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: 10701928
• 负责人: J. Todd Arnedt
• 金额: $ 71.59万
• 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/10701928
• 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; Recreation; 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 improvement; improved; improved outcome; improvement on sleep; 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，大麻使用和与大麻有关的问题在越来越普遍 美国。在定期使用大麻的人中，很大的失眠是常见的。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合并症，其中80％ 参与者报告说，他们定期使用大麻来管理失眠症状。另外，睡觉 问题通常是减少大麻使用障碍的大麻使用的障碍。认知的 失眠（CBTI）的行为疗法对与其他人的失眠患者非常有效 健康状况，包括大量和/或有问题使用物质的状况；虽然不是 在有问题的大麻使用的人中进行了全面测试。在最近填写的国家药物滥用研究所 R34随机对照试验试验，我们的小组发现，与远程医疗的睡眠相比 卫生教育（SHE-TM）条件，一种量身定制的远程医疗CBTI（CBTI-CB-TM） 在非 - 寻求治疗的成年人使用大麻进行睡眠。除了与 在使用大麻的人中治疗失眠的治疗，与大麻使用的特定机制和 失眠知之甚少。我们建议评估是否基本的睡眠调节系统 - 体内稳态睡眠驱动器 - 使用有问题的大麻的受试者失调，以及是否发生变化 该机制与临床结局有关。这是拟议研究的目的是招募 有200名有问题大麻的成年人的样本和失眠来评估（1）CBTI-CB-TM的效率 与SHE-TM进行睡眠，大麻使用和相关的白天症状以及（2）CBTI-CB-TM的影响 体内稳态睡眠系统及其与临床结果的关联。基于最近的成功 R34，拟议的研究将检查与CBTI-CB-TM随机化相关的长期结局 并利用睡眠体内平衡的最先进的度量来检查有关之间联系的因素 大麻使用，干预措施的内容和客观的睡眠结果。这些发现很重要 了解大麻使用和睡眠之间的关系以及识别大麻之间的关系 有助于改善报告有问题的人群的策略 大麻使用和睡眠问题。