CONNECT for Depressed Cannabis Users Trial
Condition: Substance Abuse; Depression
MeSH terms: Substance-Related Disorders; Depression
Study type: Interventional

Summary: 
      The purpose of this study is to test the usefulness of a computer-assisted intervention for
      depressed cannabis users by combining peer and therapist social network support via Facebook
      that uses the techniques of cognitive behavioral therapy and motivational enhancement therapy
      (CBT/MET) to help with relapse prevention skills, reduce cannabis use and depressive
      symptoms, and improve treatment adherence. All participants will receive 10 weeks of the
      computer assisted intervention which includes weekly 60 minute (1 hour) sessions. All
      participants will also be part of a secret Facebook group (CONNECT). The goal of this secret
      Facebook group is to reinforce the knowledge and skills taught in the computer assisted
      intervention and to provide social support.
    

Detailed description: 
      An estimated 8.4 million adults in the U.S. experience co-occurring psychiatric and SUDs,
      largely accounted for by comorbid mood disorder-SUD. Cannabis is the most widely used illicit
      substance among individuals with depressive disorders1. Likewise, elevated rates of major
      depression are observed among those with cannabis use disorders (CUD)2.

      The use of technology-based platforms for behavioral intervention delivery in primary care
      settings, focusing on comorbidity, is a promising approach to broadening availability of
      evidence-based treatments for this high-need population, at low cost.

      With support from a NIDA High Priority, Short-Term Project Award, the present investigative
      team (PI Dr. Glasner-Edwards and Drs. Budney and Kay-Lambkin) piloted SHADE (Self-Help for
      Alcohol and Other Drug Use and Depression), a computerized intervention model combining
      cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET), in a primary
      psychiatric care setting, where integrated interventions addressing both mental health and
      SUDs are not readily accessible. Preliminary data indicate that SHADE: (1) was feasible and
      acceptable, (2) facilitated treatment engagement and retention in a difficult-to-treat
      comorbid population with major depression and CUD; and (3) effectively reduced cannabis use
      and depression. As a next step to optimize the efficacy of this intervention model, the
      present proposal is designed to develop and integrate a social media component to the SHADE
      intervention program, based on a program established and tested by Co-I Dr. Ramo in an RCT4.

      To this end, we propose to: (a) develop and refine, with user feedback, a social
      media-assisted therapy intervention, CONNECT (Connected Cannabis Users' Network for
      Enhancement of Cognitive Therapy), which combines the use of Facebook for social network
      support with SHADE in a population of adults with CUD and major depression; and (b) collect
      preliminary data to evaluate effect sizes and investigate trends for the impact of CONNECT
      plus SHADE on cannabis use, depressive symptoms, and health service utilization. Moreover, we
      will gather preliminary data for social network analysis, to understand the mechanism(s) by
      which the social media component of CONNECT promotes health behavior change in the key
      outcome domains of the present study.

      The use of a social media platform (i.e., Facebook) will increase the accessibility of the
      intervention as Facebook can be accessed using a variety of technology devices.

      Aim 1. To develop and refine, with user feedback, a 10-week, social media-assisted
      intervention (CONNECT) combining a computer-assisted, integrated treatment program (SHADE)
      with private Facebook groups to facilitate peer and clinician support for therapeutic
      objectives. The CONNECT intervention targets cannabis use and depression in a population of
      depressed adults with CUD receiving psychiatric care.

      Hypothesis 1: Participants will report that CONNECT is user-friendly and helpful in providing
      opportunities for between-session practice of therapy skills, peer and clinician support, and
      information that enable them to prevent cannabis relapse and manage depression.

      Aim 2. To test the impact of CONNECT plus SHADE on cannabis use, depression, adherence to
      psychiatric care, and healthcare outcomes.

      Hypothesis 2a: Among depressed substance dependent adults in an outpatient psychiatric care
      setting, CONNECT plus SHADE will led to clinical outcomes in reducing cannabis use and
      depression, and improving adherence to psychiatric care during and after treatment.

      Aim 3. To test whether social network variables mediate or moderate the impact of CONNECT.

      Hypothesis 3: Participants with more expansive Facebook social networks within CONNECT will
      benefit more from the program. Factors that influence engagement in the Facebook component of
      CONNECT will also be explored (e.g., social network characteristics and content of peer and
      therapist interaction via the social network), and engagement will be examined as a potential
      moderator of cannabis use and depression outcomes.
    

Intervention name(s): SHADE therapy + CONNECT FaceBook support
Intervention type(s): Behavioral
Intervention description(s): See "study arms" description.
Intervention model: Single Group Assignment
Intervention model description: Participants will receive SHADE therapy for drug use and depression for 10 weeks plus CONNECT FaceBook social support.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cannabis; CONNECT; Depression; FaceBook