Intervention Efficacy in Trials Targeting Cannabis Use Disorders in Patients with Comorbid Psychosis Systematic Review and Meta-analysis

Hjorthøj, Carsten; Baker, Amanda; Fohlmann, Allan; Nordentoft, Merete

doi:10.2174/13816128113199990431

Cited by 18 publications

(16 citation statements)

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“…Systematic reviews have found that the evidence on effective interventions for comorbid substance misuse in established psychosis is very limited, with interventions tending to have little effect. [17][18][19] Despite a promising pilot study, 20 a large Medical Research Council-funded trial, the MIDAS (Motivational Interventions for Drugs & Alcohol misuse in Schizophrenia) study, showed no effect on primary or secondary outcomes from a relatively lengthy intervention (29 sessions over 9 months) consisting of motivational interviewing (MI) and cognitive-behavioural therapy (CBT). The difficulties of intervening effectively in established psychosis suggest that it may be fruitful to target an earlier stage of illness when, according to several recent studies, patterns of use are in a state of substantial flux.…”

Section: Resultsmentioning

confidence: 99%

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

Rains

Marwaha

Strang

et al. 2019

Health Technol Assess

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Background Cannabis is the most prevalent illicit substance among people with psychosis, and its use is associated with poorer clinical and social outcomes. However, so far, there has been limited evidence that any treatment is effective for reducing use. Contingency management (CM) is an incentive-based intervention for substance misuse that has a substantial evidence base across a range of substances and cohorts. However, to date there have been no randomised controlled trials (RCTs) of CM as a treatment for cannabis use specifically in psychosis. Objective To conduct a RCT investigating the clinical effectiveness and cost-effectiveness of CM in reducing cannabis use among Early Intervention in Psychosis (EIP) service users. Design The CIRCLE (Contingency Intervention for Reduction of Cannabis in Early Psychosis) trial was a rater-blinded, multicentre RCT with two arms. Participants were randomised 1 : 1 to either an CM arm, in which participants received CM for cannabis use alongside an optimised treatment-as-usual programme including structured psychoeducation, or a control arm in which participants received the treatment as usual only. Setting EIP services across the Midlands and the south-east of England. Participants The main eligibility criteria were EIP service users with a history of psychosis, aged 18–36 years, and having used cannabis at least once per week during 12 of the previous 24 weeks. Intervention The CM intervention offered financial incentives (i.e. shopping vouchers) for cannabis abstinence over 12 once-weekly sessions, confirmed using urinalysis. The maximum value in vouchers that participants could receive was £240. Main outcome measures The main outcome was time to relapse, operationalised as admission to an acute mental health service or hospital. The primary outcome was assessed at 18 months post inclusion using electronic patient records. Secondary outcomes assessed the clinical effectiveness and cost-effectiveness of the intervention, for which data were collected at 3 and 18 months. Results A total of 278 participants were randomised to the CM arm and 273 were randomised to the control arm. In total, 530 (96%) participants were followed up for the primary outcome. There was no significant difference in time to admission between trial arms by 18 months following consent (hazard ratio 1.03, 95% confidence interval 0.76 to 1.40). There were no statistically significant differences in most secondary outcomes, including cannabis use, at either follow-up assessment. There were 58 serious adverse events, comprising 52 inpatient episodes, five deaths and one arrest. Limitations Participant retention was low at 18 months, limiting the assessment of secondary outcomes. A different CM intervention design or reward level may have been effective. Conclusions The CM intervention did not appear to be effective in reducing cannabis use and acute relapse among people with early psychosis and problematic cannabis use. Future work Cannabis use is still a significant clinical concern in this population. A pressing need remains to identify suitable treatments. A wider perspective on the social circumstances of young people with psychosis may be needed for a successful intervention to be found. Trial registration Current Controlled Trials ISRCTN33576045. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 45. See the NIHR Journals Library website for further project information.

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Section: Resultsmentioning

confidence: 99%

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

Rains

Marwaha

Strang

et al. 2019

Health Technol Assess

View full text Add to dashboard Cite

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“…Consequently, this stresses the need to include specific interventions for the management of cannabis misuse in early intervention services. However, current psychosocial interventions may have limited efficacy in this population [ 36 ] and the few available studies of specialized substance abuse treatments for FEP patients have not demonstrated substantially better rates of reduction or abstinence in substance use compared with non-specialized treatments [ 37 , 38 ]. At the same time, it is worth noting that some behavioural treatments for drug abuse in people with severe mental disorders have proven to be efficacious both in reducing substance use and improving community-functioning [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Social Functioning Trajectories of Young First-Episode Psychosis Patients with and without Cannabis Misuse: A 30-Month Follow-Up Study

et al. 2015

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The aim of the study was to investigate trajectories of social functioning in young people with first-episode psychosis (FEP) with and without cannabis misuse using a secondary analysis of data from the Episode-II trial. Forty-two young people with FEP and comorbid cannabis use disorder were compared with 39 young people with FEP but without a cannabis use disorder. Social functioning was assessed every 6 months during a 30-month follow-up. Multilevel linear growth curve modeling was used to compare the social functioning trajectories over time for those with and without cannabis misuse. Cannabis misuse was not associated with social functioning at baseline assessment. Over a 30-month follow-up, FEP patients without cannabis disorder showed significant improvements in their social functioning, whereas patients with cannabis misuse at baseline displayed no such improvement. Patients with and without cannabis misuse differed significantly in their levels of social functioning after 24 months. Similar results were obtained after adjusting for potential confounders (i.e., age, gender, negative symptoms, premorbid functioning, DSM-IV diagnoses, baseline social functioning and other substance use). In the context of a specialized early intervention service, patients with cannabis misuse at baseline did not attain the improvements in social outcomes observed in their counterparts without cannabis misuse. There is a need to develop effective interventions to reduce cannabis misuse to ultimately improve social outcomes in young people with psychosis.

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“…Longer interventions for cannabis use in both early and chronic populations were found to be more efficacious in a recent meta-analysis. 34 Contingency management has preliminary evidence in reducing cannabis use in people with severe mental illness 35,36 but has not been studied in EPP.…”

Section: Limitationsmentioning

confidence: 99%

Psychosocial Interventions in Reducing Cannabis Use in Early Phase Psychosis

2016

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Objective: Cannabis use in people with early phase psychosis (EPP) can have a significant impact on long-term outcomes. The purpose of this investigation was to describe current cannabis use treatment practices in English-speaking early intervention services (EISs) in Canada and determine if their services are informed by available evidence. Method: Thirty-five Canadian English-speaking EISs for psychosis were approached to complete a survey through email, facsimile, or online in order to collect information regarding their current cannabis use treatment practices. Results: Data were acquired from 27 of the 35 (78%) programs approached. Only 12% of EISs offered formal services that targeted cannabis use, whereas the majority (63%) of EISs offered informal services for all substance use, not specifically cannabis. In programs with informal services, individual patient psychoeducation (86%) was slightly more common than individual motivational interviewing (MI) (76%) followed by group patient psychoeducation (52%) and information handouts (52%). Thirty-seven percent of EISs offered formal services for substance use, and compared to programs with informal services, more MI, cognitive-behavioural therapy, and family services were offered, with individual treatment modalities more common than groups. No EISs used contingency management, even though it has some preliminary evidence in chronic populations. Evidence-based service implementation barriers included appropriate training and administrative support. Conclusions: While most English-speaking Canadian EIS programs offer individual MI and psychoeducation, which is in line with the available literature, there is room for improvement in cannabis treatment services based on current evidence for both people with EPP and their families. Abré gé Objectif : L'utilisation du cannabis chez les personnes en phase précoce de psychose (PPP) peut avoir un effet significatif sur les résultats à long terme. Le but de cette recherche était de décrire les pratiques actuelles de traitement de l'utilisation du cannabis dans les services d'intervention précoce (SIP) anglophones du Canada et de déterminer si leurs services sont éclairés par les données probantes disponibles.

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Intervention Efficacy in Trials Targeting Cannabis Use Disorders in Patients with Comorbid Psychosis Systematic Review and Meta-analysis

Abstract: Psychosocial interventions appear moderately efficacious in reducing quantity of cannabis-use and positive symptoms.

Cited by 18 publications

References 0 publications

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

Social Functioning Trajectories of Young First-Episode Psychosis Patients with and without Cannabis Misuse: A 30-Month Follow-Up Study

Psychosocial Interventions in Reducing Cannabis Use in Early Phase Psychosis

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