Trial Summary
What is the purpose of this trial?The goal of this study is to disentangle relationships between acute cannabis use and withdrawal on proximal depression and suicide risk and recovery in adolescents ages 12-18 years by incorporating time-varying patterns of substance use, mood, and SI. This project aims to guide the development of scalable, individualized, accessible, and affordable interventions aimed to reduce depression and suicide risk among adolescents.
Is Contingency Management a promising treatment for depression and cannabis use?Yes, Contingency Management is a promising treatment for cannabis use, especially when combined with other therapies. It has been shown to help people reduce or stop using cannabis, even for those with mental health issues like depression.13578
Do I have to stop taking my current medications for this trial?The trial protocol does not specify whether you need to stop taking your current medications. However, it does not mention any requirement to discontinue existing medications, so you may not need to stop them.
What safety data exists for contingency management in treating depression and cannabis use?The systematic review titled 'Contingency Management for Treatment of Cannabis Use Disorder in Co-Occurring Mental Health Disorders' suggests that contingency management (CM) is effective in reducing cannabis use and achieving abstinence in individuals with co-occurring mental health disorders, such as psychotic-spectrum or major depressive disorder. However, the review indicates a need for additional longitudinal studies with larger sample sizes and longer follow-up periods to fully evaluate the sustained effects and safety of CM. The other studies focus on CM's efficacy in promoting abstinence in various substance use disorders, but they do not specifically address safety data for CM in the context of depression and cannabis use.12678
What data supports the idea that Contingency Management for Depression and Cannabis Use is an effective treatment?The available research shows that Contingency Management (CM) is effective in reducing cannabis use and achieving abstinence among individuals with both cannabis use disorder and mental health issues like depression. One study found that CM led to better abstinence outcomes compared to other treatments, with the highest rates of abstinence when combined with cognitive behavioral therapy. Another study highlighted CM's success in promoting drug abstinence, suggesting its broad utility in treating substance abuse disorders.12468
Eligibility Criteria
This trial is for adolescents aged 12-18 who experience depression or suicidal thoughts and use cannabis. It aims to understand how cannabis affects their mood and risk of suicide, with the goal of creating better interventions.Inclusion Criteria
I responded to more than 60% of the prompts in the first phase.
I am between 12 and 18 years old.
Exclusion Criteria
I cannot speak or write in English fluently.
I do not have severe cognitive issues like major psychosis or dementia.
I have been diagnosed with epilepsy.
I am able to understand and participate in the study without any impairment.
Treatment Details
The study tests a strategy called 'contingency management' which rewards individuals for abstaining from cannabis use, to see if it helps reduce depression and suicidal thoughts in youth.
3Treatment groups
Experimental Treatment
Active Control
Group I: Cannabis Abstinence (CB-Abst)Experimental Treatment1 Intervention
Those randomized to the abstinence condition will be asked to stop using cannabis for eight weeks. They will participate in a contingency management protocol, which uses an escalating remuneration schedule to incentivize abstinence. Abstinence is confirmed biochemically via progressively decreasing values of creatinine-adjusted THCCOOH.
Group II: Cannabis Monitoring (CB-Mon)Active Control1 Intervention
Those randomized to the monitoring condition will be asked to make no changes to their cannabis use frequency or dose for the duration of the eight week study.
Group III: Pre-intervention Pooled Groups (EMA Phase 1 Only)Active Control1 Intervention
All enrolled participants will participate in approximately two weeks of EMA data collection prior to being randomized and starting intervention procedures to characterize mood during baseline use as usual (CB-Abst or CB-Mon).
Contingency management for cannabis abstinence is already approved in United States, European Union, Canada for the following indications:
🇺🇸 Approved in United States as Contingency Management for:
- Substance Abuse Treatment
- Cannabis Use Disorder
🇪🇺 Approved in European Union as Contingency Management for:
- Substance Abuse Treatment
- Cannabis Use Disorder
🇨🇦 Approved in Canada as Contingency Management for:
- Substance Abuse Treatment
- Cannabis Use Disorder
Find a clinic near you
Research locations nearbySelect from list below to view details:
Massachusetts General HopsitalBoston, MA
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Who is running the clinical trial?
Massachusetts General HospitalLead Sponsor
National Institute on Drug Abuse (NIDA)Collaborator
References
Abstinence rates following behavioral treatments for marijuana dependence. [2022]Previous studies have noted particular difficulty in achieving abstinence among those who are marijuana dependent. The present study employed a dismantling design to determine whether adding contingency management (ContM) to motivational enhancement therapy plus cognitive behavioral therapy (MET+CBT), an intervention used in prior studies of treatment for marijuana dependence, would enhance abstinence outcomes. 240 marijuana dependent participants were recruited via advertisements and assigned to either MET+CBT, ContM-only, MET+CBT+ContM, or to a case-management control condition. All interventions involved 9 weekly 1-h sessions, except for the ContM-only condition whose sessions lasted about 15 min. ContM provided reinforcement for marijuana-free urine specimens, in the form of vouchers redeemable for goods or services. Follow-up data were collected at posttreatment and at 3-month intervals for 1 year. The two ContM conditions had superior abstinence outcomes: ContM-only had the highest abstinence rates at posttreatment, and the MET+CBT+ContM combination had the highest rates at later follow-ups. The roles of contingency management and coping skills training in the treatment of marijuana dependence are discussed.
Contingency management: utility in the treatment of drug abuse disorders. [2019]Contingency management (CM) is a strategy that uses positive reinforcement to improve the clinical outcomes of substance abusers in treatment, especially sustained abstinence from drugs of abuse. Further, CM has been adopted to improve methodology and interpretation of outcomes in clinical trials testing new pharmacotherapies and to improve adherence to efficacious medications in substance abuse patients. Thus, CM has proven to be widely useful as a direct therapeutic intervention and as a tool in treatment development.
Coping skills training and contingency management treatments for marijuana dependence: exploring mechanisms of behavior change. [2021]Achieving abstinence in the treatment of marijuana dependence has been difficult. To date the most successful treatments have included combinations of motivation enhancement treatment (MET) plus cognitive-behavioral coping skills training (CBT) and/or contingency management (ContM) approaches. Although these treatment approaches are theoretically based, their mechanisms of action have not been explored fully. The purpose of the present study was to explore mechanisms of behavior change from a marijuana treatment trial in which CBT and ContM were evaluated separately and in combination.
Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less. [2021]To evaluate reciprocal enhancement (combining treatments to offset their relative weaknesses) as a strategy to improve cannabis treatment outcomes. Contingency management (CM) with reinforcement for homework completion and session attendance was used as a strategy to enhance cognitive-behavioral therapy (CBT) via greater exposure to skills training; CBT was used as a strategy to enhance durability of CM with rewards for abstinence.
A randomised controlled trial of the clinical and cost-effectiveness of a contingency management intervention compared to treatment as usual for reduction of cannabis use and of relapse in early psychosis (CIRCLE): a study protocol for a randomised controlled trial. [2021]Around 35-45 % of people in contact with services for a first episode of psychosis are using cannabis. Cannabis use is associated with delays in remission, poorer clinical outcomes, significant increases in the risk of relapse, and lower engagement in work or education. While there is a clear need for effective interventions, so far only very limited benefits have been achieved from psychological interventions. Contingency management (CM) is a behavioural intervention in which specified desired behavioural change is reinforced through financial rewards. CM is now recognised to have a substantial evidence base in some contexts and its adoption in the UK is advocated by the National Institute for Health and Care Excellence (NICE) guidance as a treatment for substance or alcohol misuse. However, there is currently little published data testing its effectiveness for reducing cannabis use in early psychosis.
Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial. [2022]Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an internet-based monitoring and goal-setting control group in a nationwide sample of cigarette smokers.
A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients. [2022]Contingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence.
Contingency Management for Treatment of Cannabis Use Disorder in Co-Occurring Mental Health Disorders: A Systematic Review. [2023]Amongst individuals with a mental health disorder, a comorbid diagnosis of cannabis use disorder (CUD) is associated with numerous adverse consequences, including more severe symptom profiles, poorer treatment response, and reduced psychosocial functioning. Contingency management (CM), a method to specifically reinforce target behavior attainment (e.g., substance use abstinence), may provide an effective intervention in treating cannabis use in patients with a dual diagnosis of CUD and a mental health disorder. A systematic search examining the effects of CM on cannabis use, clinical, cognitive, and psychosocial outcomes in patients with a mental health disorder on PubMed, PsycINFO, and EMBASE databases up to November 2022 was performed. Six studies met inclusion criteria for our review. We found CM to be efficacious in producing cannabis use reductions and abstinence amongst individuals with a psychotic-spectrum or major depressive disorder. Additional longitudinal studies with larger sample sizes, other psychiatric populations, and longer follow-up periods are needed to evaluate the sustained effects of CM.