Pilot trial of a telehealth-delivered behavioral economic intervention promoting cannabis-free activities among adults with cannabis use disorder.

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. Journal of psychiatric research. 2023 Jul 1; 163:202-210.

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• CDA 18-008 – Using telehealth to expand treatment access for Veterans with opioid use disorder

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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.