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

项目总结/摘要 在AUD患者中，大麻是最常用的精神活性物质。尽管最初 有证据表明大麻使用（CU）对纵向AUD治疗的总体不利影响 结果，关于CU如何影响酒精消费和渴望存在显着分歧。竞争 关于CU和酒精之间关联的理论集中在CU是否作为替代物（即， 代替酒精的作用，导致渴望、使用和危害的减少）或补充（即， 增强酒精的影响，导致增加的渴望，使用和危害）。在非- 参与治疗的样品表明了重要的机制（例如，渴望）和调节器（例如，频率 CU，同时使用的历史，特质冲动）可以阐明这些竞争的理论。一个重要的差距， 这些文献是在研究自然主义CU对酒精渴望的预期和瞬间影响 和酒精治疗中的个人消费。拟议的研究旨在利用以下方法解决这一差距： 一个密集的纵向设计，全面检查内和人与人之间的CU模式， 治疗开始后关键的第一年的酒精结果。早期的主要成果 治疗是酒精的渴望和危险的酒精消费模式（消费率和数量 消费）。使用酒精生物传感器可以客观地测量这些酒精消耗量 自然发生的模式。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，以及第一个在自然界中研究这些关联的人。 环境中使用BACtrack Skyn被动测量透皮酒精浓度（TAC）。醇 渴望将被衡量为CU的一个重要结果，以及CU的一种机制。 导致酒精消费。纵向生态瞬时评估（EMA）爆破设计（4个10- 基线、1个月、2个月和3个月时的日间爆发）将用于隔离CU对酒精的瞬时影响 渴望和消费（通过TAC测量）在最近的大麻使用者分层样本。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 治疗开始后第一年的AUD缓解模式。本研究将直接告知：a）临床 关于酒精治疗期间CU风险的决策，B）AUD的未来干预发展， 及c）在扩大大麻合法化后的政策;并与 在NIH的成瘾合作研究。

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.