Approach Bias Modification for the Treatment of Cannabis Use Disorder
Condition: Cannabis Use Disorder
MeSH terms: Marijuana Abuse
Study type: Interventional

Summary: 
      Effective and durable treatments for cannabis use disorder remain elusive. Given the
      increasing prevalence rates of cannabis use and CUD nationwide, investigation of novel
      treatments is warranted. Implicit cognitive processing is an emerging, and potentially
      critical therapeutic target.

      Cognitive models of addiction posit an override of explicit control-related cognitive
      processes by implicit reward-driven processes resulting from chronic drug exposure. One form
      of implicit cognitive processing is approach bias, or, the automatic tendency to approach
      rather than avoid drug cues, which has been identified for alcohol, nicotine, opioids, and
      cannabis. Cannabis approach bias predicts increased cannabis use, dependence severity, and
      cannabis-related problems among heavy cannabis users. Approach bias modification (ABM) is a
      novel treatment approach that seeks to reduce approach bias by attenuating the
      incentive-salience of drug cues, and subsequently, drug cue reactivity and drug use. ABM has
      been shown to reduce relapse rates in alcohol dependent adults by 10-13% at one-year
      follow-up, and dependence severity in nicotine dependent adults. Our pilot data suggests that
      ABM may also reduce cannabis craving and that gender may moderate the effect of ABM on
      cannabis sessions per day in non-treatment seeking adults with CUD. A recent fMRI study with
      alcohol-dependent adults found decreased mesolimbic activation in participants who received
      ABM compared to sham-control participants. ABM appears to target implicit reward-driven
      processes, and could be an effective adjunct to traditional psychosocial and/or future
      pharmacological interventions that target explicit control-related processes.

      Building on our promising feasibility data, the proposed K23 research study will examine the
      effects of ABM on cue-reactivity and cannabis outcomes in a four-session randomized,
      double-blind, sham-controlled pilot treatment trial. One-hundred and six (106)
      treatment-seeking adults with moderate to severe CUD will be randomized to receive either
      MET/CBT plus ABM or Motivational Enhancement Therapy/Cognitive Behavioral Therapy(MET/CBT)
      plus sham-ABM. An equal number of men and women will be recruited and randomization will be
      stratified by gender. ABM sessions will occur following each of the three weekly MET/CBT
      therapy sessions. Primary outcomes will include cannabis cue-reactivity and cannabis use.
    


Intervention name(s): Approach Bias Modification (ABM); Sham ABM; Psychosocial therapy for cannabis use disorder.
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Approach bias modification (ABM) is a novel treatment that involves retraining the implicit action tendency to approach a drug cue by manipulating contingencies in a stimulus-response paradigm.; Sham ABM involves similar computerized procedures that mimic the active experimental condition, but do not involve manipulation of response contingencies and thus it does not contain any "active" intervention.; All participants will receive psychosocial therapy for cannabis use disorder.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment