Targeting insomnia to improve outcomes in adults with problematic cannabis use

针对失眠，改善大麻使用问题成年人的结果

• 批准号: 10557992
• 负责人: J. Todd Arnedt
• 金额: $ 73.24万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557992
• 关键词: Adult; Aftercare; Alcohols; Cannabis; Chronic; Circadian Rhythms; Clinical; Cognitive Therapy; Cohort Studies; Comorbid Insomnia; Data; Education; Electroencephalography; Frequencies; Future; HIV risk; Health; Homeostasis; Hygiene; Individual; Intervention; Link; Measures; Mediating; Medical; Medical Marijuana; National Institute of Drug Abuse; Neurocognitive; Outcome; Participant; Patients; Polysomnography; Population; Prevalence; Process; REM Sleep; Randomized; Randomized Controlled Trials; Reporting; Respondent; Risk; Risk Behaviors; Sampling; Sleep; Sleep Architecture; Sleep Disorders; Sleeplessness; Slow-Wave Sleep; Substance Use Disorder; Symptoms; System; Telemedicine; Testing; Therapeutic Intervention; Time; United States; Withdrawal; Work; cannabis withdrawal; cognitive benefits; cognitive testing; comorbidity; comparative efficacy; evidence base; follow-up; functional outcomes; improved; improved functioning; improved outcome; indexing; innovation; marijuana use; marijuana use disorder; medical specialties; novel; novel strategies; pilot trial; poor sleep; primary outcome; psychosis risk; recruit; sleep abnormalities; substance use; substance use treatment; success; symptom management

Cannabis use, heavy cannabis use, and cannabis-related problems are becoming increasingly common in the United States. Among those who use cannabis regularly, significant insomnia is common. For example, our data from 800 patients seeking medical cannabis indicate that insomnia is a chief comorbidity, with 80% of participants reporting that they regularly use cannabis to manage symptoms of insomnia. In addition, sleep problems are often a barrier to reducing cannabis use among those with Cannabis Use Disorders. Cognitive Behavioral Therapy for insomnia (CBTi) is highly effective in individuals with insomnia comorbid with other health conditions, including those with heavy and/or problematic use of substances; although it has not been fully tested in those with problematic cannabis use. In a recently-completed National Institute on Drug Abuse R34 randomized controlled pilot trial, our group found that, compared to a telemedicine-delivered Sleep Hygiene Education (SHE-TM) condition, a tailored telemedicine-delivered CBTi (CBTi-CB-TM) improved insomnia and daytime functioning and reduced cannabis use more during short-term follow-up among non- treatment-seeking adults using cannabis for sleep. In addition to important clinical questions related to the treatment of insomnia in those who use cannabis, the specific mechanisms linking heavy cannabis use and insomnia are poorly understood. We propose to evaluate whether a fundamental sleep regulatory system – homeostatic sleep drive – is dysregulated in subjects with problematic cannabis use and whether changes in this mechanism are associated with clinical outcomes. Thus, the aims of the proposed study are to recruit a sample of 200 adults with problematic cannabis use and insomnia to evaluate (1) the efficacy of CBTi-CB-TM vs. SHE-TM for sleep, cannabis use, and associated daytime symptoms and (2) the effects of CBTi-CB-TM on the homeostatic sleep system and its association with clinical outcomes. Building on the success of the recent R34, the proposed study will examine the longer-term outcomes associated with randomization to CBTi-CB-TM and utilize state-of-the-art measures of sleep homeostasis to examine the factors underlying the links between cannabis use, contents of the intervention, and objective sleep outcomes. These findings have important implications for understanding the relationship between cannabis use and sleep, as well as for identifying strategies to help improve outcomes in the large and growing group of individuals who report problematic cannabis use and sleep problems.

大麻使用、重度大麻使用以及与大麻相关的问题在美国越来越普遍