title: Treatment models for targeting tobacco use during treatment for cannabis use disorder: case series.
abstract: Approximately 50% of individuals seeking treatment for cannabis use disorders (CUD) also smoke tobacco, and tobacco smoking is a predictor of poor outcomes for those in treatment for CUD. Quitting tobacco is associated with long-term abstinence from alcohol and illicit drugs, yet there are no established treatments for CUD that also target tobacco smoking. This report highlights issues related to cannabis and tobacco co-use and discusses potential treatment approaches targeting both substances. Data is shared from the first six participants enrolled in an intervention designed to simultaneously target tobacco use in individuals seeking treatment for CUD. The twelve-week program comprised computer-assisted delivery of Motivational Enhancement Therapy, Cognitive Behavioral Therapy, and Contingency Management, i.e., abstinence-based incentives for CUD. In addition, participants were encouraged to complete an optional tobacco intervention consisting of nicotine-replacement therapy and computer-assisted delivery of a behavioral treatment tailored for tobacco and cannabis users. All participants completed the cannabis intervention and at least a portion of the tobacco intervention: all completed at least one tobacco computer module (mean=2.5 modules) and 50% initiated nicotine replacement therapy. Five of six participants achieved abstinence from cannabis. The number of tobacco quit attempts was lower than expected, however all participants attempted to reduce tobacco use during treatment. Simultaneously targeting tobacco during treatment for CUD did not negatively impact cannabis outcomes. Participation in the tobacco intervention was high, but cessation outcomes were poor suggesting that alternative strategies might be needed to more effectively prompt quit attempts and enhance quit rates.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Rivermill Complex, Suite B3-1, 85 Mechanic St., Lebanon, NH 03766, United States. Electronic address: Dustin.C.Lee@Dartmouth.edu.
authors.forename: Dustin C
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Rivermill Complex, Suite B3-1, 85 Mechanic St., Lebanon, NH 03766, United States.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Budney
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Rivermill Complex, Suite B3-1, 85 Mechanic St., Lebanon, NH 03766, United States.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Brunette
authors.affiliation: Department of Psychiatry, University of Vermont, UHC Campus/OH3, Stop # 482, 1 South Prospect St., Burlington, VT 05401, United States.
authors.forename: John R
authors.initials: JR
authors.lastname: Hughes
authors.affiliation: Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, CMU. 1, rue Michel-Servet, 1211 Genève 4, Switzerland.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Etter
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Rivermill Complex, Suite B3-1, 85 Mechanic St., Lebanon, NH 03766, United States.
authors.forename: Catherine
authors.initials: C
authors.lastname: Stanger
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D012984:Software; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome; D055815:Young Adult
keywords: Behavior; Cannabis; Co-use; Dependence; Tobacco; Treatment