Effect of Cannabis Use on Alcohol Craving and Consumption among those in Alcohol Treatment

项目摘要/摘要 在AUD患者中，大麻是最常用的精神活性物质。虽然最初 有证据表明，大麻使用(CU)对纵向AUD治疗的总体有害影响 结果，在CU如何影响酒精消费和渴望的问题上存在重大分歧。竞争 关于CU和酒精之间联系的理论集中在CU是否作为替代品(即， 取代酒精的影响，从而减少渴望、使用和伤害)或补充(即， 增强酒精的影响，导致渴望、使用和伤害的增加)。非政府组织的前期工作 参与治疗的样本提出了重要的机制(例如，渴望)和调节因素(例如，频率 CU，同时使用的历史，特征冲动)可以解释这些相互竞争的理论。有一个重要的差距 这些文献是关于自然主义CU对酒精渴求的预期和瞬时影响的研究 以及个人在酒精治疗中的消费。拟议的研究旨在通过以下方式解决这一差距 一种密集的纵向设计，全面考察CU的人内和人与人之间的模式 在治疗开始后关键的第一年内的酒精结果。早期研究的关键成果 治疗是酒精渴求和有风险的酒精消费模式(饮酒率和饮酒量 消耗)。使用酒精生物传感器可以客观地测量这些酒精消耗量 自然出现的模式。拟议的项目将是迄今为止最全面的审查 CU对酒精治疗结果的影响以及首次在自然情况下检查这些关联 使用BACTrack Skyn被动测量经皮酒精浓度(TAC)的环境。酒精 渴求将被衡量为CU在当下的一个重要结果，以及CU 会导致饮酒。纵向生态瞬时评估(EMA)突发设计(4个10- 基线、1个月、2个月和3个月的日突发事件)将用于隔离CU对酒精的瞬时影响 最近吸食大麻的分层样本中的渴望和消费(通过TAC衡量)。在此之后 EMA阶段，参与者将进行6个月、9个月和12个月的随访，以完全捕获CU和酒精 在治疗开始后的第一年内，模式/AUD缓解。这项研究将直接告知：a)临床 酒精治疗期间CU风险的决策，b)AUD的未来干预发展， 和c)扩大大麻合法化后的政策；并与联合国毒品和犯罪问题办公室 美国国立卫生研究院关于成瘾的合作研究。

PROJECT SUMMARY/ABSTRACT Among those with AUD, cannabis is the most commonly used psychoactive substance. Although initial evidence suggests an overall detrimental impact of cannabis use (CU) on longitudinal AUD treatment outcomes, there is significant divergence about how CU impacts alcohol consumption and craving. Competing theories about the association between CU and alcohol focus on whether CU acts as a substitute (i.e., replacing the effects of alcohol, resulting in decreased craving, use, and harms) or complement (i.e., enhancing the effects of alcohol, resulting in increased craving, use, and harms). Preliminary work in non- treatment engaged samples suggests important mechanisms (e.g., craving) and moderators (e.g., frequency of CU, history of simultaneous use, trait impulsivity) may elucidate these competing theories. An important gap in the literature is in the examination of prospective and momentary effects of naturalistic CU on alcohol craving and consumption among individuals in alcohol treatment. The proposed study aims to address this gap using an intensive longitudinal design to comprehensively examine within- and between-person patterns of CU on alcohol outcomes over the critical first year after treatment initiation. Key outcomes among those early in treatment are alcohol craving and risky alcohol consumption patterns (rate of consumption and volume consumed). Use of alcohol biosensors allow for the objective measurement of these alcohol consumption patterns as they naturally occur. The proposed project will be the most comprehensive examination to date of the impact of CU on alcohol treatment outcomes and the first to examine these associations in the natural environment using the BACtrack Skyn to passively mesure transdermal alcohol concentration (TAC). Alcohol craving will be measured as an important outcome of CU in the moment, as well as a mechanism by which CU leads to alcohol consumption. A longitudinal ecological momentary assessment (EMA) burst design (four 10- day bursts at baseline, 1, 2, and 3 months) will be used to isolate the momentary impact of CU on alcohol craving and consumption (measured via TAC) in a stratified sample of recent cannabis users. Following this EMA phase, participants will engage in 6, 9, and 12 month follow-ups to fully capture CU and alcohol patterns/AUD remission over the first year after treatment initiation. This research will directly inform: a) clinical decision-making about the risks of CU during alcohol treatment, b) future intervention development for AUD, and c) policy in the wake of expanding cannabis legalization; and is well-aligned with the objectives of the Collaborative Research on Addiction at NIH.