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、大量使用大麻以及与大麻相关的问题在该地区变得越来越普遍 美国。在经常使用大麻的人中，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，失眠是主要的合并症，其中 80% 参与者报告说，他们经常使用大麻来控制失眠症状。另外，睡觉 这些问题往往是大麻使用障碍患者减少大麻使用的障碍。认知的 失眠行为疗法（CBTi）对于患有失眠症并伴有其他疾病的个体非常有效 健康状况，包括大量和/或有问题地使用物质的情况；虽然还没有被 对那些有大麻使用问题的人进行了全面测试。在最近建成的国家药物滥用研究所 R34 随机对照试点试验，我们小组发现，与远程医疗提供的睡眠相比 卫生教育 (SHE-TM) 条件，定制的远程医疗提供的 CBTi (CBTi-CB-TM) 得到改善 在短期随访期间，非吸烟者失眠和白天功能减少，大麻使用量减少。 使用大麻入睡寻求治疗的成年人。除了与以下相关的重要临床问题外 大麻吸食者失眠的治疗、大量吸食大麻与失眠相关的具体机制 人们对失眠知之甚少。我们建议评估基本的睡眠调节系统是否 – 稳态睡眠驱动——在大麻使用有问题的受试者中失调，以及是否发生变化 该机制与临床结果相关。因此，本研究的目的是招募 对 200 名有大麻使用问题和失眠问题的成年人进行样本评估（1）CBTi-CB-TM 的功效 与 SHE-TM 在睡眠、大麻使用和相关日间症状方面的比较以及 (2) CBTi-CB-TM 对睡眠、大麻使用和相关日间症状的影响 稳态睡眠系统及其与临床结果的关系。在近期成功的基础上 R34，拟议的研究将检查与 CBTi-CB-TM 随机化相关的长期结果 并利用最先进的睡眠稳态测量方法来检查睡眠之间联系的潜在因素 大麻的使用、干预的内容和客观的睡眠结果。这些发现具有重要意义 对于理解大麻使用和睡眠之间的关系以及识别大麻的影响 帮助改善报告问题的庞大且不断增长的群体的结果的策略 大麻使用和睡眠问题。