0686 Cognitive Behavioral Therapy for Insomnia to Reduce Cannabis Use: Results from a Pilot Randomized Controlled Trial

Abstract

Abstract Introduction Cannabis use, including use for insomnia, has increased significantly in the United States over the past decade. Cannabis use disorders and/or heavy cannabis use have been linked to numerous negative outcomes, including poor work performance, other substance use, increased risk of psychosis, and neurocognitive deficits. In a pilot randomized controlled trial, we compared telemedicine-delivered CBT for insomnia tailored to individuals regularly using cannabis for sleep (CBT-CB-TM) to sleep hygiene education (SHE-TM) for improving sleep and daytime functioning and for reducing cannabis use. Methods Adults with chronic insomnia who reported using cannabis for sleep at least three times weekly were recruited through advertisements and at local cannabis dispensaries and screened for disqualifying sleep, medical, and mental health disorders. Fifty-seven eligible participants (43 women, mean age 37.6 ± 12.8 years) were randomized to 6 sessions of CBT-CB-TM (n=30) or SHE-TM (n=27). Participants completed self-reported measures of insomnia (Insomnia Severity Index, primary outcome), daytime functioning (sleep beliefs, depression, and overall functioning) and cannabis use before and after treatment and at 8-week follow-up. Results Mixed models showed that scores improved more on the Insomnia Severity Index (β=-2.83, se=0.62, p<.001) and Dysfunctional Beliefs and Attitudes about Sleep scale (β=-0.73, se=0.25, 9<.006) in the CBT-CB-TM compared to SHE-TM condition. Small pre- to post-treatment reductions in the daily frequency of cannabis use were evident for CBT-CB-TM compared to SHE-TM participants (pre-post change: 0.60 ± 0.94 vs. -0.04 ± 0.35, p<.007). Depression symptoms (PHQ-8: CBT-CB-TM 8.5 ± 0.7 to 6.8 ± 1.0 vs. SHE-TM 9.1 ± 0.7 to 7.0 ± 0.9, p<.004), and overall functioning (SF-12 MCS: CBT-CB-TM 43.3 ± 1.9 to 50.8 ± 2.9 vs. SHE-TM 39.8 ± 2.0 to 51.6 ± 2.5, p<.0005) improved in both conditions from pre-treatment through follow-up. Conclusion Telemedicine-delivered CBT for insomnia improved sleep and reduced cannabis use more than a matched behavioral placebo control in this pilot trial of adults using cannabis regularly for insomnia. These preliminary findings support the need for adequately-powered randomized controlled trials with longer follow-up periods to evaluate the efficacy of targeting insomnia to reduce problematic cannabis use. Support (If Any) R34 DA047466 (MPI: MA Ilgen, JT Arnedt)