Specialized psychosocial treatment plus treatment as usual (TAU) <i>versus</i> TAU for patients with cannabis use disorder and psychosis: the CapOpus randomized trial

Hjorthøj, Carsten; Fohlmann, Allan; Larsen, Axel; Gluud, Christian; Arendt, Mikkel; Nordentoft, Merete

doi:10.1017/s0033291712002255

Cited by 55 publications

(64 citation statements)

References 48 publications

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“…The 33 studies included in this review were undertaken in a range of countries: the USA (13 studies [39][40][41][42][43][44][45][46][47][48][49][50][51] ), Australia (seven studies [52][53][54][55][56][57][58] ), Germany (three studies [59][60][61], Brazil (two studies 62,63 ), Canada (two studies 64,65 ), Switzerland (two studies 66,67 ), Denmark (one study 68 ), Ireland (one study 69 ) and worldwide (two studies, one utilising internet-based interventions 70 and the other undertaken in a number of locations worldwide 71 ) (Tables 1 and 2). …”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The included studies can be broadly categorised into those that sought to treat the 'general cannabis users population' (26 studies; [39][40][41][42][43][44][45][46][47][48][49][50][51]53,55,56,[59][60][61][62][63]65,67,70,71,75 see Table 1) and those that sought to treat patients with a 'dual diagnosis' (patients with both a psychiatric condition and cannabis use, seven studies; 52,54,57,58,66,68,69 see Table 2). Among the psychiatric studies, two studies 52,66 included participants with schizophrenia, psychosis or bipolar disorder (via ICD-10 criteria), one study 68 included those with schizophrenia spectrum diagnosis (via ICD-10 criteria), two studies 54,69 included those with psychosis (via DSM-IV criteria) and two studies 57,58 included those with major depressive disorder (via DSM-IV criteria and a score ≥ 17 on the Beck Depression Inventory II).…”

Section: General or Psychiatricmentioning

confidence: 99%

“…Among the psychiatric studies, two studies 52,66 included participants with schizophrenia, psychosis or bipolar disorder (via ICD-10 criteria), one study 68 included those with schizophrenia spectrum diagnosis (via ICD-10 criteria), two studies 54,69 included those with psychosis (via DSM-IV criteria) and two studies 57,58 included those with major depressive disorder (via DSM-IV criteria and a score ≥ 17 on the Beck Depression Inventory II).…”

Section: General or Psychiatricmentioning

confidence: 99%

“…56,63 Conversely, the psychiatric studies all employed referral mechanisms (four studies 52,54,66,68 ) or a combination of referral and voluntary recruitment methods (three studies 57,58,69 ). Therefore, the 'general population' studies mostly involved self-selected participants who may have been more motivated to cease use than the average cannabis user.…”

Section: Recruitmentmentioning

confidence: 99%

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Psychological and psychosocial interventions for cannabis cessation in adults: a systematic review short report

Cooper

Chatters

Kaltenthaler

et al. 2015

Health Technol Assess

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BackgroundCannabis is the most commonly used illicit drug worldwide. Cannabis dependence is a recognised psychiatric diagnosis, often diagnosed via theDiagnostic and Statistical Manual of Mental Disorderscriteria and theInternational Classification of Diseases, 10th Revision. Cannabis use is associated with an increased risk of medical and psychological problems. This systematic review evaluates the use of a wide variety of psychological and psychosocial interventions, such as motivational interviewing (MI), cognitive–behavioural therapy (CBT) and contingency management.ObjectiveTo systematically review the clinical effectiveness of psychological and psychosocial interventions for cannabis cessation in adults who use cannabis regularly.Data sourcesStudies were identified via searches of 11 databases [MEDLINE, EMBASE, Cochrane Controlled Trials Register, Health Technology Assessment (HTA) database, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, PsycINFO, Web of Science Conference Proceedings Citation Index, ClinicalTrials.gov andmetaRegister of Current Controlled Trials] from inception to February 2014, searching of existing reviews and reference tracking.MethodsRandomised controlled trials (RCTs) assessing psychological or psychosocial interventions in a community setting were eligible. Risk of bias was assessed using adapted Cochrane criteria and narrative synthesis was undertaken. Outcomes included change in cannabis use, severity of cannabis dependence, motivation to change and intervention adherence.ResultsThe review included 33 RCTs conducted in various countries (mostly the USA and Australia). General population studies: 26 studies assessed the general population of cannabis users. Across six studies, CBT (4–14 sessions) significantly improved outcomes (cannabis use, severity of dependence, cannabis problems) compared with wait list post treatment, maintained at 9 months in the one study with later follow-up. Studies of briefer MI or motivational enhancement therapy (MET) (one or two sessions) gave mixed results, with some improvements over wait list, while some comparisons were not significant. Four studies comparing CBT (6–14 sessions) with MI/MET (1–4 sessions) also gave mixed results: longer courses of CBT provided some improvements over MI. In one small study, supportive–expressive dynamic psychotherapy (16 sessions) gave significant improvements over one-session MI. Courses of other types of therapy (social support group, case management) gave similar improvements to CBT based on limited data. Limited data indicated that telephone- or internet-based interventions might be effective. Contingency management (vouchers for abstinence) gave promising results in the short term; however, at later follow-ups, vouchers in combination with CBT gave better results than vouchers or CBT alone. Psychiatric population studies: seven studies assessed psychiatric populations (schizophrenia, psychosis, bipolar disorder or major depression). CBT appeared to have little effect over treatment as usual (TAU) based on four small studies with design limitations (both groups received TAU and patients were referred). Other studies reported no significant difference between types of 10-session therapy.LimitationsIncluded studies were heterogeneous, covering a wide range of interventions, comparators, populations and outcomes. The majority were considered at high risk of bias. Effect sizes were reported in different formats across studies and outcomes.ConclusionsBased on the available evidence, courses of CBT and (to a lesser extent) one or two sessions of MI improved outcomes in a self-selected population of cannabis users. There was some evidence that contingency management enhanced long-term outcomes in combination with CBT. Results of CBT for cannabis cessation in psychiatric populations were less promising, but may have been affected by provision of TAU in both groups and the referred populations. Future research should focus on the number of CBT/MI sessions required and potential clinical effectiveness and cost-effectiveness of shorter interventions. CBT plus contingency management and mutual aid therapies warrant further study. Studies should consider potential effects of recruitment methods and include inactive control groups and long-term follow-up. TAU arms in psychiatric population studies should aim not to confound the study intervention.Study registrationThis study is registered as PROSPERO CRD42014008952.FundingThe National Institute for Health Research HTA programme.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: General or Psychiatricmentioning

confidence: 99%

Section: General or Psychiatricmentioning

confidence: 99%

Section: Recruitmentmentioning

confidence: 99%

See 2 more Smart Citations

Psychological and psychosocial interventions for cannabis cessation in adults: a systematic review short report

Cooper

Chatters

Kaltenthaler

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…For patients with reward-processing deficits it may be difficult to replace substance use -an immediately rewarding, highly reinforcing behaviour -with other recreational activities whose reward signals may not be strong or coherent enough to overcome the deficit. Given the limited efficacy of standard cannabis treatments in patients with SSD, 5 it may be necessary to better understand motivations for cannabis use in this population to reduce this behaviour and avoid its negative consequences of increased positive symptoms and readmission to hospital. 6 Psychosis vulnerability in adolescence may predict subsequent cannabis use, 7 but the specific aspects of psychotic illness that may drive this association remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Do reward-processing deficits in schizophrenia-spectrum disorders promote cannabis use? An investigation of physiological response to natural rewards and drug cues

Cassidy

Brodeur

Lepage

et al. 2014

jpn

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Psychosocial interventions for people with both severe mental illness and substance misuse

Hunt

Siegfried

Morley

et al. 2013

Cochrane Database of Systematic Reviews

109

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Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis: the CapOpus randomized trial

Abstract: CapOpus did not reduce the frequency, but possibly the amount, of cannabis use. This is similar to the findings of previous trials in this population. Implementation of CapOpus-type interventions is thus not warranted at present but subgroup analyses call for further trials.

Cited by 55 publications

References 48 publications

Psychological and psychosocial interventions for cannabis cessation in adults: a systematic review short report

Psychological and psychosocial interventions for cannabis cessation in adults: a systematic review short report

Do reward-processing deficits in schizophrenia-spectrum disorders promote cannabis use? An investigation of physiological response to natural rewards and drug cues

Psychosocial interventions for people with both severe mental illness and substance misuse

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