Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States of America.
Innovative Programs Research Group, University of Washington, United States of America.
J Subst Abuse Treat. 2019 Mar;98:39-46. doi: 10.1016/j.jsat.2018.12.005. Epub 2018 Dec 18.
Tobacco smoking among those seeking treatment for cannabis use disorder (CUD) is common and is a negative predictor of cannabis outcomes. Quitting tobacco may be beneficial for those seeking to quit cannabis use. This initial proof of concept, controlled trial was designed to compare a simultaneous versus sequential tobacco intervention among those seeking treatment for CUD. Sixty-seven adults received either a simultaneous (SIM) or sequential (SEQ) approach to tobacco cessation in the context of outpatient treatment for CUD. A tobacco intervention (TI) that combined web-based counseling with nicotine replacement therapy (NRT) was provided during weeks 1-12 for SIM and was delayed until weeks 13-24 for SEQ. During weeks 1-12, no between-condition significant differences were observed on treatment participation or cannabis use outcomes. The majority of SIM participants initiated TI counseling (62%), 50% made at least one quit attempt and 41% initiated NRT. Interestingly, 39% in SEQ made tobacco quit attempts and 18% initiated NRT on their own before the TI was offered to them. However, only 30% of those in SEQ continued treatment during weeks 13-24, which compromised between-condition comparisons following the TI, but illustrated a potential clinical concern with delaying the TI. Tobacco cessation outcomes generally were poor and did not differ between conditions. This initial controlled trial suggests that addressing tobacco use during CUD treatment is acceptable and generates action towards tobacco cessation. Additional trials testing more intensive TI models may be necessary to identify more efficacious interventions for co-use of cannabis and tobacco.
在寻求治疗大麻使用障碍（CUD）的人群中，吸烟现象很普遍，而且是大麻治疗结果的负面预测指标。戒烟可能对那些寻求戒除大麻使用的人有益。这项初步的概念验证、对照试验旨在比较同时与序贯干预治疗 CUD 患者的吸烟问题。67 名成年人在门诊治疗 CUD 的背景下，分别接受了同时（SIM）或序贯（SEQ）的戒烟方法。在第 1-12 周，对 SIM 患者提供了一种结合网络咨询和尼古丁替代疗法（NRT）的戒烟干预（TI），而对 SEQ 患者则延迟到第 13-24 周。在第 1-12 周，在治疗参与或大麻使用结果方面，SIM 和 SEQ 两组之间没有观察到显著的治疗差异。SIM 组的大多数参与者开始了 TI 咨询（62%），50%的人至少尝试了一次戒烟，41%的人开始使用 NRT。有趣的是，SEQ 组有 39%的人自行尝试戒烟，18%的人在 TI 提供给他们之前开始使用 NRT。然而，只有 30%的 SEQ 组在第 13-24 周继续治疗，这影响了 TI 后的组间比较，但说明了延迟 TI 的潜在临床关注。戒烟结果普遍较差，且两组之间无差异。这项初步的对照试验表明，在治疗 CUD 期间解决吸烟问题是可以接受的，并促使人们采取行动戒烟。可能需要进行更多的临床试验，测试更有效的 TI 模型，以确定针对大麻和烟草共使用的更有效的干预措施。
