Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
J Subst Use Addict Treat. 2024 Nov;166:209472. doi: 10.1016/j.josat.2024.209472. Epub 2024 Aug 5.
To improve treatment access for emerging adults with cannabis use disorder (CUD), we developed a telehealth counseling-plus-mHealth intervention and remotely conducted a single-arm open pilot study to preliminarily evaluate its feasibility in primary care.
A multidisciplinary team including youth developed the intervention using the structure of the MOMENT intervention: two weekly counselor-delivered Motivational Enhancement Therapy (MET) sessions, then two weeks of smartphone surveys (4 prompted/day) querying socioemotional contexts and cannabis use, with pre-programmed messages on report of personal triggers for use (Ecological Momentary Intervention; EMI). The team adapted the MET for virtual delivery; created material to enhance self-reflection, plan behavior change, and anticipate withdrawal; shortened the sessions; and tested them with five youth actors. EMI messages were created to align with the MET and programmed to minimize repetition. Patients aged 18-25 using recreational cannabis ≥3 days/week were recruited from an urban medical practice. Participants received the intervention and responded to surveys on satisfaction and burden. At baseline, post-intervention, and two months, participants reported behavior change readiness/importance/confidence and cannabis use. EMI engagement was calculated as % days with ≥1 phone survey completed.
Fourteen eligible patients enrolled; 79 % used cannabis daily/near-daily and 100 % reported use problems. All completed both MET sessions and responded to EMI surveys. All agreed/strongly agreed that they felt respected by, comfortable with, and trust for the counselor and that the activities and discussion were helpful; all rated the MET sessions as very good/excellent. Technical issues were infrequent and minor. Median EMI engagement was 100 % (≥1 report/day) in each week. Behavior change confidence was higher post-intervention and importance and confidence were higher at two months vs. baseline. By two months, 11 participants had started to change cannabis use; median percent days of use in the past 30 days declined by 27 % and average times of use per use day declined by 28 %. All rated intervention quality as good, very good, or excellent.
Emerging adults were highly satisfied and engaged with a telehealth MET counseling-plus-mHealth EMI intervention for cannabis use and reported higher motivation to change cannabis use and less use post-intervention and at 2-month follow-up.
为了改善新兴成年人群体的大麻使用障碍（CUD）的治疗机会，我们开发了一种远程医疗咨询加移动健康（mHealth）干预措施，并进行了一项单臂开放式试点研究，初步评估其在初级保健中的可行性。
一个由青年组成的多学科团队使用 MOMENT 干预措施的结构开发了干预措施：两次每周由顾问提供的动机增强治疗（MET）课程，然后是两周的智能手机调查（每天 4 次提示），询问社会情感背景和大麻使用情况，并根据个人使用触发因素（生态瞬时干预；EMI）报告预编程消息。团队调整了 MET 以进行虚拟交付；创建了材料以增强自我反思、计划行为改变和预测戒断；缩短了课程；并与五名青年演员一起进行了测试。EMI 消息是根据 MET 创建的，并编程以最小化重复。从一家城市医疗实践中招募了年龄在 18-25 岁之间、每周至少使用大麻 3 天的患者。参与者接受了干预，并对满意度和负担进行了调查。在基线、干预后和两个月时，参与者报告了行为改变的准备/重要性/信心和大麻使用情况。EMI 参与度计算为完成≥1 次电话调查的天数百分比。
14 名符合条件的患者入组；79%的患者每天/几乎每天使用大麻，100%的患者报告存在使用问题。所有人都完成了两次 MET 课程和 EMI 调查。所有人都同意/强烈同意他们感到受到顾问的尊重、舒适和信任，并且活动和讨论很有帮助；所有人都将 MET 课程评为非常好/优秀。技术问题很少且轻微。每周 EMI 参与度均为 100%（每天≥1 次报告）。干预后行为改变信心较高，两个月时重要性和信心均高于基线。两个月时，11 名参与者已开始改变大麻使用情况；过去 30 天内使用天数的中位数下降了 27%，每次使用天数的使用次数中位数下降了 28%。所有人都将干预质量评为好、非常好或优秀。
新兴成年人对远程医疗 MET 咨询加移动健康 EMI 干预大麻使用非常满意且参与度高，并报告说在干预后和 2 个月随访时，改变大麻使用的动机更高，使用量更少。
