CONNECT for Depressed Cannabis Users Trial

An estimated 8.4 million adults in the U.S. experience co-occurring psychiatric and SUDs,
largely accounted for by comorbid mood disorder-SUD. Cannabis is the most widely used illicit
substance among individuals with depressive disorders1. Likewise, elevated rates of major
depression are observed among those with cannabis use disorders (CUD)2.

The use of technology-based platforms for behavioral intervention delivery in primary care
settings, focusing on comorbidity, is a promising approach to broadening availability of
evidence-based treatments for this high-need population, at low cost.

With support from a NIDA High Priority, Short-Term Project Award, the present investigative
team (PI Dr. Glasner-Edwards and Drs. Budney and Kay-Lambkin) piloted SHADE (Self-Help for
Alcohol and Other Drug Use and Depression), a computerized intervention model combining
cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET), in a primary
psychiatric care setting, where integrated interventions addressing both mental health and
SUDs are not readily accessible. Preliminary data indicate that SHADE: (1) was feasible and
acceptable, (2) facilitated treatment engagement and retention in a difficult-to-treat
comorbid population with major depression and CUD; and (3) effectively reduced cannabis use
and depression. As a next step to optimize the efficacy of this intervention model, the
present proposal is designed to develop and integrate a social media component to the SHADE
intervention program, based on a program established and tested by Co-I Dr. Ramo in an RCT4.

To this end, we propose to: (a) develop and refine, with user feedback, a social
media-assisted therapy intervention, CONNECT (Connected Cannabis Users' Network for
Enhancement of Cognitive Therapy), which combines the use of Facebook for social network
support with SHADE in a population of adults with CUD and major depression; and (b) collect
preliminary data to evaluate effect sizes and investigate trends for the impact of CONNECT
plus SHADE on cannabis use, depressive symptoms, and health service utilization. Moreover, we
will gather preliminary data for social network analysis, to understand the mechanism(s) by
which the social media component of CONNECT promotes health behavior change in the key
outcome domains of the present study.

The use of a social media platform (i.e., Facebook) will increase the accessibility of the
intervention as Facebook can be accessed using a variety of technology devices.

Aim 1. To develop and refine, with user feedback, a 10-week, social media-assisted
intervention (CONNECT) combining a computer-assisted, integrated treatment program (SHADE)
with private Facebook groups to facilitate peer and clinician support for therapeutic
objectives. The CONNECT intervention targets cannabis use and depression in a population of
depressed adults with CUD receiving psychiatric care.

Hypothesis 1: Participants will report that CONNECT is user-friendly and helpful in providing
opportunities for between-session practice of therapy skills, peer and clinician support, and
information that enable them to prevent cannabis relapse and manage depression.

Aim 2. To test the impact of CONNECT plus SHADE on cannabis use, depression, adherence to
psychiatric care, and healthcare outcomes.

Hypothesis 2a: Among depressed substance dependent adults in an outpatient psychiatric care
setting, CONNECT plus SHADE will led to clinical outcomes in reducing cannabis use and
depression, and improving adherence to psychiatric care during and after treatment.

Aim 3. To test whether social network variables mediate or moderate the impact of CONNECT.

Hypothesis 3: Participants with more expansive Facebook social networks within CONNECT will
benefit more from the program. Factors that influence engagement in the Facebook component of
CONNECT will also be explored (e.g., social network characteristics and content of peer and
therapist interaction via the social network), and engagement will be examined as a potential
moderator of cannabis use and depression outcomes.

Inclusion Criteria:

1. Between the ages of 18 and 65;

2. DSM-5 diagnosis of CUD, with use reported on >50 of the past 90 days;

3. DSM-5 diagnosis of Major Depressive Disorder (Lifetime);

4. Current Patient Health Questionnaire-9 (PHQ9) score > 9;

5. Uses Facebook or willing to join and learn how to use it;

6. Having received treatment for depression in the past year.

Exclusion Criteria: