Department of Psychiatry and Addictology, University of Montreal, 2900 boulevard Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
Research Center of the University Institute in Mental Health of Montreal, Montreal, QC, Canada.
JMIR Ment Health. 2024 Nov 27;11:e58499. doi: 10.2196/58499.
The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD.
This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD.
Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model.
Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms.
Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention.
大麻使用障碍（CUD）和严重精神障碍（SMD）的双重诊断导致患者情况复杂。大麻使用已知会对精神症状、药物依从性和疾病预后产生负面影响。此外，目前可用的心理治疗方法在该人群中的效果有限。在这种情况下，我们的研究团队开发了虚拟角色干预，这是一种使用虚拟现实作为治疗工具来治疗 SMD 患者 CUD 的方法。
这项初步临床试验旨在评估 32 名 SMD 和 CUD 双重诊断患者接受为期 8 次的虚拟角色干预治疗后的 1 年随访期间，该方法对 CUD 的疗效。
在 8 次干预疗程中，参与者有机会与代表其生活中重要人物的虚拟角色进行对话，该角色由治疗师实时动画呈现。主要结果是大麻的消耗量和使用频率。次要结果包括大麻使用问题的严重程度、改变的动机、使用大麻的保护策略、大麻使用的后果、精神症状和生活质量。使用线性混合效应模型评估干预前评估期、干预后和干预结束后 3、6 和 12 个月报告结果的变化。
大麻消耗量显著减少，并且在 12 个月的随访中保持不变（d=0.804；P<.001；通过尿液定量证实）。大麻使用频率在 3 个月随访时出现较小的显著减少（d=0.384；P=.03）。此外，CUD 的严重程度、与大麻相关的负面后果、改变大麻使用的动机以及减轻与大麻使用相关的危害的策略均有所改善。最后，生活质量和精神症状也有适度的改善。
总的来说，这种独特的干预方法显示出有希望的结果，并且似乎在干预结束后 12 个月内仍保持不变。为了克服初步研究的方法学限制，目前正在进行一项单盲随机对照试验，以比较虚拟角色干预治疗 CUD 与常规成瘾干预的效果。
