Targeting insomnia to improve outcomes in adults with problematic cannabis use

吸食大麻、大量吸食大麻以及与大麻有关的问题在 美国。在那些经常吸食大麻的人中，严重失眠是很常见的。例如，我们的 来自800名寻求医用大麻的患者的数据表明，失眠是一种主要的共病，80%的 参与者报告说，他们经常使用大麻来控制失眠症状。此外，睡眠 在大麻使用障碍患者中，问题往往是减少大麻使用的障碍。认知 失眠行为疗法(CBTi)对失眠合并其他疾病的患者非常有效 健康状况，包括大量和/或有问题地使用物质的情况；尽管还没有 在那些大麻使用有问题的人身上进行了全面的测试。在最近完成的国家药物滥用研究所 R34随机对照试验，我们的团队发现，与远程医疗提供的睡眠相比 卫生教育(SHE-TM)条件，量身定做的远程医疗交付CBTI(CBTi-CB-TM)得到改善 失眠和日间功能和减少大麻使用在短期随访期间在非 寻求治疗的成年人使用大麻睡觉。除了重要的临床问题外， 治疗吸食大麻者的失眠，与大量吸食大麻有关的具体机制 人们对失眠知之甚少。我们建议评估一个基本的睡眠调节系统- 动态平衡睡眠驱动力-在有问题的大麻使用的受试者中调节失调，以及 这一机制与临床结果有关。因此，拟议研究的目的是招募一名 200例有问题的大麻使用和失眠的成人样本评估(1)CBTi-CB-TM的疗效 与SHE-TM相比，用于睡眠、大麻使用和相关的白天症状，以及(2)CBTi-CB-TM对 稳态睡眠系统及其与临床结果的关系。在最近的成功基础上 R34，拟议的研究将检查与随机使用CBTi-CB-TM相关的长期结果 并利用最先进的睡眠动态平衡测量方法来检查潜在的因素 大麻使用、干预内容和客观睡眠结果。这些发现具有重要的意义 对理解大麻使用和睡眠之间的关系以及确定 帮助改善报告有问题的庞大且不断增长的个人群体的结果的战略 大麻使用和睡眠问题。

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.