Cognitive Behavioral Therapy for Alcoholism and Cannabis Abuse

Overseen By Kelly Xiao, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Centre for Addiction and Mental Health

Disqualifiers: Suicidal ideation, Unstable psychiatric, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

400 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, you must be able to safely abstain from alcohol and cannabis for 12 hours before assessments.

What data supports the effectiveness of the treatment Cognitive Behavioral Therapy (CBT) for alcoholism and cannabis abuse?

Research shows that Cognitive Behavioral Therapy (CBT) is effective for treating both alcohol and cannabis use disorders. Studies have found that people who received CBT reported better outcomes, such as increased abstinence and fewer substance-related problems, compared to those who did not receive the treatment. ^{1 2 3 4 5}

Is Cognitive Behavioral Therapy (CBT) safe for treating alcohol and cannabis use disorders?

Cognitive Behavioral Therapy (CBT) is generally considered safe for treating various substance use disorders, including alcohol and cannabis use. It is a well-established, evidence-based treatment that has been used safely in both individual and group settings. ^{2 5 6 7 8}

How is Cognitive Behavioral Therapy (CBT) different from other treatments for alcoholism and cannabis abuse?

Cognitive Behavioral Therapy (CBT) is unique because it focuses on changing thought patterns and behaviors related to substance use, and it can be delivered in various formats, including computer-based programs, which makes it more accessible and flexible compared to traditional in-person therapy sessions. ^{2 3 5 6 9}

What is the purpose of this trial?

This 2-arm study will recruit participants with 1) alcohol use disorder and 2) cannabis use disorder for a 12-week cognitive behavioral therapy, following a thorough baseline assessments on executive function, incentive salience, and negative emotionality.

Research Team

Matthew Sloan, MD

Principal Investigator

Centre for Addiction and Mental Health

Eligibility Criteria

This trial is for adults over 18 who have been diagnosed with alcohol use disorder (AUD) or cannabis use disorder (CUD), are willing to participate in group therapy, and can abstain from substances before assessments. They must meet specific criteria for risky drinking or frequent cannabis use. Those unable to communicate in English or unwilling to follow the study's abstinence requirements cannot join.

Inclusion Criteria

I can speak and understand English well enough to give informed consent.

I can avoid alcohol, cannabis, and other substances (except tobacco) for 12 hours before tests.

Meets criteria for risky drinking, defined as > 10 drinks per week for females and > 15 drinks per week for males on average over the past 30 days (AUD group) or daily or near-daily cannabis use over the past 30 days, defined as ≥ 4 days of cannabis use per week on average (CUD group)

Exclusion Criteria

Active suicidal ideation at time of assessment

Suicide attempt within the past month

Unstable psychiatric or medical status (e.g., acute psychosis or mania) or unstable use of another substance that may interfere with participation in groups (e.g. active fentanyl use)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants undergo thorough baseline assessments of executive function, incentive salience, and negative emotionality

1-2 weeks

Treatment

Participants receive 12 weeks of cognitive behavioral therapy (CBT) for their respective disorders, with optional pharmacotherapy for AUD and motivational enhancement therapy for CUD

12 weeks

Weekly group therapy sessions

Follow-up

Participants are monitored for changes in drug consumption, craving, and other psychological measures

4 weeks

Treatment Details

Interventions

• CBT

Trial Overview The study tests if assessing three brain functions—executive function, incentive salience, and negative emotionality—before treatment can predict how well people with AUD or CUD respond to therapy. Participants will receive 12 weeks of cognitive behavioral therapy (CBT), with additional pharmacotherapy for AUD if needed.

Participant Groups

Group I: Cannabis Use Disorder Experimental Treatment 1 Intervention

Participants will be treated with 12 weeks of CBT + motivational enhancement therapy for CUD (group therapy).

Group II: Alcohol Use Disorder Experimental Treatment 1 Intervention

Participants will be treated with 12 weeks of CBT for AUD (group therapy) and have the option to receive evidence-based pharmacotherapy for AUD guided by a pharmacotherapy algorithm.

Who Is Running the Clinical Trial?

Centre for Addiction and Mental Health

Lead Sponsor

Trials

388

Recruited

84,200+

Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario

Collaborator

Trials

1

Recruited

400+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

AFP Innovation Fund

Collaborator

Trials

9

Recruited

1,500+

Findings from Research

A meta-analysis of 10 randomized controlled trials involving 2,027 participants found that behavioral therapies (BTs) significantly improve outcomes for cannabis use disorders compared to control conditions, with an effect size of 0.44, indicating that patients receiving BTs fared better than 66% of those in control groups.

Behavioral therapies were effective in reducing both the frequency and severity of cannabis use, as well as improving psychosocial functioning, with larger effect sizes observed in studies using waitlist controls compared to those with active control comparisons.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral therapies for treatment-seeking cannabis users: a meta-analysis of randomized controlled trials. Davis, ML., Powers, MB., Handelsman, P., et al.[2022]

A study involving 68 individuals with alcohol use disorders showed that those receiving web-based cognitive behavioral therapy (CBT4CBT) had significantly higher treatment completion rates and greater increases in the percentage of days abstinent compared to standard treatment alone.

The web-based CBT4CBT program was found to be safe and feasible, with preliminary evidence suggesting it may reduce the costs of alcohol use disorder-related services compared to standard treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Trial of Computerized Cognitive Behavioral Therapy for Alcohol Use Disorders: Efficacy as a Virtual Stand-Alone and Treatment Add-On Compared with Standard Outpatient Treatment. Kiluk, BD., Devore, KA., Buck, MB., et al.[2018]

Cognitive Behavioral Therapy (CBT) is an effective treatment for adults with alcohol or other drug use disorders, showing significant efficacy compared to minimal care and usual care control conditions.

While CBT can be combined with other treatments like Motivational Interviewing and pharmacotherapy for better outcomes, it does not consistently outperform other established treatment methods, and its mechanisms of action require further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Cognitive Behavioral Therapy for Alcohol and Other Drug Use Disorders: Is a One-Size-Fits-All Approach Appropriate? Magill, M., Kiluk, BD., Ray, LA.[2023]

A randomized controlled trial involving 229 participants demonstrated that both six-session (6CBT) and single-session (1CBT) cognitive-behavioral interventions significantly improved treatment outcomes for cannabis dependence compared to a delayed-treatment control group.

Participants in the 6CBT group not only reported higher rates of abstinence but also experienced a greater reduction in cannabis consumption and related problems, highlighting the effectiveness of structured CBT in promoting cannabis cessation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder. Copeland, J., Swift, W., Roffman, R., et al.[2022]

In a study of 140 adults with cocaine use disorder undergoing web-based cognitive-behavior therapy (CBT), higher baseline positive affect (PA) was linked to less frequent cocaine use during treatment, suggesting that enhancing positive emotions may improve treatment outcomes.

While negative affect (NA) scores decreased over time in both CBT and treatment as usual, higher NA during treatment was associated with increased cocaine use, indicating that managing negative emotions could be crucial for successful recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Positive and negative affect in cocaine use disorder treatment: Change across time and relevance to treatment outcome. Decker, SE., Morie, KP., Malin-Mayo, B., et al.[2020]

A study involving 55 patients with alcohol use disorder showed that interactive, personalized computer-based cognitive behavioral therapy (CBT) was effective, leading to significant reductions in alcohol consumption and increased abstinence rates over a 3-month follow-up.

Both the computer-based CBT and placebo groups improved in their drinking outcomes, but the CBT group showed greater engagement in Alcoholics Anonymous and better self-efficacy regarding alcohol use, suggesting that computer-based CBT could be a valuable tool in treating AUD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computerised cognitive behavioural therapy for alcohol use disorder: a pilot randomised control trial. Farren, CK., Milnes, J., Lambe, K., et al.[2019]

A study involving 63 participants found that adding computer-based cognitive behavioral therapy (CBT4CBT) to standard treatment for alcohol use disorder (AUD) was more effective and cost-effective than standard treatment alone, costing about $35.08 for each additional day of reduced drinking.

While CBT4CBT+monitoring was slightly less costly and more effective than standard treatment, overall treatment costs did not significantly differ across conditions, indicating that further research is needed to fully understand the cost-benefit of computer-delivered CBT for AUD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot economic evaluation of computerized cognitive behavioral therapy for alcohol use disorder as an addition and alternative to traditional therapy. Kacmarek, CN., Yates, BT., Nich, C., et al.[2023]

The combination of cognitive behavioral therapy (CBT) and transdermal nicotine replacement therapy (NRT) significantly reduced tobacco smoking in participants, from an average of 12.6 cigarettes per day to 2.1 by the end of the 10-week treatment.

While cannabis use did not significantly decrease, the study suggests that treating both nicotine and cannabis dependence simultaneously is safe, as there was no increase in cannabis use when tobacco smoking was reduced, and participants reported high satisfaction with the treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive behavioral therapy and the nicotine transdermal patch for dual nicotine and cannabis dependence: a pilot study. Hill, KP., Toto, LH., Lukas, SE., et al.[2021]

Cognitive Behaviour Therapy (CBT) shows limited effectiveness for treating co-occurring depression and substance use, with only modest improvements compared to no treatment, based on a review of 12 clinical trials.

While CBT is not proven to be more effective than other psychotherapies, it does lead to consistent improvements in both depression and substance use outcomes, and these benefits appear to increase over time during follow-up.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use: current evidence and directions for future research. Hides, L., Samet, S., Lubman, DI.[2018]

References

1. United States pubmed.ncbi.nlm.nih.gov

Behavioral therapies for treatment-seeking cannabis users: a meta-analysis of randomized controlled trials. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Randomized Trial of Computerized Cognitive Behavioral Therapy for Alcohol Use Disorders: Efficacy as a Virtual Stand-Alone and Treatment Add-On Compared with Standard Outpatient Treatment. [2018]

3. New Zealand pubmed.ncbi.nlm.nih.gov

Efficacy of Cognitive Behavioral Therapy for Alcohol and Other Drug Use Disorders: Is a One-Size-Fits-All Approach Appropriate? [2023]

4. United States pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Positive and negative affect in cocaine use disorder treatment: Change across time and relevance to treatment outcome. [2020]

6. England pubmed.ncbi.nlm.nih.gov

Computerised cognitive behavioural therapy for alcohol use disorder: a pilot randomised control trial. [2019]

7. England pubmed.ncbi.nlm.nih.gov

A pilot economic evaluation of computerized cognitive behavioral therapy for alcohol use disorder as an addition and alternative to traditional therapy. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Cognitive behavioral therapy and the nicotine transdermal patch for dual nicotine and cannabis dependence: a pilot study. [2021]

9. Australia pubmed.ncbi.nlm.nih.gov

Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use: current evidence and directions for future research. [2018]