Targeting tobacco cessation during treatment for cannabis use disorders

描述（由申请人提供）：大约50%寻求大麻使用障碍（CUD）治疗的人经常吸烟。将烟草与大麻相结合已成为吸食大麻的常见方法，无论是通过使用钝头（将大麻卷成中空的雪茄），将烟草添加到关节，还是在大麻之后立即吸食烟草（追逐）。对于那些试图戒烟的人来说，吸烟是大麻结果的负面预测因素，反之亦然。类似的给药途径和烟草和大麻的重复配对使用可能会导致学习的关联，加强使用这两种物质的行为，并使戒烟更加困难。也许甚至比使用酒精或其他药物更有益，在停止吸烟的同时停止大麻可能是有益的。目前很少有科学信息涉及如何在治疗CUD期间最好地针对吸烟。该项目的长期目标是制定一项有效的干预协议， 在这一人群中吸烟，而不会对大麻的结果产生不利影响，也许会增强它们。一个两阶段的第一阶段治疗开发项目将实现以下三个具体目标。首先，将制定治疗方案和手册，将针对吸烟的定制干预（尼古丁替代疗法和行为咨询）与针对CUD的最佳干预（目标1）相结合。利用基于网络的咨询方案将使干预措施的提供标准化，并促进最终的传播。试点研究将提供可接受性和可行性的初步测试，并对干预措施进行修改。第二，第1阶段，概念验证研究将比较这种联合干预措施与仅针对CUD的干预措施（目标2）。主要假设断言，干预（1）将被大多数吸烟的CUD门诊患者接受;（2）将导致更多的戒烟尝试和更高的戒烟率比仅CUD治疗;（3）不会对大麻结果产生不利影响，并可能增强它们。结果和条件差异的估计将为后续第2阶段疗效试验的规划和设计提供信息。最后，该项目将评估特定结果调节因子的潜力，如冲动性（延迟折扣率），以预测结果并为后续治疗开发工作提供信息（目标3）。如果这些假设得到证实，该议定书的传播将减少与烟草和大麻依赖有关的不良心理和健康后果。此外，研究结果将通过推进与大麻和烟草吸烟的相互作用以及有助于开始使用，滥用和尝试戒烟的生物和行为因素相关的知识，为未来的预防和干预策略的发展提供信息。 公共卫生相关性：该项目旨在开发和测试同时治疗大麻使用障碍和吸烟的干预措施。这一点很重要，因为超过50%的寻求治疗以帮助停止使用大麻的成年人也经常吸烟，这降低了他们成功治疗的机会，并增加了不良的急性和长期的心理和健康后果。拟议的治疗将整合现有的基于计算机的大麻和烟草行为干预措施，并使用尼古丁替代药物来改善这种难以治疗的临床人群的结果。

DESCRIPTION (provided by applicant): Approximately 50% of persons seeking treatment for cannabis-use disorders (CUDs) regularly smoke tobacco. Combining tobacco with cannabis has become a common method of smoking cannabis either via use of blunts (rolling cannabis into hollowed out cigars), adding tobacco to joints, or smoking tobacco immediately after cannabis (chasing). Tobacco smoking is a negative predictor of cannabis outcomes for those trying to quit using cannabis, and vice versa. The similar route of administration and repeated pairing of tobacco and cannabis use likely results in learned associations that strengthen the behavior for using both substances, and make quitting more difficult. Perhaps even more than with use of alcohol or other drugs, stopping tobacco at the same time as cannabis may be beneficial. Little scientific information currently addresses how to best target tobacco smoking during treatment for CUDs. The long-term goal of this project is to develop an effective protocol for intervening in tobacco smoking in this population without adversely affecting cannabis outcomes, and perhaps enhancing them. A two-phase, Stage 1 therapy development project will accomplish the following three Specific Aims. First, a treatment protocol and manual will be developed that integrates a tailored intervention for tobacco smoking (nicotine replacement therapy and behavioral counseling) with an optimal intervention for CUD (Aim 1). Utilization of web-based counseling programs will standardize delivery of the intervention and foster eventual dissemination. A pilot study will provide an initial test of acceptability and feasibility, and infrm modifications to the intervention. Second, a Stage 1, proof-of-concept study will compare this combined intervention to one that targets CUD only (Aim 2). The primary hypotheses assert that the intervention (1) will be accepted by the majority of CUD outpatients who smoke tobacco; (2) will result in more tobacco quit attempts and higher tobacco cessation rates than the CUD-only treatment; and (3) will not adversely affect cannabis outcomes, and possibly enhance them. Estimates of outcomes and condition differences will inform the planning and design of a subsequent Stage 2 efficacy trial. Last, the project will evaluate the potential of specific moderators of outcomes, such as impulsivity (delay discounting rate), to predict outcomes and inform subsequent treatment development efforts (Aim 3). If the hypotheses were confirmed, dissemination of this protocol would reduce adverse psychosocial and health consequences associated with tobacco and cannabis dependence. Moreover, findings will inform future development of prevention and intervention strategies by advancing knowledge related to the interplay of cannabis and tobacco smoking and the biologic and behavioral factors that contribute to initiation of use, misuse, and attempts to quit using them. PUBLIC HEALTH RELEVANCE: This project aims to develop and test an intervention for the simultaneous treatment of cannabis use disorders and tobacco smoking. This is important because over 50% of adults seeking treatment to help stop cannabis use also smoke tobacco regularly, which decreases their chance for a successful treatment outcome and increases adverse acute and long-term psychosocial and health consequences. The proposed treatment will integrate existing computer-based behavioral interventions for cannabis and tobacco and use nicotine replacement medications to improve outcomes in this difficult to treat clinical population.