Cognitive behavioral therapy for insomnia to reduce cannabis use: Results from a pilot randomized controlled trial

J Todd Arnedt; Deirdre A Conroy; Haylie Stewart; Emily Yeagley; Gabrielle Bowyer; Kipling M Bohnert; Mark A Ilgen

doi:10.1016/j.drugalcdep.2023.109835

Cognitive behavioral therapy for insomnia to reduce cannabis use: Results from a pilot randomized controlled trial

Drug Alcohol Depend. 2023 May 1;246:109835. doi: 10.1016/j.drugalcdep.2023.109835. Epub 2023 Mar 11.

Authors

J Todd Arnedt¹, Deirdre A Conroy², Haylie Stewart³, Emily Yeagley⁴, Gabrielle Bowyer³, Kipling M Bohnert⁵, Mark A Ilgen⁴

Affiliations

¹ Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA. Electronic address: tarnedt@med.umich.edu.
² Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
³ The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
⁴ The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
⁵ Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road Room B601, East Lansing, MI 48824, USA.

PMID: 36940598
DOI: 10.1016/j.drugalcdep.2023.109835

Abstract

Background: Individuals with regular cannabis use demonstrate adverse health outcomes, yet infrequently seek treatment. Insomnia, a common co-occurring complaint, could be targeted to reduce cannabis use and improve functioning in these individuals. In an intervention development study, we refined and tested the preliminary efficacy of a telemedicine-delivered CBT for insomnia tailored to individuals with regular cannabis use for sleep (CBTi-CB-TM).

Methods: In this single-blind randomized trial, fifty-seven adults (43 women, mean age 37.6 ± 12.8 years) with chronic insomnia and cannabis use for sleep ≥3 times/week received CBTi-CB-TM (n = 30) or sleep hygiene education (SHE-TM, n = 27). Participants completed self-reported assessments of insomnia (Insomnia Severity Index [ISI]) and cannabis use (Timeline Followback [TLFB] and daily diary data) at pre-treatment, post-treatment, and 8-week follow-up.

Results: ISI scores improved significantly more in the CBTi-CB-TM compared to SHE-TM condition (β = -2.83, se=0.84, P = 0.004, d=0.81). At 8-week follow-up, 18/30 (60.0 %) CBTi-CB-TM compared to 4/27 (14.8 %) SHE-TM participants were in remission from insomnia (X² =12.8, P = 0.0003). The TLFB showed a small reduction in past 30-day cannabis use for both conditions (β = -0.10, se=0.05, P = 0.026); CBTi-CB-TM participants demonstrated greater post-treatment reductions in the % of days cannabis was used within 2 h of bedtime (-29.1 ± 7.9 % fewer days vs. 2.6 ± 8.0 % more days, P = 0.008).

Conclusions: CBTi-CB-TM is feasible, acceptable, and demonstrated preliminary efficacy for improving sleep and cannabis-related outcomes among non-treatment-seeking individuals with regular cannabis use for sleep. Although sample characteristics limit generalizability, these findings support the need for adequately powered randomized controlled trials with longer follow-up periods.

Keywords: CBT; Cannabis; Insomnia; Randomized controlled trial; Telemedicine.

Publication types

Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Adult
Cannabis*
Cognitive Behavioral Therapy* / methods
Female
Humans
Middle Aged
Pilot Projects
Single-Blind Method
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome
Young Adult