Development of CONNECT: a Social Media Intervention for Depressed Cannabis Users

项目摘要 这项研究的目的是改善对患有抑郁症和共病大麻使用的成年人的治疗 疾病（CUD）与创新，社会媒体辅助干预策略。拟议的干预 通过Facebook将同伴和治疗师社交网络支持与集成的计算机辅助 结合认知行为疗法（CBT）和动机增强疗法（MET）的治疗方案 减少大麻使用和抑郁症状。2014年，申请人获得了NIDA高优先级，短- 长期项目奖试点测试阴影（自助酒精和其他药物使用和抑郁症），a 在初级精神病护理环境中，结合CBT和MET的计算机化干预， 针对心理健康和药物使用障碍的干预措施并不容易获得。 初步数据表明，将SHADE与抑郁症的精神护理相结合：（a）是可行的， 可接受，（B）促进难以治疗的共病人群的治疗参与和保留， 严重抑郁症和CUD;以及（c）显著减少抑郁症状和大麻 使用.为了优化这种模式的循证心理治疗实施抑郁症大麻用户 接受常规护理（TAU）在初级精神病设置，拟议的研究整合了社会网络 支持部分纳入阴影干预方案。本研究的具体目的是：（1） 根据用户反馈，制定社交媒体辅助干预措施（大麻用户联网， 增强认知疗法（Enhancement of Cognitive Therapy，简称ACECT），用于治疗抑郁的大麻使用者， 通过私人Facebook小组提供同伴和治疗师社交网络支持，以减少大麻使用， 抑郁症，并改善治疗保留; 2）为了测试，在试点RCT（N=50）中， 在改善大麻使用，抑郁症和医疗保健结果方面， 在初级精神科环境中患有CUD的抑郁成年人; 3）检查社会网络变量是否 减轻或调解的影响，我们假设，SHADE + ECT将产生上级 在减少大麻使用、改善抑郁症状和治疗方面与SHADE相关的临床结局 保留，并减少治疗期间和治疗后的卫生服务利用。此外，我们预计， 社会网络支持的组成部分，将有一个直接影响的质量和数量， 参与者的成瘾和抑郁康复社会支持网络，一种公认的变化机制 CBT和MET方法治疗共病人群，这些变化将与 大麻使用和抑郁症的结果。通过提供临床医生和同行支持，最大限度地提高技能 从SHADE采购，ECOECT可以提供一个具有成本效益和易于部署的战略， 在初级精神病护理环境中治疗抑郁的大麻使用者，这种模式可以扩展到 SUD治疗不足的其他环境。

PROJECT ABSTRACT The objective of this research is to improve treatment for adults with depression and comorbid cannabis use disorders (CUD) with an innovative, social media-assisted intervention strategy. The proposed intervention combines peer and therapist social network support via Facebook with an integrated, computer-assisted therapy program combining cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) to reduce cannabis use and depressive symptoms. In 2014 the applicant received a NIDA High Priority, Short- Term Project Award to pilot test SHADE (Self-Help for Alcohol and Other Drug Use and Depression), a computerized intervention combining CBT and MET, in a primary psychiatric care setting, where integrated interventions addressing both mental health and substance use disorders (SUDs) are not readily accessible. Preliminary data indicate that integrating SHADE with psychiatric care for depression: (a) is feasible and acceptable, (b) facilitates treatment engagement and retention in a difficult-to-treat comorbid population with major depression and CUD; and (c) produces significant reductions in depressive symptoms and cannabis use. To optimize this model of evidence-based psychotherapy implementation for depressed cannabis users receiving usual care (TAU) in a primary psychiatric setting, the proposed study integrates a social network support component into the SHADE intervention program. The specific aims of this research are: 1) To develop, with user feedback, a social media-assisted intervention (Connected Cannabis Users’ Network for Enhancement of Cognitive Therapy; CONNECT) for depressed cannabis users that combines SHADE with peer and therapist social network support via a private Facebook group for reducing cannabis use and depression, and improving treatment retention; 2) To test, in a pilot RCT (N=50), the incremental efficacy of CONNECT over and above SHADE in improving cannabis use, depression, and healthcare outcomes among depressed adults with CUD in a primary psychiatric setting; 3) To examine whether social network variables moderate or mediate the impact of CONNECT. We hypothesize that SHADE + CONNECT will yield superior clinical outcomes relative to SHADE in reducing cannabis use, improving depressive symptoms and treatment retention, and reducing health service utilization during and after treatment. Moreover, we expect that the social network support component of CONNECT will have a direct effect on the quality and quantity of participants’ social support network for addiction and depression recovery, a recognized mechanism of change in CBT and MET approaches to the treatment of comorbid populations, and these changes will be associated with cannabis use and depression outcomes. By providing both clinician and peer support to maximize skills acquisition from SHADE, CONNECT may provide a cost-effective and easily deployable strategy for the treatment of depressed cannabis users in a primary psychiatric care setting, a model that may be extended to other settings where SUDs are undertreated.