issues often arise. Objective Through adherence-focused guidance enhancement, we aimed to increase adherence to and the effectiveness of internet-based self-help among cannabis users. Methods From July 2016 to May 2019, cannabis users (n=775; male: 406/575, 70.6%, female: 169/575, 29.4%; age: mean 28.3 years) not in treatment were recruited from the general population and were randomly assigned to (1) an adherence-focused guidance enhancement internet-based self-help intervention with social presence, (2) a similar intervention with an impersonal service team, and (3) access to internet as usual. Controls who were placed on a waiting list for the full intervention after 3 months underwent an assessment and had access to internet as usual. The primary outcome measurement was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in common mental disorder symptoms, and intervention adherence. Differences between the study arms in primary and secondary continuous outcome variables at baseline, posttreatment, and follow-up were tested using pooled linear models. Results All groups exhibited reduced cannabis-use days after 3 months (social presence: –8.2 days; service team: –9.8 days; internet as usual: –4.2 days). The participants in the service team group (P=.01, d=.60) reported significantly fewer cannabis-use days than those in the internet as usual group; the reduction of cannabis use in the social presence group was not significant (P=.07, d=.40). There was no significant difference between the 2 intervention groups regarding cannabis-use reduction. The service team group also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after 3 months to those in the internet as usual group. Conclusions The adherence-focused guidance enhancement internet-based self-help intervention with an impersonal service team significantly reduced cannabis use, cannabis-use disorder, dependence severity, and general anxiety symptoms. Trial Registration ISRCTN Registry ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185
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Affiliation(s)
- Christian Baumgartner
- Swiss Research Institute for Public Health and Addiciton, University of Zurich, Zürich, Switzerland
| | - Michael Patrick Schaub
- Swiss Research Institute for Public Health and Addiciton, University of Zurich, Zürich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiciton, University of Zurich, Zürich, Switzerland
| | - Doris Malischnig
- Institute for Addiction Prevention, Addiction and Drug Coordination Vienna, Vienna, Austria
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiciton, University of Zurich, Zürich, Switzerland
| | - Marc Walter
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lars Stark
- Arud Centre for Addiction Medicine, Zurich, Switzerland
| | - David Daniel Ebert
- Department for Sport and Health Sciences, Chair for Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | | | - Severin Haug
- Swiss Research Institute for Public Health and Addiciton, University of Zurich, Zürich, Switzerland
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Lin JA, Harris SK, Shrier LA. Trait mindfulness and cannabis use-related factors in adolescents and young adults with frequent use. Subst Abus 2021; 42:968-973. [PMID: 33798028 DOI: 10.1080/08897077.2021.1901179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) are effective in adult substance-use treatment and may be helpful for adolescents and young adults (AYAs). One target of MBIs is to improve trait mindfulness, which has been associated with better lifestyle and health outcomes. To inform MBIs for reducing cannabis use in AYAs, we sought to identify how trait mindfulness was associated with cannabis-related problems and quit attempts, as well as with motivation to change use in youth who report frequent use. Methods: Participants aged 15-24 years using cannabis ≥ 3x/week were recruited from AYA clinics in a northeastern US city to participate in a cannabis-use intervention pilot, randomized trial. At baseline, we assessed cannabis-use history, problems associated with use, attempts to quit, and trait mindfulness. All participants were offered two sessions of motivational enhancement therapy, during which they rated motivation to quit cannabis. Regression analyses were conducted to assess associations between trait mindfulness and cannabis use-related problems, attempts to quit, and motivation to change. Results: Seventy participants, mean age 20.7 ± 1.9 years, enrolled. Sixty percent identified as female, 47% as Black non-Hispanic, and 31% as Hispanic. Participants started using cannabis at mean age 15.0 ± 2.8 years and were using ≥ 3x/week by 17.0 ± 2.3 years. Higher mindfulness scores were associated with fewer cannabis-related problems (p = 0.004) and fewer quit attempts (p = 0.035). The number of cannabis-related problems did not significantly mediate the relationship between mindfulness and quit attempts. Trait mindfulness did not predict motivation to change cannabis use. Conclusions: Among AYAs using cannabis frequently, higher trait mindfulness was associated with both fewer cannabis use--related problems and fewer quit attempts. Future research should assess whether trait mindfulness is an appropriate target for decreasing cannabis use and the utility of MBIs for reducing cannabis-use behaviors.
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Affiliation(s)
- Jessica A Lin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Center for Adolescent Substance Use and Addiction Research, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Bonar EE, Cunningham RM, Sweezea EC, Blow FC, Drislane LE, Walton MA. Piloting a brief intervention plus mobile boosters for drug use among emerging adults receiving emergency department care. Drug Alcohol Depend 2021; 221:108625. [PMID: 33631541 PMCID: PMC8026691 DOI: 10.1016/j.drugalcdep.2021.108625] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE There are few efficacious prevention interventions for emerging adults (ages 18-25) drug use and concomitant risks (e.g., sexual risk behaviors). We developed and evaluated the feasibility and acceptability of an Emergency Department (ED)-initiated brief intervention (BI) combined with booster messaging as a clinician-extender primarily focusing on drug use, with a secondary focus on condomless sex. We examined descriptive outcomes of alcohol, drug use, and condomless sex. PROCEDURES We recruited N = 63 emerging adults who used drugs (primarily cannabis) from an ED (72.4 % participation rate). Their mean age was 21.7 years (SD = 2.3); 67 % were female and 52.4 % were Black/African American. Participants randomized to the intervention (N = 31) received a BI and 28 days of tailored booster messaging (based on drug use motives) daily, and the control condition received a community resource brochure. A post-test occurred at 1-month with a follow-up at 2-months. RESULTS The intervention was well-received (83.9 % allocated completed the BI) with 79 % overall liking the BI and 71 % finding it helpful to discuss substances. Mean ratings of booster messages were >4.0 (5-point scale); 77 % liked the daily messages and 91 % found them helpful. Descriptively, the intervention group evidenced absolute reductions over time on alcohol outcomes, cannabis use, and condomless sex. CONCLUSIONS This BI with booster messages was feasible and acceptable in the target population of emerging adults who use drugs (i.e., mostly cannabis). This intervention model, initiated during a healthcare visit and accompanied by a clinician-extender, should be tested in a future fully-powered trial.
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Affiliation(s)
- Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA; Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
| | - Emily C Sweezea
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI, 48109-2800, USA
| | - Laura E Drislane
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Department of Psychology and Philosophy, Sam Houston State University, 1901 Avenue I, Huntsville, TX, 77340, USA
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA
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Teeters JB, King SA, Hubbard SM. A mobile phone-based brief intervention with personalized feedback and interactive text messaging is associated with changes in driving after cannabis use cognitions in a proof-of-concept pilot trial. Exp Clin Psychopharmacol 2021; 29:203-209. [PMID: 34043401 PMCID: PMC8376090 DOI: 10.1037/pha0000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Driving after cannabis use (DACU) is a significant public health concern and represents one of the riskiest cannabis-related behaviors. Though years of research has demonstrated that cannabis use impairs driving ability, many college students report believing that cannabis use does not impair their driving abilities. This perception of low danger may contribute to a permissive attitude toward DACU. The present proof-of-concept pilot study examined the preliminary efficacy of a mobile phone-based intervention with personalized feedback and text messaging to increase perceptions of dangerousness of DACU. Participants were 77 college cannabis users (65.8% women; average age = 21.2; 88.3% Caucasian) who endorsed DACU at least three times in the past 3 months. After completing baseline measures, participants were randomly assigned to one of three conditions: (a) personalized feedback plus interactive text messaging (PFT), (b) personalized feedback only (PF), or (c) informational control (IC). Participants completed outcome measures 3 months post intervention. Repeated measures mixed models revealed that compared to those in the IC condition, cannabis users in the PFT condition reported significantly greater increases over time in the perception of dangerousness of DACU. These findings provide initial support for the short-term efficacy of a mobile phone-based intervention for changing perceptions related to dangerousness of DACU among college cannabis users. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jenni B Teeters
- Department of Psychological Sciences, Western Kentucky University
| | - Shelby A King
- Department of Psychological Sciences, Western Kentucky University
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Papinczak ZE, Connor JP, Feeney GF, Gullo MJ. Additive effectiveness and feasibility of a theory-driven instant assessment and feedback system in brief cannabis intervention: A randomised controlled trial. Addict Behav 2021; 113:106690. [PMID: 33075644 DOI: 10.1016/j.addbeh.2020.106690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
Assessment and personalised feedback are important components of brief interventions (BIs) for cannabis use. A key outcome is to increase motivation to change during this short interaction. The diversity of available assessments and time burden scoring them pose a challenge for routine use in clinical practice. An instant assessment and feedback (iAx) system was developed to administer assessments informed by bioSocial Cognitive Theory, that were instantly scored and benchmarked against clinical norms, to provide patient feedback and guide treatment planning. This study evaluated the feasibility and additive effectiveness of the iAx on motivation to change cannabis use, when compared to treatment as usual (TAU), in a single-session BI. A randomised controlled trial was conducted in a public hospital alcohol and drug outpatient clinic. Eighty-seven cannabis users (Mage = 26.41; 66% male) were assigned to the BI utilising the iAx (iAx; n = 44) or to the standard BI (TAU; n = 43). Patients completed pre- and post-BI assessments of motivation to change and a post-BI measure of treatment satisfaction. Practitioners completed a feedback survey. Patients receiving iAx reported a significantly greater increase in motivation to change from pre- to post-BI compared to patients receiving TAU (d = 0.49, p = .03). Treatment satisfaction was high across both conditions, with no significant difference between groups (p = .57). Practitioners also reported a high level of satisfaction with the iAx system. In summary, findings support the feasibility and additive effectiveness of the iAx to enhance patient motivation during cannabis BI.
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Macatee RJ, Albanese BJ, Okey SA, Afshar K, Carr M, Rosenthal MZ, Schmidt NB, Cougle JR. Impact of a computerized intervention for high distress intolerance on cannabis use outcomes: A randomized controlled trial. J Subst Abuse Treat 2020; 121:108194. [PMID: 33357604 DOI: 10.1016/j.jsat.2020.108194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/02/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prevalence of regular cannabis use and cannabis use disorder (CUD) have increased in the past two decades, but treatment-seeking is low and extant brief interventions do not target causal risk factors implicated in etiological models of addiction. Elevated distress intolerance (DI) is one risk factor that has been empirically linked with greater CUD severity and maintenance in regular users, but, to our knowledge, research has never targeted it in a brief intervention among cannabis users with CUD or at high risk. The current RCT evaluated the impact of a DI intervention (i.e., Distress Tolerance Intervention [DTI]) compared to a healthy habits control intervention (i.e., Healthy Video Control [HVC]) on DI and cannabis use outcomes. METHOD We randomized cannabis users with high DI (N = 60) to the DTI or HVC condition and they received two computerized intervention sessions. We assessed relief cannabis craving at pre- and post-treatment; and we assessed DI, cannabis use coping motives, use-related problems, and use frequency at pre- and post-treatment as well as one- and four-month follow-ups. We assessed CUD symptoms via interviews at pre-treatment and four-month follow-up. RESULTS Significant, durable reductions in DI and all cannabis use outcomes occurred in both conditions. Compared to the HVC condition, the DTI led to greater reductions in use frequency during the treatment period. Reductions in self-reported DI were correlated with reductions in coping motives and CUD symptoms. CONCLUSION The DTI's impact on all outcomes was largely comparable to the control condition, though it may have utility as an adjunctive intervention.
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Affiliation(s)
| | | | - Sarah A Okey
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Kaveh Afshar
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Meghan Carr
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - M Zachary Rosenthal
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Winters KC, Mader J, Budney AJ, Stanger C, Knapp AA, Walker DD. Interventions for cannabis use disorder. Curr Opin Psychol 2020; 38:67-74. [PMID: 33338844 DOI: 10.1016/j.copsyc.2020.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
How to treat adults and adolescents with a Cannabis Use Disorder is a burgeoning research area. This article reviews the empirical literature pertaining to several psychosocial approaches (cognitive-behavior therapy, motivational enhancement, and contingency management), all of which are associated with favorable outcomes. We also review the emerging research on the use of pharmacotherapy, brief interventions and technology-delivered interventions, and conclude with an overview of future research needs.
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Halladay J, Woock R, El-Khechen H, Munn C, MacKillop J, Amlung M, Ogrodnik M, Favotto L, Aryal K, Noori A, Kiflen M, Georgiades K. Patterns of substance use among adolescents: A systematic review. Drug Alcohol Depend 2020; 216:108222. [PMID: 32971420 DOI: 10.1016/j.drugalcdep.2020.108222] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/10/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This review characterizes empirically derived patterns of multiple (multi-) substance use among adolescents. A secondary objective was to examine the extent to which mental health symptomatology was included in the empirical analyses examining substance use patterns. METHODS Eligible studies included those that used cluster-based approaches, included the assessment of at least two different substances, and were based on study samples with mean ages between 11 and 18 years. 4665 records were screened including 461 studies for full-text screening. RESULTS 70 studies were included with common clusters being: low use, single or dual substance use, moderate general multi-use, and high multi-use. The most common patterns of single or multi-substance use were: alcohol only, alcohol with cannabis and/or tobacco, and use of alcohol, tobacco, and cannabis with and without other drugs. Lower socioeconomic status, older age, and male gender were consistent predictors of multi-use clusters. Only 37 % of studies compared differences in levels of mental health across clusters with symptoms consistently associated with a greater likelihood of multi-use. Only 29 % of studies included mental health indicators in cluster-based analyses, with over half identifying distinct mental health and substance use clusters. Fit indices in cluster analyses and measurement properties of substance use were heterogeneous and inconsistently reported across studies. CONCLUSIONS Distinct patterns of substance use were derived but methodological differences prevented direct comparison and reduced capacity to generalize across studies. There is a need to establish standardized methodological approaches to identify robust patterns of substance use to enhance etiological, prognostic, and intervention research.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - R Woock
- Department of Social Sciences, McMaster University, Canada.
| | - H El-Khechen
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - C Munn
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - J MacKillop
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - M Amlung
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - M Ogrodnik
- NeuroFit Lab, Department of Kinesiology, McMaster University, Canada.
| | - L Favotto
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - K Aryal
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - A Noori
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - M Kiflen
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Population Health Research Institute, Hamilton, ON, Canada.
| | - K Georgiades
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Offord Centre for Child Studies, McMaster University, Canada.
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45
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The Lower-Risk Cannabis Use Guidelines (LRCUG): A ready-made targeted prevention tool for cannabis in New Zealand. PUBLIC HEALTH IN PRACTICE 2020; 1:100046. [PMID: 36101675 PMCID: PMC9461312 DOI: 10.1016/j.puhip.2020.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022] Open
Abstract
Cannabis use is common, especially among young people, and associated with risks for select acute and chronic adverse health and social outcomes. New Zealand features overall high cannabis use levels, yet may soon follow other jurisdictions and implement legalization of non-medical cannabis use and supply towards public health objectives. While existing cannabis-oriented interventions mainly focus on primary prevention and treatment (e.g., for dependence), key harms from use are crucially influenced by risk factors that can be modified by the user. On this basis, and similar to other health behavior-oriented interventions, ‘Lower-Risk Cannabis Use Guidelines’ (LRCUG), consisting of 10 recommendation clusters for lower-risk use, were systematically developed in Canada as an evidence-based, targeted prevention tool towards reducing adverse outcomes among cannabis users. We briefly summarize the concept of and experiences with implementation of the LRCUG elsewhere, and describe how their adoption as a population health intervention may serve public health goals of possible cannabis legalization in New Zealand and elsewhere. Cannabis is common, but involves risks for acute and chronic adverse outcomes. Many adverse outcomes are influenced by user-modifiable risk factors. Cannabis use and supply legalization may be implemented in New Zealand. Evidence-based ‘Lower-Risk Cannabis Use Guidelines’ are a targeted prevention tool. LRCUG may serve a valuable intervention towards legalization’s public health outcomes.
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46
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Steele DW, Becker SJ, Danko KJ, Balk EM, Adam GP, Saldanha IJ, Trikalinos TA. Brief Behavioral Interventions for Substance Use in Adolescents: A Meta-analysis. Pediatrics 2020; 146:peds.2020-0351. [PMID: 32928988 DOI: 10.1542/peds.2020-0351] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Adolescents with problematic substance use (SU) are at risk for far-reaching adverse outcomes. OBJECTIVE Synthesize the evidence regarding the effects of brief behavioral interventions for adolescents (12-20 years) with problematic SU. DATA SOURCES We conducted literature searches in Medline, the Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo through October 31, 2019. STUDY SELECTION We screened 33 272 records and citations for interventions in adolescents with at least problematic SU, retrieved 1831 articles, and selected 22 randomized controlled trials of brief interventions meeting eligibility criteria for meta-analysis. DATA EXTRACTION We followed Agency for Healthcare Research and Quality guidelines. We categorized brief interventions into components, including motivational interviewing (MI), psychoeducation, and treatment as usual. Outcomes included SU (abstinence, days used per month) for alcohol and cannabis, and substance-related problem scales. Strength of evidence (SoE) was assessed. RESULTS Both pairwise and network meta-analyses were conducted by using random effects models. Compared to treatment as usual, the use of MI reduces heavy alcohol use days by 0.7 days per month (95% credible interval [CrI]: -1.6 to 0.02; low SoE), alcohol use days by 1.1 days per month (95% CrI -2.2 to -0.3; moderate SoE), and overall substance-related problems by a standardized net mean difference of 0.5 (95% CrI -1.0 to 0; low SoE). The use of MI did not reduce cannabis use days, with a net mean difference of -0.05 days per month (95% CrI: -0.26 to 0.14; moderate SoE). LIMITATIONS There was lack of consistently reported outcomes and limited available comparisons. CONCLUSIONS The use of MI reduces heavy alcohol use, alcohol use days, and SU-related problems in adolescents but does not reduce cannabis use days.
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Affiliation(s)
- Dale W Steele
- Evidence-based Practice Center, Center for Evidence Synthesis in Health and .,Departments of Health Services, Policy, and Practice and.,Departments of Emergency Medicine.,Pediatrics, and
| | - Sara J Becker
- Behavioral and Social Sciences, School of Public Health and.,Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kristin J Danko
- Evidence-based Practice Center, Center for Evidence Synthesis in Health and.,Departments of Health Services, Policy, and Practice and
| | - Ethan M Balk
- Evidence-based Practice Center, Center for Evidence Synthesis in Health and.,Departments of Health Services, Policy, and Practice and
| | - Gaelen P Adam
- Evidence-based Practice Center, Center for Evidence Synthesis in Health and.,Departments of Health Services, Policy, and Practice and
| | - Ian J Saldanha
- Evidence-based Practice Center, Center for Evidence Synthesis in Health and.,Departments of Health Services, Policy, and Practice and
| | - Thomas A Trikalinos
- Evidence-based Practice Center, Center for Evidence Synthesis in Health and.,Departments of Health Services, Policy, and Practice and
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47
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Adelman WP. The Need to Focus Research on Adolescent Cannabis Use Interventions. Pediatrics 2020; 146:peds.2020-012336. [PMID: 32928987 DOI: 10.1542/peds.2020-012336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- William P Adelman
- Division of Adolescent Medicine, Children's Mercy Hospital, Kansas City, Missouri; and University of Missouri Kansas City, Kansas City, Missouri
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48
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Yonkers KA, Dailey JI, Gilstad-Hayden K, Ondersma SJ, Forray A, Olmstead TA, Martino S. Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. J Subst Abuse Treat 2020; 113:107995. [PMID: 32359666 DOI: 10.1016/j.jsat.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Jason I Dailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Wayne State University, Merrill Palmer Skillman Institute, 71 E. Ferry Ave, Detroit, MI 48202, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Todd A Olmstead
- University of Texas at Austin, PO Box Y, Austin, TX 78713, USA.
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Mader J, Smith JM, Smith J, Christensen DR. Protocol for a feasibility study investigating the UCalgary's Cannabis Café: education and harm reduction initiative for postsecondary students. BMJ Open 2020; 10:e032651. [PMID: 32051305 PMCID: PMC7045139 DOI: 10.1136/bmjopen-2019-032651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/23/2019] [Accepted: 01/23/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION High rates of cannabis consumption among emerging adults in Canada represent an important public health issue. As part of the legalisation of cannabis, health objectives were established by the Government of Canada including reducing risky patterns of consumption and cannabis related harm among vulnerable populations. Despite these ambitions, few evidenced based education programmes have been evaluated in the literature. The aim of this study is to describe and evaluate the acceptability of a novel harm reduction and education initiative titled, UCalgary's Cannabis Café. The Cannabis Café incorporates components shown to be effective in reducing risky substance consumption on campuses and substance related stigma. An important objective of the Café is the dissemination of methods to reduce risk in the form of Canada's Lower-Risk Cannabis Use Guidelines. METHODS AND ANALYSIS The study will take the form of a non-experimental, observational cohort design, where participants will be asked to complete four surveys (baseline, immediate follow-up, 1 month and 3 months). The primary outcomes of the study will be the feasibility of the initiative including acceptability and implementation. Secondary outcomes include knowledge uptake of methods to reduce risk of cannabis related harm, descriptive cannabis norms and changes in cannabis consumption. ETHICS AND DISSEMINATION The study was approved by the University of Calgary Conjoint Health Research Ethics Board (#REB18-1364). The investigators will develop a guideline outlining the Cannabis Café to assist in the replication of this initiative at other locations and publish the results from the study in a peer-reviewed manuscript.
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Affiliation(s)
- Joel Mader
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Jennifer Smith
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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