Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.
Institute for Addiction Prevention, Office of Addiction and Drug Policy of Vienna, Vienna, Austria.
J Med Internet Res. 2022 Apr 20;24(4):e30138. doi: 10.2196/30138.
Prevalence rates for lifetime cannabis use and cannabis use disorder are much higher in people with attention deficit/hyperactivity disorder than in those without. CANreduce 2.0 is an intervention that is generally effective at reducing cannabis use in cannabis misusers. This self-guided web-based intervention (6-week duration) consists of modules grounded in motivational interviewing and cognitive behavioral therapy.
We aimed to evaluate whether the CANreduce 2.0 intervention affects cannabis use patterns and symptom severity in adults who screen positive for attention deficit/hyperactivity disorder more than in those who do not.
We performed a secondary analysis of data from a previous study with the inclusion criterion of cannabis use at least once weekly over the last 30 days. Adults with and without attention deficit/hyperactivity disorder (based on the Adult Attention deficit/hyperactivity disorder Self-Report screener) who were enrolled to the active intervention arms of CANreduce 2.0 were compared regarding the number of days cannabis was used in the preceding 30 days, the cannabis use disorder identification test score (CUDIT) and the severity of dependence scale score (SDS) at baseline and the 3-month follow-up. Secondary outcomes were Generalized Anxiety Disorder score, Center for Epidemiological Studies Depression scale score, retention, intervention adherence, and safety.
Both adults with (n=94) and without (n=273) positive attention-deficit/hyperactivity disorder screening reported significantly reduced frequency (reduction in consumption days: with: mean 11.53, SD 9.28, P<.001; without: mean 8.53, SD 9.4, P<.001) and severity of cannabis use (SDS: with: mean 3.57, SD 3.65, P<.001; without: mean 2.47, SD 3.39, P<.001; CUDIT: with: mean 6.38, SD 5.96, P<.001; without: mean 5.33, SD 6.05, P<.001), as well as anxiety (with: mean 4.31, SD 4.71, P<.001; without: mean 1.84, SD 4.22, P<.001) and depression (with: mean 10.25, SD 10.54; without: mean 4.39, SD 10.22, P<.001). Those who screened positive for attention deficit/hyperactivity disorder also reported significantly decreased attention deficit/hyperactivity disorder scores (mean 4.65, SD 4.44, P<.001). There were no significant differences in change in use (P=.08), dependence (P=.95), use disorder (P=.85), attention deficit/hyperactivity disorder status (P=.84), depression (P=.84), or anxiety (P=.26) between baseline and final follow-up, dependent on positive attention-deficit/hyperactivity disorder screening. Attention deficit/hyperactivity disorder symptom severity at baseline was not associated with reduced cannabis use frequency or severity but was linked to greater reductions in depression (Spearman ρ=.33) and anxiety (Spearman ρ=.28). Individuals with positive attention deficit/hyperactivity disorder screening were significantly less likely to fill out the consumption diary (P=.02), but the association between continuous attention deficit/hyperactivity disorder symptom severity and retention (Spearman ρ=-0.10, P=.13) was nonsignificant. There also was no significant intergroup difference in the number of completed modules (with: mean 2.10, SD 2.33; without: mean 2.36, SD 2.36, P=.34), and there was no association with attention deficit/hyperactivity disorder symptom severity (Spearman ρ=-0.09; P=.43). The same was true for the rate of adverse effects (P=.33).
Cannabis users screening positive for attention deficit/hyperactivity disorder may benefit from CANreduce 2.0 to decrease the frequency and severity of cannabis dependence and attenuate symptoms of depression and attention deficit/hyperactivity disorder-related symptoms. This web-based program's advantages include its accessibility for remote users and a personalized counselling option that may contribute to increased adherence and motivation to change among program users.
International Standard Randomized Controlled Trial Number (ISRCTN) 11086185; http://www.isrctn.com/ISRCTN11086185.
与没有注意力缺陷/多动障碍的人相比，患有注意力缺陷/多动障碍的人一生中使用大麻和大麻使用障碍的流行率要高得多。CANreduce 2.0 是一种通常可有效减少大麻滥用者大麻使用的干预措施。这种自我指导的基于网络的干预措施（持续 6 周）由基于动机访谈和认知行为疗法的模块组成。
我们旨在评估 CANreduce 2.0 干预措施是否会影响筛查出患有注意力缺陷/多动障碍的成年人的大麻使用模式和症状严重程度，而不是那些没有注意力缺陷/多动障碍的成年人。
我们对先前一项研究的数据进行了二次分析，纳入标准为过去 30 天内每周至少使用大麻一次。将患有（根据成人注意力缺陷/多动障碍自我报告筛查器）和不患有（注意力缺陷/多动障碍筛查阴性）注意力缺陷/多动障碍的成年人（根据成人注意力缺陷/多动障碍自我报告筛查器）纳入 CANreduce 2.0 的积极干预组，比较他们在过去 30 天内每天使用大麻的天数、大麻使用障碍识别测试（CUDIT）和严重程度依赖性量表（SDS）的得分，以及 3 个月的随访情况。次要结局为广泛性焦虑症评分、流行病学研究中心抑郁量表评分、保留率、干预依从性和安全性。
报告有注意力缺陷/多动障碍筛查阳性（n=94）和阴性（n=273）的成年人均显著减少了大麻使用的频率（消费天数减少：有：平均 11.53，SD 9.28，P<.001；无：平均 8.53，SD 9.4，P<.001）和严重程度（SDS：有：平均 3.57，SD 3.65，P<.001；无：平均 2.47，SD 3.39，P<.001；CUDIT：有：平均 6.38，SD 5.96，P<.001；无：平均 5.33，SD 6.05，P<.001），以及焦虑（有：平均 4.31，SD 4.71，P<.001；无：平均 1.84，SD 4.22，P<.001）和抑郁（有：平均 10.25，SD 10.54；无：平均 4.39，SD 10.22，P<.001）。注意力缺陷/多动障碍筛查阳性的人也报告注意力缺陷/多动障碍评分显著降低（平均 4.65，SD 4.44，P<.001）。基于注意力缺陷/多动障碍筛查阳性或阴性，在使用（P=.08）、依赖（P=.95）、使用障碍（P=.85）、注意力缺陷/多动障碍状态（P=.84）、抑郁（P=.84）或焦虑（P=.26）方面，基线和最终随访之间没有显著差异。注意力缺陷/多动障碍症状严重程度与减少大麻使用频率或严重程度无关，但与减少抑郁（Spearman ρ=.33）和焦虑（Spearman ρ=.28）有关。注意力缺陷/多动障碍筛查阳性的人填写消费日记的可能性显著降低（P=.02），但注意力缺陷/多动障碍症状严重程度与保留率之间的关联（Spearman ρ=-0.10，P=.13）无统计学意义。完成的模块数量也没有显著的组间差异（有：平均 2.10，SD 2.33；无：平均 2.36，SD 2.36，P=.34），且与注意力缺陷/多动障碍症状严重程度无关（Spearman ρ=-0.09；P=.43）。不良反应发生率也相同（P=.33）。
筛查出注意力缺陷/多动障碍的大麻使用者可能受益于 CANreduce 2.0，以减少大麻依赖的频率和严重程度，并减轻抑郁和注意力缺陷/多动障碍相关症状。这个基于网络的程序的优点包括它对远程用户的可访问性和个性化咨询选项，这可能有助于提高程序用户的依从性和改变动机。
国际标准随机对照试验编号（ISRCTN）11086185；http://www.isrctn.com/ISRCTN11086185。
