14h30_05_A1_23_Tom Freeman
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Transcript of 14h30_05_A1_23_Tom Freeman
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7/25/2019 14h30_05_A1_23_Tom Freeman
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How can we optimise treatment of people
who are cannabis dependent?
Tom Freeman
Clinical Psychopharmacology UnitUniversity College London, UK
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Disclosure statement:I have no conflicts of interest
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EMCDDA (April 2015)
Overview ofcurrent treatment
Strategies forimprovement
Outline of talk
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CURRENT TREATMENT
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What is the problem?
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Current treatment
Psychological Approaches
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Cannabis specific:CANDIS
Current treatment
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Hoch et al. 2011, 2012, 2014
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Cannabis specific:CANDIS
MI resolve ambivalence &strengthen motivation to change
CBT cannabis education,
cognitions-emotions-behaviours, newcoping skills
Psychosocial problem solving (e.g.
unemployment)
MI: Motivational Interviewing; CBT: Cognitive Behavioural Therapy
Current treatment
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Cannabis specific:CANDIS
End treatment: 46.3% abstinentvs. 17.7% in waiting list
6 months: 35.7% abstinent
Hoch et al. 2011, 2012, 2014
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Current treatment
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General approaches
Based on similar concepts
(e.g. MI/CBT)
Tailored to individual need
All drug groups treated together;cannabis users are younger with
different problems
Current treatment
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Unmet clinical need
EMCDDA (April 2015)
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STRATEGIES FOR IMPROVEMENT
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1) Increase European investment
Treatment provision
Research funding
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2) Refine psychological approaches
MI (1-2 sessions) and CBT (4-14 sessions) beneficial
CM may improve further
Optimum number of
sessions (cost effective?)
Cannabis-specific vs. general approaches?
Cooper et al. (2015) Health Technology Assessment
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2) Refine psychological approaches
Control group (drug trial)
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2) Refine psychological approaches
Control group (drug trial) Control group (psychological trial)
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2) Refine psychological approaches
Control group (drug trial) Control group (psychological trial)
Placebo versus nocebo
Move beyond everything works
Consider single- or even double- blinding
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3) Find effective pharmacotherapies
Oral THCwithdrawal, maintenance
THC/CBD spray
withdrawal, maintenance
N-acetylcysteine (GLU modulator)
2.4 greater odds of negative urine
Gabapentin (GABA modulator)
use, withdrawal, depression, sleep, problems
Allsop et al. (2014), Gray et al. (2012), Levin et al. (2011), Mason et al. (2012)
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Placebo
CBD 200mg
CBD 400mg
CBD 800mg
4 weeks
24 weeks
Dependent on
cannabis &
want to quit
Primary outcome: cannabis use during
treatment
3) Find effective pharmacotherapies
http://www.mrc.ac.uk/ -
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4) Prioritise specific populations
Adolescence: huge clinical need & potentially the mostvulnerable
Co-morbid mental health problems: psychological
interventions are not effective
Cooper et al. (2015) Health Technology Assessment
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5) Improve access to treatment
Telephone & computer: small effect across 10 studies
Computer vs. therapist MI/CBT/CM?Same attendance, retention and cannabis use outcomes
Smartphone: promising area Jan Copeland (symposium on Friday)
Budney et al. (2011), Tait et al. (2013)
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Hindocha et al. (submitted)
6) Dont forget about tobacco
Europe: 78 92%
Australasia: 40 50%
Americas: 7 12%
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Is cannabis a gateway for harder drugs?
Reverse gateway: people are exposed to tobacco first by
using cannabis
Tobacco linked to greater cannabis dependence and relapse
Dual abstinence: best outcome
Haney et al. (2010), Hindocha et al. (2015), Patton et al. (2005)
6) Dont forget about tobacco
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Harm reduction?
Pipes/bongs/vaporizers may facilitate use without tobacco
6) Dont forget about tobacco
12thAug 2015
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Rising clinical need across Europe
Specific/general psychological approaches
How to optimise treatment?
1) Increase European investment
2) Refine psychological approaches
3) Find effective pharmacotherapies
4) Prioritise specific populations
5) Improve access to treatment
6) Dont forget about tobacco
Conclusion
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Clinical Psychopharmacology Unit, UCL
Celia Morgan, Exeter
Adam Winstock,GDS
Michael Lynskey,KCL
Thanks to collaborators and funders
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Tailor treatment to individual need
DSM-5 Cannabis Use Disorder
Continue despite problems: psychological/physicalTime spent obtaining, using, recovering
Use more/longer than intended
Tolerance
Craving/strong desire
Give up other activities
Unable to control use or quit
Withdrawal
Failure to meet important obligations
Continue despite problems: social/interpersonal
Use in hazardous situations