Prospective changes in patient-reported and objective functioning following reduction of cannabis use - PROJECT SUMMARY/ABSTRACT Rates of cannabis use and cannabis use disorder (CUD) among adults in the United States are increasing and the perception of harm associated with cannabis use continues to decline. Further, motivation to completely abstain from cannabis is low. Harm reduction strategies and their benefits have strong empirical support across other substances (alcohol, opioids, and stimulants) with validation of non-abstinence endpoints as indicators of treatment success. While preliminary evidence–some from our group—suggests that cannabis harm reduction may yield benefit in certain domains, a comprehensive, prospective, and rigorous assessment of the potential benefits of reduced cannabis consumption has not yet been conducted. The accumulating evidence base to suggest benefits to cannabis use reduction is promising; however, this literature is limited in four key ways: 1) knowledge has largely been derived from secondary analysis of trials that were not designed to evaluate the benefits of harm reduction and that did not measure cannabis use and reduction in standard delta-9- tetrahydrocannabinol (THC) units, 2) thresholds of meaningful cannabis reduction are lacking, 3) there are no consensus outcomes to demonstrate cannabis use reduction results in meaningful improvement, and 4) studies have failed to comprehensively capture patient-reported and objective improvement in functioning. The current proposal seeks to address an important gap in knowledge and is informed by our group’s data-driven metrics of clinically significant cannabis use reduction. We propose an 8-week cannabis use reduction trial for adults (ages 18+; N=176) with CUD. All participants will receive comprehensive CUD treatment, inclusive of cognitive behavioral therapy, brief motivational interviewing, and incentives for reduction. Specific aims are to assess: 1) associations between cannabis reduction and end-of-treatment cannabis-related problems, 2) improvements in objective measures of sleep and cognitive performance based on degree on cannabis use reduction, and 3) quality of life, CUD criteria count and severity, and other psychosocial improvements based on degree of cannabis use reduction. The overarching hypothesis is that participants reducing cannabis use will show significant, dose-dependent improvement across patient-reported and objective outcomes. In an exploratory aim, we also propose to capture patients’ perceptions of their areas of greatest improvement, as well as successful reduction strategies. Despite strong empirical support for harm reduction for other substances, it is currently unknown if cannabis harm reduction approaches will produce beneficial outcomes. The proposed study will fill a critical gap, as it is specifically designed to recruit those interested in cannabis reduction for a reduction-focused trial and will assess a variety of patient-reported and objective outcomes. Results will have the potential to impact CUD research and treatment by promoting a shift toward alternative, non-abstinence outcomes of treatment success.
