Affective Management Training for Cannabis Misuse
Condition: Cannabis Use Disorder
MeSH terms: Marijuana Abuse
Study type: Interventional

Summary: 
      Emerging evidence suggests that it is not the negative affect per se but underlying
      maladaptive cognitive, behavioral, and emotional responses to it that put an individual at
      risk of pathological substance use. Maladaptive reactivity to negative affect may account for
      the association between substance-use and emotional disorders and may contribute to poor
      treatment outcomes for Substance Use Disorder. Thus, teaching adolescents and young adults
      (herein referred to as "adolescents") skills to manage negative affect may improve
      therapeutic outcomes of treatment for substance use disorder. Cannabis-use disorder (CUD)
      among adolescents is a prevalent and growing public health concern. Maladaptive reactivity to
      negative affect contributes to the maintenance of CUD and accounts for the associations
      between symptoms of emotional disorders and cannabis use. Still, maladaptive reactivity to
      negative affect has not yet been targeted in an intervention for CUD. Thus, the overarching
      aim of this proposal is to develop and pilot test a treatment for CUD that emphasizes the
      reduction of maladaptive responding to negative affect in adolescents. Participants will be
      placed in either a standard cognitive behavioral therapy for CUD, or the proposed affective
      management therapy. The investigators hypothesize that affective management training will
      yield greater reductions in the participants' use of cannabis, as well as greater
      improvements to the participants' negative thoughts and emotions, compared to the standard
      cognitive behavioral therapy.
    

Detailed description: 
      This project aims to develop and evaluate a behavioral intervention for adolescent cannabis
      use disorder that emphasizes adaptive responding to negative affective symptoms (e.g.,
      depression, anxiety). Maladaptive cognitive, behavioral, and emotional reactions to negative
      affect are associated with substance use and substance use problems (including cannabis).
      Adolescence and young adulthood represents a developmental period in which the regulation of
      negative emotions is still being developed, as well as a time when cannabis use is prevalent
      and cannabis use disorders onset. Thus, developing and evaluating cannabis use disorder
      interventions that emphasize the improvement of responding to negative affect may be
      particularly important for this developmental period. First, the investigators developed an
      intervention that weaves skills and strategies for responding adaptively to negative affect,
      particularly as it relates to high-risk times for cannabis craving and use, into an
      evidence-based substance use disorder intervention for individuals in late adolescence and
      early adulthood. After delivering it to a small sample of participants, the investigators
      will gather feedback to guide refinements to the intervention. After refining the
      intervention, which will be a 12-session individual treatment, we will conduct the pilot
      randomized clinical trial. Participants (N = 80) aged 18-25 with cannabis use disorder and
      elevations in constructs representing maladaptive reactivity to negative affect (i.e., high
      anxiety sensitivity, low distress tolerance, or facets of emotion dysregulation including
      high emotional suppression and low cognitive reappraisal ability) will be randomized to
      receive either: (a) standard cognitive behavioral therapy for adolescent substance use
      disorders (SUD-CBT) or (b) the novel intervention we develop, affective management training
      for cannabis use disorders (CUD-AMT). Participants will be assessed at baseline,
      post-treatment, and a 6-month follow-up assessment on self-report and behavioral indices of
      the targeted mechanisms, as well as on substance use outcomes (both cannabis-specific and
      substances more broadly defined). A sub-set of participants (n = 50) will also undergo pre-
      and post-treatment fMRI assessment to evaluate whether neural indices of emotion regulation
      are improved to a greater extent in CUD-AMT compared to SUD-CBT. Cannabis use disorder is the
      most prevalent substance use disorder among adolescents and young adults, and often leads to
      the use of other substances. Negative affect and disorders associated with high negative
      affect (i.e., anxiety and unipolar mood disorders) are highly prevalent and associated with
      significant substance use disorder comorbidity. Targeting a process that is still malleable
      in late adolescence and young adulthood and that is associated with the maintenance of
      substance use disorders has the potential to reduce the burden of substance use disorders in
      this population, thus making a significant public health impact.
    

Intervention name(s): CUD-AMT; SUD-CBT
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants will be trained to manage their negative thoughts and emotions while also receiving treatment for cannabis misuse; Participants will receive traditional cognitive behavioral therapy for substance use disorder
Other intervention name(s): Cannabis Use Disorder-Affective Management Treatment; Substance Use Disorder-Cognitive Behavioral Therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment