A Remote Behavioral Economics-Based Intervention for Cannabis Use Disorder: Bridging Gaps in Care

About This Grant

Project Summary/Abstract In the current landscape of increasing access to adult-use cannabis via legalization and lower-than-ever cannabis-related risk perceptions, cannabis use and cannabis use disorder (CUD) are increasing in the United States. CUD, occurring in about 22% of people who use cannabis, is associated with serious consequences on health and wellbeing, including worsened mental health. Despite these outcomes, fewer than 10% of people living with CUD receive treatment or care for this chronic condition. To improve engagement and accessibility of CUD care, we urgently need to develop and study new care models with proactive outreach and provision of new, appealing interventions that meet the goals of the large population of patients with CUD who are not actively seeking traditional substance use disorder treatments. Virtually-delivered care (herein: synchronous videoconferencing between providers and patients across locations) can potentially improve accessibility and appeal of different intervention strategies while reducing stigma about engaging in treatment for substance use disorders. Our proposed strategy seeks to increase involvement in CUD care by delivering interventions in patient-preferred locations and reducing barriers to attending traditional treatments, including by supporting harm reduction and wellbeing outcomes. Behavioral economics-based interventions as applied to CUD bring novel approaches to substitute alternative, healthier behaviors for cannabis use. There is an untapped potential for virtually-delivered, behavioral economic approaches to engage the large majority of individuals who have CUD, who otherwise do not receive treatment, but could benefit from change. Building on our prior work engaging non-treatment-seeking adults in virtual substance use interventions, we piloted a novel behavioral economic intervention, infused with motivational interviewing principles (MI-BE). The MI-BE intervention engages adults with CUD into a virtual intervention focused on enhancing valued activities (with reinforcement for cannabis-free activity sampling) and reducing cannabis use. Using a Hybrid Type 1 efficacy-implementation design, we will evaluate the virtually-delivered behavioral economic-based intervention for CUD compared to an enhanced usual care (EUC) control condition. Patients with CUD will be recruited from a large health system and randomized to either MI-BE or an EUC and followed over 1 year. We will then evaluate the effect of MI-BE vs. EUC on cannabis and health outcomes (e.g., quality of life/functioning), and explore behavioral economic mechanisms of change (e.g., cannabis demand, cannabis-free reinforcement). With consideration for future translation, we will also collect and evaluate qualitative data from clinicians/administrators (N=10) and selected participants (N=20) on barriers and facilitators to future implementation in healthcare settings using a rapid analysis process. Impact: The findings from this study will have a significant public health impact and move the field forward as a novel, patient-centered, scalable approach to address the gap in care that is urgently needed in the context of rising CUD rates.