Affective Management Training for Cannabis Misuse

This project aims to develop and evaluate a behavioral intervention for adolescent cannabis
use disorder that emphasizes adaptive responding to negative affective symptoms (e.g.,
depression, anxiety). Maladaptive cognitive, behavioral, and emotional reactions to negative
affect are associated with substance use and substance use problems (including cannabis).
Adolescence and young adulthood represents a developmental period in which the regulation of
negative emotions is still being developed, as well as a time when cannabis use is prevalent
and cannabis use disorders onset. Thus, developing and evaluating cannabis use disorder
interventions that emphasize the improvement of responding to negative affect may be
particularly important for this developmental period. First, the investigators developed an
intervention that weaves skills and strategies for responding adaptively to negative affect,
particularly as it relates to high-risk times for cannabis craving and use, into an
evidence-based substance use disorder intervention for individuals in late adolescence and
early adulthood. After delivering it to a small sample of participants, the investigators
will gather feedback to guide refinements to the intervention. After refining the
intervention, which will be a 12-session individual treatment, we will conduct the pilot
randomized clinical trial. Participants (N = 80) aged 18-25 with cannabis use disorder and
elevations in constructs representing maladaptive reactivity to negative affect (i.e., high
anxiety sensitivity, low distress tolerance, or facets of emotion dysregulation including
high emotional suppression and low cognitive reappraisal ability) will be randomized to
receive either: (a) standard cognitive behavioral therapy for adolescent substance use
disorders (SUD-CBT) or (b) the novel intervention we develop, affective management training
for cannabis use disorders (CUD-AMT). Participants will be assessed at baseline,
post-treatment, and a 6-month follow-up assessment on self-report and behavioral indices of
the targeted mechanisms, as well as on substance use outcomes (both cannabis-specific and
substances more broadly defined). A sub-set of participants (n = 50) will also undergo pre-
and post-treatment fMRI assessment to evaluate whether neural indices of emotion regulation
are improved to a greater extent in CUD-AMT compared to SUD-CBT. Cannabis use disorder is the
most prevalent substance use disorder among adolescents and young adults, and often leads to
the use of other substances. Negative affect and disorders associated with high negative
affect (i.e., anxiety and unipolar mood disorders) are highly prevalent and associated with
significant substance use disorder comorbidity. Targeting a process that is still malleable
in late adolescence and young adulthood and that is associated with the maintenance of
substance use disorders has the potential to reduce the burden of substance use disorders in
this population, thus making a significant public health impact.

Inclusion Criteria:

- must be between ages of 18-25; meet diagnostic criteria for cannabis use disorder;
score > 1 Standard deviation above the norm on the Positive and Negative Affect
Scale-Negative Affect Subscale, and > 1 standard deviation above the norm on either
the Anxiety Sensitivity Index, the Distress Tolerance Scale, or the Emotion Regulation
Questionnaire; either not on medication or stabilized on medication; fluent in
English; and must satisfy usual fMRI criteria.

Exclusion Criteria:

- marked cognitive impairment; moderate to severe suicidality; unstable manic or
psychotic symptoms; or primary substance of dependence is not cannabis.