Exploring survey methods for measuring consumption quantities of cannabis flower and concentrate products.

Background: Researchers need accurate measurements of cannabis consumption quantities to assess risks and benefits. Survey methods for measuring cannabis flower and concentrate quantities remain underdeveloped.Objective: We examined "grams" and "hits" units for measuring flower and concentrate quantities, and calculating milligrams of THC (mgTHC).Methods: Online survey participants (n = 2,381) reported preferred unit (hits or grams), past-week hits and grams for each product, and product %THC. Quantile regression compared mgTHC between unit-preference subgroups. Hits-based mgTHC calculations assumed a universal grams-per-hit ratio (GPHR). To examine individualized GPHRs, we tested a "two-item approach," which divided total grams by total hits, and "one-item approach," which divided 0.5 grams by responses to the question: "How many total hits would it take you to finish 1/2 g of your [product] by [administration method]?"Results: Participants were primarily daily consumers (77%), 50% female sex, mean age 39.0 (SD 16.4), 85% White, 49% employed full-time. Compared to those who preferred the hits unit, those who preferred the grams unit reported consuming more hits and grams, higher %THC products, and consequently, larger median mgTHC (flower-hits mgTHC: 32 vs. 91 (95%CI: 52-67); flower-grams mgTHC: 27 vs. 113 (95%CI: 73-95); concentrate-hits mgTHC: 29 vs. 59 (95%CI: 15-43); concentrate-grams mgTHC: 61 vs. 129 (95%CI: 43-94)). "Two-item" and "one-item" approach GPHRs were similar and frequently 50% larger or smaller than the universal GPHR.Conclusion: Allowing respondents to choose "hits" or "grams" when reporting cannabis quantities does not compromise mgTHC estimates. A low-burden, one-item approach yields individualized "hit sizes" that may improve mgTHC estimates.

Daily Cannabis Use Is a Barrier to Tobacco Cessation Among Tobacco Quitline Callers at 7-Month Follow-up.

INTRODUCTION: Cannabis use is increasing among cigarette smokers in the United States. Prior studies suggest that cannabis use may be a barrier to smoking cessation. Yet, the extent to which this is the case among adults seeking to quit tobacco use remains unclear. Tobacco quitlines are the most common provider of no-cost treatment for adults who use smoke in the United States. This study investigated the association between cannabis use and smoking cessation outcomes among quitline callers. AIMS AND METHODS: Participants included callers to the New York State Smokers' Quitline, who were seeking to quit smoking cigarettes and were contacted for outcome assessment 7 months after intake. Thirty-day point prevalence abstinence rates were calculated and compared among cannabis use groups, based on frequency of past-30-day cannabis use at baseline (none: 0 days, occasional: 1-9 days, regular: 10-19 days, and daily: 20-30 days). RESULTS: Approximately 8.3% (n = 283) of participants (n = 3396) reported past-30-day cannabis use at baseline. Callers with daily cannabis use (20-30 days per month) had significantly lower odds of 30-day abstinence, relative to those who did not use cannabis (odds ratio = 0.5; 95% confidence interval [0.3, 0.9]). CONCLUSIONS: Daily cannabis use appears to be associated with poorer smoking cessation treatment outcomes among adults seeking to quit smoking cigarettes via a quitline. Because quitlines are among the most accessible, affordable, and frequently utilized community-based treatments available in the United States, and the prevalence of cannabis use is increasing among cigarette smokers, detailed inquiry into cannabis use might enhance cigarette smoking cessation outcomes. IMPLICATIONS: Quitlines are free of cost and accessible to millions of smokers in the United States. The current study found an inverse relationship between daily cannabis use at baseline and 30-day abstinence from cigarette smoking at 7-month follow-up among New York State Smokers' Quitline callers. Findings suggest that daily cannabis use may be a barrier to smoking cessation and sustained abstinence among those seeking help to stop smoking cigarettes.

Is it "loud" enough?: A qualitative investigation of blunt use among African American young adults.

Heavy blunt use is common among young adult cannabis users, especially African Americans. This exploratory qualitative study aimed to examine how African American young adults understand, talk about and experience their blunt use. Semi-structured interviews were conducted with adults reporting daily or almost daily blunt use in the past month (N = 20; 75% male). Thematic analysis of the audio-recorded interviews revealed aspects of how blunts are described, made and used among heavy blunt users. The three emergent themes have implications for the assessment of cannabis use and intervention development for heavy blunt users.

Comparing the feasibility of four web-based recruitment strategies to evaluate the treatment preferences of rural and urban adults who misuse non-prescribed opioids.

This cross-sectional study examined the feasibility of using four different web-based strategies to recruit rural and urban adults who use opioids non-medically for a survey on opioid use disorder (OUD) treatment preferences, and compared the treatment preferences of rural versus urban participants. Preferences for medication for opioid use disorder (MOUD) formulation and OUD treatment models were assessed through an online survey. Recruitment advertisements were shown on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (MTurk). Participants were categorized by zip code into urban versus rural residence using the Centers for Medicaid and Medicaid Health Resources and Services Administration definitions. OUD treatment preferences were compared using chi-square and t-tests. Among the 851 participants recruited, 815 provided zip codes and were classified as residing in rural (n = 200, 24.5%) or urban (n = 615, 75.4%) regions. A crowdsourcing service (MTurk) recruited the most rural participants, while posts on a social news website (Reddit) recruited the most urban participants (χ23 = 17.0, p < 0.01). While preferred MOUD formulation and OUD treatment model did not differ by rurality, rural participants were more likely to report a willingness to receive OUD treatment integrated with general medical care (χ21 = 18.9, p < 0.0001). This study demonstrated that web-based strategies are feasible for recruiting rural adults who misuse opioids. Results suggest OUD treatment preferences largely did not differ by rural residence, and highlight the importance of enhancing the availability and increasing education about MOUD formulations in rural regions.

Web-based cognitive behavior therapy for chronic pain patients with aberrant drug-related behavior: How did it work and for whom?

This study explored mediating pathways, moderating factors, and moderated mediation effects of a web-based, cognitive behavioral therapy (CBT) intervention for chronic pain patients with aberrant drug-related behavior (ADRB). In a 2-arm RCT, patients with chronic pain who screened positive for ADRB received treatment-as-usual (TAU, n = 55) or TAU plus a 12-week, web-based CBT intervention (n = 55). Assessments were conducted at weeks 4, 8, and 12, and at 1- and 3-months post intervention. Web-CBT significantly reduced pain catastrophizing, which, in turn, reduced pain interference and pain severity via a pathway of pain catastrophizing. Web-CBT also significantly reduced ADRB both directly and indirectly by reducing pain catastrophizing. For pain interference and pain severity, web-CBT was more effective than TAU for younger patients (≤ age 50). For pain severity, web-CBT was more effective for both younger patients (≤ age 50), and those with a lifetime substance use disorder. Findings suggest that web-CBT's positive impact on pain outcomes and ADRB are mediated by its effect on pain catastrophizing, and its treatment effects may be most robust for younger patients and those with histories of substance dependence.

Effects of anxiety sensitivity on cannabis, alcohol, and nicotine use among adolescents: evaluating pathways through anxiety, withdrawal symptoms, and coping motives.

Anxiety sensitivity (AS) is a promising intervention target due to its relevance to negative health behaviors broadly, and substance use specifically. The aim of the current study was to evaluate the direct and indirect pathways through which elevated AS could relate to recent substance use among a national adolescent sample recruited via social-media. As predicted, AS was indirectly associated with greater likelihood of using alcohol, cigarettes, and electronic nicotine delivery systems in the past-month through anxiety symptoms. Regarding cannabis, AS was directly related to increased likelihood of past-month cannabis use; however, the indirect relation between AS and likelihood of past-month use via anxiety symptoms was not significant. Through chained indirect effects, AS was related positively to past-month alcohol and cannabis use via anxiety symptoms and coping-related motives, and through withdrawal symptoms and coping-related motives. Study findings can be used to generate hypotheses on potential pathways through which AS could prospectively relate to substance use among youth.

Perceived safety of cannabis intoxication predicts frequency of driving while intoxicated.

Driving under the influence of cannabis (DUIC) is a public health concern, and data are needed to develop screening and prevention tools. Measuring the level of intoxication that cannabis users perceive as safe for driving could help stratify DUIC risk. This study tested whether intoxication levels perceived as safe for driving predicted past-month DUIC frequency. Online survey data were collected in 2017 from a national sample of n = 3010 past-month cannabis users with lifetime DUIC (age 18+). Respondents indicated past-month DUIC frequency, typical cannabis intoxication level (1-10 scale), and cannabis intoxication level perceived as safe for driving (0-10 scale). Approximately 24%, 38%, 13%, and 24% of respondents engaged in DUIC on 0, 1-9, 10-19, and 20-30 days respectively in the past month. Among these four DUIC frequency groups, median typical intoxication varied little (5-6), but median intoxication perceived as safe for driving varied widely (3-8). Higher intoxication levels perceived as safe for driving corresponded to frequent DUIC (Spearman's rho: 0.46). For each unit increase in intoxication level perceived as safe for driving, the odds of past-month DUIC increased 18% to 68% (multinomial logistic regression odds ratio - MOR1-9 days: 1.18, 95% CI: 1.13-1.23; MOR10-19 days: 1.40, 95% CI: 1.30-1.50; MOR20-30 days: 1.68, 95% CI: 1.57-1.80). In this targeted sample of past-month cannabis users, DUIC frequency varied widely, but daily/near-daily DUIC was common (24%). Measuring intoxication levels perceived as safe for driving permits delineation of past-month DUIC frequency. This metric has potential as a component of public health prevention tools.

An update on cannabis use disorder with comment on the impact of policy related to therapeutic and recreational cannabis use.

Confusion and controversy related to the potential for cannabis use to cause harm, or alternatively to provide benefit, continues globally. This issue has grown in intensity and importance with the increased recognition of the public health implications related to the escalation of the legalization of cannabis and cannabinoid products. This selective overview and commentary attempt to succinctly convey what is known about one potential consequence of cannabis use, the development of cannabis use disorder (CUD). Such knowledge may help guide a reasonable and objective public health perspective on the potential impact of cannabis use and CUD. Current scientific data and clinical observation strongly support the contention that cannabis use, like the use of other substances such as alcohol, opioids, stimulants, and tobacco, can develop into a use disorder (addiction) with important clinical consequences. Epidemiological data indicate that the majority of those who use cannabis do not have problems related to their use, but a substantial subset (10-30%) do report experiencing symptoms and consequences consistent with a CUD. Treatment seeking for CUD comprises a substantial proportion of all substance use treatment admissions, yet treatment response rates show much room for improvement. Changing cannabis policies related to its therapeutic and recreational use are likely to impact the development of CUD and its course; however, definitive data on such effects are not yet available. Clearly, the development of more effective prevention and treatment strategies is needed for those vulnerable to developing a CUD and for those with a CUD.

Cannabis regulatory science: risk-benefit considerations for mental disorders.

The evolving legal cannabis landscape in the US continues to present novel regulatory challenges that necessitate the development of a Cannabis Regulatory Science. Two specific issues of concern within Cannabis Regulatory Science are (1) the impact that cannabis use has on the incidence, prevalence, and severity of mental disorders, and (2) how cannabis laws and regulations modify this impact. This paper first provides several conceptual points that are useful for evaluating the relationship between cannabis use and mental disorders. Second, it selectively reviews and comments on data relevant to the relationship between cannabis use and depression, several forms of anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Next, regulatory and public health parallels between the nascent cannabis industry and the pharmaceutical, tobacco, and alcohol industries are discussed. The focus is on specific types of industry practices that may harm those with or at risk for mental disorders. Recommendations are then offered for legal cannabis regulations that could mitigate this harm. Last, future research goals are discussed for building the field of Cannabis Regulatory Science and addressing the potential negative impact of cannabis on those with mental disorders.

The potential impact of cannabis legalization on the development of cannabis use disorders.

Specific provisions of legal cannabis legislation and regulation could influence cannabis initiation, frequency and quantity of use, and progression to cannabis use disorder. This brief essay highlights scientifically based principles and risk factors that underlie substance use and addiction that can be leveraged to inform policies that might mitigate the development and consequences of cannabis use disorder. Specifically, pharmacologic, access/availability, and environmental factors are discussed in relation to their influence on substance use disorders to illustrate how regulatory provisions can differentially affect these factors and risk for addiction. Relevant knowledge from research and experience with alcohol and tobacco regulation are also considered. Research designed to inform regulatory policy and to evaluate the impact of cannabis legislation on cannabis use and problems is progressing. However, definitive findings will come slowly, and more concerted efforts and resources are needed to expedite this process. In the meantime, policymakers should take advantage of the large body of scientific literature on substance use to foster empirically-guided, common sense approaches to cannabis policy that focus on prevention of addiction.

Development of a Self-Report Measure of Reward Sensitivity:A Test in Current and Former Smokers.

INTRODUCTION: Tobacco use or abstinence may increase or decrease reward sensitivity. Most existing measures of reward sensitivity were developed decades ago, and few have undergone extensive psychometric testing. METHODS: We developed a 58-item survey of the anticipated enjoyment from, wanting for, and frequency of common rewards (the Rewarding Events Inventory-REI). The current analysis focuses on ratings of anticipated enjoyment. The first validation study recruited current and former smokers from Internet sites. The second study recruited smokers who wished to quit and monetarily reinforced them to stay abstinent in a laboratory study and a comparison group of former smokers. In both studies, participants completed the inventory on two occasions, 3-7 days apart. They also completed four anhedonia scales and a behavioral test of reduced reward sensitivity. RESULTS: Half of the enjoyment ratings loaded on four factors: socializing, active hobbies, passive hobbies, and sex/drug use. Cronbach's alpha coefficients were all ≥0.73 for overall mean and factor scores. Test-retest correlations were all ≥0.83. Correlations of the overall and factor scores with frequency of rewards and anhedonia scales were 0.19-0.53, except for the sex/drugs factor. The scores did not correlate with behavioral tests of reward and did not differ between current and former smokers. Lower overall mean enjoyment score predicted a shorter time to relapse. DISCUSSION: Internal reliability and test-retest reliability of the enjoyment outcomes of the REI are excellent, and construct and predictive validity are modest but promising. The REI is comprehensive and up-to-date, yet is short enough to use on repeated occasions. Replication tests, especially predictive validity tests, are needed. IMPLICATIONS: Both use of and abstinence from nicotine appear to increase or decrease how rewarding nondrug rewards are; however, self-report scales to test this have limitations. Our inventory of enjoyment from 58 rewards appears to be reliable and valid as well as comprehensive and up-to-date, yet is short enough to use on repeated occasions. Replication tests, especially of the predictive validity of our scale, are needed.

Does Tobacco Abstinence Decrease Reward Sensitivity? A Human Laboratory Test.

INTRODUCTION: Animal studies report abstinence from nicotine makes rewards less rewarding; however, the results of human tests of the effects of cessation on reward sensitivity are mixed. The current study tested reward sensitivity in abstinent smokers using more rigorous methods than most prior studies. METHODS: A human laboratory study compared outcomes for 1 week prior to quitting to those during 4 weeks postquit. The study used smokers trying to quit, objective and subjective measures, multiple measures during smoking and abstinence, and monetary rewards to increase the prevalence of abstinence. Current daily smokers (n = 211) who were trying to quit completed an operant measure of reward sensitivity and a survey of pleasure from various rewards as well as self-reports of anhedonia, delay discounting, positive affect, and tobacco withdrawal twice each week. A comparison group of long-term former smokers (n = 67) also completed the tasks weekly for 4 weeks. Primary analyses were based on the 61 current smokers who abstained for all 4 weeks. RESULTS: Stopping smoking decreased self-reported pleasure from rewards but did not decrease reward sensitivity on the operant task. Abstinence also decreased self-reported reward frequency and increased the two anhedonia measures. However, the changes with abstinence were small for all outcomes (6%-14%) and most lasted less than a week. CONCLUSIONS: Abstinence from tobacco decreased most self-report measures of reward sensitivity; however, it did not change the objective measure. The self-report effects were small. IMPLICATIONS: Animal research suggests that nicotine withdrawal decreases reward sensitivity. Replication tests of this in humans have produced inconsistent results. We report what we believe is a more rigorous test. We found smoking abstinence slightly decreases self-reports of reward sensitivity but does not do so for a behavioral measure of reward sensitivity.

Evaluating the Validity of Caffeine Use Disorder.

Caffeine use disorder is included in the conditions for further study section of the DSM-5. Caffeine's profile of neurobiological, behavioral, and clinical effects is similar to other common substances that humans use recreationally. Extant data suggest that a clinically meaningful addictive disorder develops in some regular caffeine users, but this literature is incomplete and not yet sufficient to determine if and how best to define and treat caffeine use disorder. An overview of the literature relevant to determining the clinical importance of problematic caffeine use is followed by discussion of potential concerns and benefits associated with its classification as a mental disorder. Concerns about overdiagnosis and trivialization of other psychiatric syndromes are weighed against the public health benefits of increased awareness and development of interventions targeting problematic caffeine use. This discussion includes consideration of alternative diagnostic approaches, improvement of assessment practices, and the need for additional clinical and epidemiological research.

Development and Initial Evaluation of a Web-Based Program to Increase Parental Awareness and Monitoring of Underage Alcohol Use: A Brief Report.

The development of a web-based parent-focused intervention to improve parental awareness and monitoring of adolescent alcohol use was preliminarily evaluated. Upon completion of baseline assessment, sixty-seven parents were randomly assigned to the experimental web-based parent-focused intervention or an assessment only control condition. Participants who completed the experimental program, relative to control participants, significantly improved knowledge of problems related to underage drinking (p < .01) while improvements in overall monitoring of their children approached significance (p = .08). Improvements in monitoring by experimental participants, relative to controls, were pronounced in phone monitoring (p < .01) and indirect monitoring (p = .05). Participants in this study improved their communication about alcohol from pre- to post-intervention regardless of intervention. There were no statistical between group differences found regarding underage drinking attitudes. This pilot evaluation demonstrates that this program warrants further examination in controlled trials with greater power. Study implications are discussed in light of results.

Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study.

INTRODUCTION: Over the past decade, treatment for opioid use disorder has expanded to include long-acting injectable and implantable formulations of medication for opioid use disorder (MOUD), and integrated treatment models systematically addressing both behavioral and physical health. Patient preference for these treatment options has been underexplored. Gathering data on OUD treatment preferences is critical to guide the development of patient-centered treatment for OUD. This cross-sectional study assessed preferences for long-acting MOUD and integrated treatment using an online survey. METHODS: An online Qualtrics survey assessed preferences for MOUD formulation and integrated treatment models. The study recruited participants (n = 851) in October and November 2019 through advertisements or posts on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (mTurk). Eligible participants scored a two or higher on the opioid pain reliever or heroin scales of the Tobacco, Alcohol Prescription Medication and other Substance Use (TAPS) Tool. Structured survey items obtained patient preference for MOUD formulation and treatment model. Using stated preference methods, the study assessed preference via comparison of preferred options for MOUD and treatment model. RESULTS: In the past year, 824 (96.8 %) participants reported non-prescribed use of opioid pain relievers (mean TAPS score = 2.72, SD = 0.46) and 552 (64.9 %) reported heroin or fentanyl use (mean TAPS score = 2.73, SD = 0.51). Seventy-four percent of participants (n = 631) reported currently or previously receiving OUD treatment, with 407 (48.4 %) receiving MOUD. When asked about preferences for type of MOUD formulation, 452 (53.1 %) preferred a daily oral formulation, 115 (13.5 %) preferred an implant, 114 (13.4 %) preferred a monthly injection and 95 (11.2 %) preferred a weekly injection. Approximately 8.8 % (n = 75) would not consider MOUD regardless of formulation. The majority of participants (65.2 %, n = 555) preferred receiving treatment in a specialized substance use treatment program distinct from their medical care, compared with receiving care in an integrated model (n = 296, 34.8 %). CONCLUSIONS: Though most participants expressed willingness to try long-acting MOUD formulations, the majority preferred short-acting formulations. Likewise, the majority preferred non-integrated treatment in specialty substance use settings. Reasons for these preferences provide insight on developing effective educational tools for patients and suggesting targets for intervention to develop a more acceptable treatment system.

Evaluating age-related disparities in cannabis-related problems among LGBT+ versus non-LGBT+ adults.

LGBT+ adults demonstrate greater cannabis-related problems (e.g., Cannabis Use Disorder [CUD]) compared to non-LGBT+ counterparts. No study has explored age-related disparities in cannabis problems across the adult lifespan, nor have studies identified specific CUD criteria that contribute to elevated CUD among LGBT+ adults. The purpose of this study was to examine associations between LGBT+ identity and age with endorsement of CUD criteria in a sample of regular cannabis consumers. An online sample of N = 4334 (25.1% LGBT+) adults aged 18-64 residing in the U.S. completed an online survey about cannabis use behaviors and CUD diagnostic criteria. Bivariate contrasts revealed significantly greater CUD criteria endorsement among LGBT+ respondents, largely driven by differences at younger ages. However, this effect disappeared in the majority of adjusted logistic regression models. LGBT+ identity was associated with greater probability of use in larger amounts (adjOR = 2.10, 95% CI: 1.22-3.60) and use despite physical/mental health problems (adjOR = 2.51, 95% CI:1.23-5.03). No age*LGBT+ identity interactions were detected. Plotted trends depict more pronounced disparities in outcomes among LGBT+ adults under 35 years. Several potential risk and protective factors including employment, education, and reasons for use were identified. There were age-related differences in these characteristics among LGBT+ and non-LGBT+ respondents. Initial findings highlight the need for LGBT+ research examining trends in health outcomes and sociodemographic and cannabis characteristics across the lifespan. The study also provides a substantive contribution regarding specific cannabis-related problems that young LGBT+ cannabis consumers may be more likely to endorse than their non-LGBT+ counterparts.

Randomized controlled trial of zolpidem as a pharmacotherapy for cannabis use disorder.

BACKGROUND: Sleep disturbance is commonly reported among individuals meeting criteria for cannabis use disorder (CUD), and people who use cannabis frequently report sleep disturbance as a contributor to failed quit attempts. The purpose of this study was to measure sleep in individuals enrolled in treatment for CUD, and to determine whether use of hypnotic medication during treatment increased abstinence rates. METHOD: The study enrolled 127 adults seeking treatment for CUD in a 12-week clinical trial and randomized to receive extended-release zolpidem (zolpidem-XR) or placebo. All participants received computerized behavioral therapy and abstinence-based contingency management. The study conducted in-home ambulatory polysomnography (PSG) assessments at baseline and during treatment to objectively measure sleep. Self-report measures of recent sleep, Insomnia Severity Index (ISI), and drug use (Timeline Follow-Back) were collected at each study visit, and the study confirmed self-reported abstinence via quantitative urine drug testing. RESULT: Participants randomized to placebo, but not zolpidem-XR exhibited significant sleep disturbance during week 1 of treatment. Sleep disturbance emerged in the zolpidem-XR group after study medication was stopped at the end of treatment. Though participants assigned to the zolpidem-XR condition had qualitatively greater rates of abstinence compared with placebo (27 % versus 15 % negative at end of treatment), the difference was not statistically significant. Treatment retention was poor (about 50 % drop out in both groups) and medication adherence was a challenge without the use of contingent incentives. CONCLUSION: Results from this randomized controlled trial suggest that zolpidem-XR can attenuate abstinence-induced sleep disturbance early in treatment for CUD, but that sleep problems are likely to emerge after the medication is stopped. Further research should identify alternative pharmacotherapies and behavioral treatments for CUD and elucidate the role of sleep disturbance in the development and maintenance of CUD.

Development of Mobile Contingency Management for Cannabis Use Reduction.

Many interventions for cannabis use disorder (CUD) are associated with decreases in frequency and quantity of use but fail to increase overall rates of sustained abstinence. It is currently unknown whether reductions in use (in the absence of sustained abstinence) result in clinically significant improvements in functioning. The objective of this study was to refine a mobile contingency management approach to reduce cannabis use to ultimately evaluate whether reductions in frequency and quantity of cannabis are related to improvements in functional and mental health status. Three cohorts of participants (n = 18 total, n = 10 women) were enrolled and completed 2 weeks of ecological momentary assessment (EMA) during a baseline ad lib cannabis use period, followed by a 6-week reduction period. Participants completed EMA assessments multiple times per day and were prompted to provide videotaped saliva cannabis testing 2-3 times daily. Data from participants who were at least 80% adherent to all EMA prompts were analyzed (13 out of 18). During the ad lib phase, participants were using cannabis on 94% of the days and reported using a mean of 1.42 grams daily. The intervention was a mobile application that participants used to record cannabis use by saliva tests to bioverify abstinence and participants completed electronic diaries to report their grams used. During the 6-week intervention phase, participants reported reducing their use days to 47% of the days with a reported mean of .61 grams daily. In the last cohort, at least 50% of the heavy users were able to reduce their cannabis use by at least 50%. The effect of cannabis reduction (versus abstinence) is largely unknown. Observations suggest that it is possible to develop a mobile intervention to reduce cannabis use among heavy users, and this paradigm can be utilized in future work to evaluate whether reductions in cannabis use among heavy users will result in improvements in functional and mental health status.

A multicomponent motivational intervention to improve adherence among adolescents with poorly controlled type 1 diabetes: a pilot study.

OBJECTIVE: To adapt and pilot test a multicomponent motivational intervention that includes family-based contingency management (CM) for adolescents with poorly controlled type 1 diabetes. METHODS: A total of 17 adolescents, age 12-17 years (M = 14.8, SD = 1.5), with type 1 diabetes (duration M = 6.2 years, SD = 4.5) and mean HbA1c of 11.6% (SD = 2.5%) were enrolled. Adolescents and their parents received 14 weeks of motivational interviewing, clinic-based CM, and parent-directed CM that targeted increased blood glucose monitoring (BGM). RESULTS: Adolescents significantly increased their BGM (p < .001) and showed significantly improved HbA1c levels (glycemic control) from pre-to posttreatment (p < .0001). CONCLUSIONS: The magnitude of improvements in the frequency of BGM and glycemic control in adolescents with type 1 diabetes is encouraging and will be tested in a randomized controlled trial.

Feasibility and utility of a structured guide for cannabis tolerance breaks in young adults.

Objective: To explore the feasibility and utility of a tolerance break (T-Break) guide on young adults' cannabis use. Participants: Young adults aged 18-29 (n = 125) who were current cannabis users. Methods: Participants recruited through posters and listservs at various universities were offered the T-Break Guide-daily activities, advice, and encouragement-to help complete a 21-day cannabis break. Bivariate analyses examined associations between Guide use and follow-up measures. Results: Compared to non-Guide users, participants who used the Guide "a lot" were more likely to complete the 21-day abstinence break (84% vs. 57%), revise their personal definition of balance to mean less cannabis (84% vs. 62%), and plan a future break (32% vs. 11%). Conclusion: Use of this self-directed T-Break Guide may help young adults take a break from cannabis use and reduce future use. Further research using more rigorous designs to test the Guide's efficacy and assess longer-term maintenance of effects is needed.