Determining the impact of cannabis use and severity on tobacco cessation outcomes: A prospective tobacco treatment trial

项目摘要/摘要 美国的烟草使用率在过去几十年里一直在稳步下降， 尽管烟草造成的负担仍然令人震惊。烟草使用率不成比例 与那些同时患有药物使用障碍和精神疾病的人相比 普通人口。特别是，吸烟者共同使用大麻的情况非常普遍， 美国成年人的共同使用似乎正在增加，这与大麻的总体增加是一致的 美国成年人的使用率。鉴于目前的大麻情况，大麻使用量可能会进一步增加。 并可能导致大麻和烟草的共同使用继续增加。尽管共同使用率很高， 对于这类人群的治疗建议和对 共同使用对成功戒烟的影响。关于大麻对戒烟影响的文献 具体而言，结果喜忧参半，充满局限性，包括方法上的差异，缺乏 生物化学验证，以确认大麻的使用状况和严重程度，以及研究样本中的变化。 目前，还没有进行前瞻性研究来评估大麻使用对烟草的影响。 停止。此外，还没有研究收集烟草治疗期间大麻使用的变化来评估 由于烟草的减少、禁欲或更令人担忧的补偿性(即增加)使用 节制/禁欲。这项拟议的应用是一项为期12周的前瞻性戒烟试验，使用 已建立的戒烟试验的典型方法和结果，但具体招募共同使用者 大麻。共同使用者将被过度抽样(2：1)，并将与仅吸烟的参与者进行比较。全 参与者(18-40岁；N=172)将接受主动戒烟治疗(varenicline，应急) 管理和心理咨询)，为期12周，而大麻的使用将不会具体 地址。将在12周内收集对烟草和大麻使用情况的生化核查 治疗，除了通过移动每日日记自我报告使用情况外。这项拟议研究的目的是： 1)审查共同吸食大麻对共同吸烟者戒烟结果的影响 纯烟草参与者(目标1)，2)在大麻共同使用者中，评估#年期间大麻使用的变化 烟草治疗(目标2)，以及3)评估大麻联合使用严重程度对 戒烟(探索性目标1)。这一拟议应用的结果可能会对 在同时吸食大麻的人中治疗烟草使用障碍，并将有助于 针对提供者的治疗建议。随着大麻使用率的持续增加，大麻的存在 戒烟试验和临床护理中的吸烟者将继续普遍，其结果来自 这项研究将有助于指导他们的治疗，并为他们提供最好的长期戒酒机会。

PROJECT SUMMARY/ABSTRACT Tobacco use rates in the United States (US) have been steadily declining over the past several decades, though the burden resulting from tobacco continues to be staggering. Tobacco use rates are disproportionately high among those with co-occurring substance use disorders and psychiatric conditions compared to the general population. In particular, cannabis co-use among tobacco users is exceedingly common and rates of co-use appear to be increasing among adults in the US, which is consistent with overall increases in cannabis use rates among US adults. Given the current cannabis landscape, further increases in cannabis use are likely and may result in continued increases in the co-use of cannabis and tobacco. Despite high rates of co-use, there is little consensus regarding treatment recommendations for this population and an understanding of the impact of co-use on successful cessation. The literature on the impact of cannabis on tobacco cessation outcomes specifically has been mixed and fraught with limitations, including methodological variation, lack of biochemical verification to confirm cannabis use status and severity, and variations in study samples. Currently, no prospective studies have been conducted to evaluate the impact of cannabis use on tobacco cessation. Further, no studies have collected cannabis use changes during tobacco treatment to assess for reductions, abstinence, or of greater concern, compensatory (i.e., increased) use as a result of tobacco reduction/abstinence. This proposed application is a prospective 12-week tobacco cessation trial using established methods and outcomes typical of tobacco cessation trials, but specifically recruiting co-users of cannabis. Co-users will be oversampled (2:1) and will be compared to tobacco only participants. All participants (ages 18-40; N=172) will receive active tobacco cessation treatment (varenicline, contingency management, and psychosocial counseling) for 12 weeks, while cannabis use will not be specifically addressed. Biochemical verification of tobacco and cannabis use will be collected throughout the 12-week treatment, in addition to self-reports of use through mobile daily dairies. The aims of this proposed study are to; 1) examine the impact of cannabis co-use on tobacco cessation outcomes among co-users compared to tobacco only participants (Aim #1), 2) among cannabis co-users, assess changes in cannabis use during tobacco treatment (Aim #2), and 3) assess for a dose-dependent impact of cannabis co-use severity on tobacco cessation (Exploratory Aim #1). The results from this proposed application have the potential to impact the treatment of tobacco use disorder among those concurrently using cannabis and will contribute to treatment recommendations for providers. As cannabis use rates continue to increase, the presence of co- users in tobacco cessation trials and presenting in clinical care will continue to be common and results from this study will help to guide their treatment and provide them with the best chances of long-term abstinence.