Impact of Reduced Cannabis Use on Functional Outcomes

近2000万美国人报告在过去一个月使用大麻，大麻的重度使用有所增加 自2007年以来，在美国增长了近60%。大量使用大麻与受教育程度较低有关， 减少体力活动，增加成瘾率，失业率和神经心理缺陷。 我们的实验室和其他人的研究表明，大麻的使用也与心理健康的增加有关。 症状以及自杀和非自杀性自伤。此外，大麻是非法药物中 与吸毒驾驶和交通事故有关，包括致命事故。虽然有证据表明， 持续的禁欲可以导致前使用者功能结果的改善， 仅大麻使用的减少（即，在没有持续禁欲的情况下）可能与 功能结局的积极变化目前尚不清楚。这是文献中的一个关键空白，因为许多 对大麻和其他药物的临床干预与大麻滥用的频率和数量的减少有关。 使用，但未能实现对总体戒烟率的影响。本研究的总体目标是 使用生态瞬时评估（EMA），一种实时的，自然的数据收集方法， 研究减少大麻使用对重度大麻使用者功能结果的影响。EMA地址 通过增强生态效度、最小化记忆等方法克服了传统评价技术的局限性 偏见，并能够检查上下文对参与者行为的影响。权变管理 (CM)将用于促进减少大麻使用的频率和数量。CM是一种密集型 行为疗法，在短期内减少非法药物使用方面非常有效。而且我们 最近开发了一种新的方法，该方法利用了移动的技术和 大麻测试，使大麻CM更便携和可行。我们已经对这种方法进行了试点测试， 研究人员对大麻重度使用者进行了调查，发现这是减少其大麻使用的一种可接受和可行的方法。的 目前的研究将使用这种技术，并结合最先进的EMA方法来研究这种影响 减少大麻使用对关键功能结果的影响。我们的中心假设是， 大麻使用量的增加将导致大麻使用者的心理健康，身体活动， 工作记忆、健康相关生活质量和驾驶行为。这项研究的基本原理是， * 提供关于大麻使用减少对毒品的潜在影响的第一个也是唯一的实时数据， 功能性成果。因此，本研究的结果将直接为正在进行的努力提供信息， 包括减少非法药物使用作为临床试验中有效的、有临床意义的结果指标， 用于治疗物质使用障碍的药物疗法。

Nearly 20 million Americans report use of cannabis in the past month, and heavy cannabis use has increased by nearly 60% in the U.S. since 2007. Heavy cannabis use is associated with lower educational attainment, reduced physical activity, and increased rates of addiction, unemployment, and neuropsychological deficits. Studies by our lab and others suggest that cannabis use is also associated with increased mental health symptoms and suicidal and nonsuicidal self-injury. In addition, cannabis is the illicit drug most strongly associated with drugged driving and traffic accidents, including fatal accidents. While there is evidence that sustained abstinence can lead to improvements in the functional outcomes of former users, the degree to which reductions in cannabis use alone (i.e., in the absence of sustained abstinence) might be associated with positive changes in functional outcomes is currently unknown. This is a critical gap in the literature, as many clinical interventions for cannabis and other drugs are associated with decreases in frequency and quantity of use, but fail to achieve an effect on overall abstinence rates. The overall objective of the present research is to use ecological momentary assessment (EMA), a real-time, naturalistic data collection method, to prospectively study the impact of reduced cannabis use on functional outcomes in heavy cannabis users. EMA addresses several limitations of traditional assessment techniques by enhancing ecological validity, minimizing memory bias, and enabling examination of the impact of context on participants' behavior. Contingency management (CM) will be used to promote reductions in frequency and quantity of cannabis use. CM is an intensive behavioral therapy that is highly effective at producing short-term reductions in illicit drug use. Moreover, we have recently developed a novel approach that leverages mobile technology and recent developments in cannabis testing to make CM for cannabis more portable and feasible. We have pilot-tested this approach with heavy cannabis users and found that it is an acceptable and feasible method to reduce their cannabis use. The present research will use this technology in conjunction with state-of-the-art EMA methods to study the impact of reduced cannabis use on key functional outcomes. Our central hypothesis is that reductions in frequency and quantity of cannabis use will lead to positive changes in cannabis users' mental health, physical activity, working memory, health-related quality of life, and driving behavior. The rationale for this research is that it will provide the first and only real-time data concerning the potential impact of reductions in cannabis use on functional outcomes. As such, the findings from the present research will directly inform ongoing efforts to include reductions in illicit drug use as a valid, clinically-meaningful outcome measure in clinical trials of pharmacotherapies for the treatment of substance use disorders.