It doesn’t take a rocket scientist to figure out that marijuana is more than a passing attraction.
Grass, herb, pot, ganja, reefer, blunt, doobie. That the ubiquitous weed has acquired more than 1,200 slang references since the 16th century is proof enough of its hold.
Since the popularity derives from intoxicating properties, there’s inevitable over-indulgence that can border on addiction, maybe even cross that line. Addiction is not the word professionals in the field use. Try cannabis use disorder (CUD), a diagnosis given for problematic marijuana use.
Which brings us to the science. State-by-state legalization of recreational marijuana use has loosened constrictions on researching marijuana use. The University of Tennessee is one of the beneficiaries.
The National Institute on Drug Abuse (NIDA) has awarded a $3.5 million grant to researchers at UT and Colorado State University to test a text-delivered counseling program for ages 18 to 25 with cannabis use disorder. Researchers estimate about 1.8 million young adults had a cannabis use disorder in the past year.
“Young adults have the highest level of cannabis use disorder among other age groups that are studied.”
Those words are from Michael Mason, the Betsey R. Bush Endowed Professor of Children and Families at Risk in the UT College of Social Work’s Center for Behavioral Health Research. He is one of the two lead researchers for the first-of-this-kind study, along with Douglas Coatsworth, professor of human development and family studies at Colorado State University in Fort Collins.
That ages 18-25 are more likely to have CUD than adolescents and older adults is enough to justify research. But there’s more.
“They don’t come to treatment,” Mason said. “That’s one of the reasons for trying to think of creative approaches to get to them. There’s a barrier, but there’s ways to get around that.”
Protocols regarding privacy and confidentiality protect participants in health studies. In this study, with research involving a controlled substance, a certificate of confidentiality applies.
“NIDA knows that these populations are hard to get at,” Mason said. “NIH (National Institutes of Health) gives a certificate of confidentiality to encourage hard-to-reach populations.”
He’s dealt with that. When gathering data for a paper in another state, a police detective approached Mason requesting information he may have acquired via cellphone during the research. The certificate of confidentiality stopped that inquiry cold.
Which offers another research opportunity. Recreational marijuana use is illegal in Tennessee. It is legal in Colorado. That will enable this study to also examine the role of legalization of marijuana on treatment outcomes as well as cost effectiveness and educational outcomes.
Who is eligible to be part of the research? There’s the age restriction, and a preliminary online survey will make an initial determination of who is qualified based on other factors. Prospects then will be interviewed in person.
The symptoms
Among the symptoms associated with CUD are taking more cannabis than was intended; difficulty controlling or cutting down on use; craving cannabis; problems at work, school or home as a result of cannabis use; giving up or reducing other activities in favor of cannabis; taking cannabis in high-risk situations; continuing to use cannabis despite physical or psychological problems; tolerance to cannabis; and withdrawal when discontinuing cannabis.
The opportunity for significant findings in cannabis research is more promising with federal agencies receptive.
“Experts have said we know more about our washing machines than we know what’s going on in drug treatment for young adults, and how to get to them and how to navigate that,” Mason said.
He has an edge in that this is not entirely new territory. Mason didn’t say, “been there, done that,” because he hasn’t yet — not exactly — but he’s set the table.
PNCT-txt
Originally, Mason developed and tested a brief in-person intervention called Peer Network Counseling (PNC). PNC is based upon behavioral principles that have strong evidence for effectiveness but uniquely focuses on participants’ close peer group to decrease risk behaviors and increase protective behavioral strategies. Mason then developed and tested PNCT-txt — an automated personalized text-delivered version of PNC — with adolescents to reduce tobacco use and with young adults to reduce hazardous alcohol use, and found promising results.
This test of the text-delivered counseling program is not for casual cannabis users. Marijuana use per se is not the bottom line. The impact on lives is the determinate.
“It really varies. I mean some people can function. The statistic is 10% of the people who begin (using cannabis) will develop a CUD. Ninety percent of the people on campus, they’re going to do it and it’s not really going to disrupt their lives and they can go on. But 10% are going to be impacted in a way that disrupts their social, personal, vocational — potentially their future career,” Mason said.
How it works
Participants complete a survey at the beginning of their treatment, and the information is used to individually tailor the four-week intervention. Up to eight personalized interactive texts are sent to participants every other day for a month, and participants can access additional booster messages at any time. PNC-txt raises awareness of close peers, the places where participants spend their time, and how peers and places can produce protective or risk-enhancing behaviors.
In two recent pilot randomized clinical trials in 2018, Mason and his colleagues tested a text-based cannabis treatment intervention on 130 young adults. They found that compared to the control group, those receiving PNC-txt had reduced heavy cannabis use, relationship and memory problems, cravings and positive THC tests. PNC-txt also increased prosocial support and reduced the amount of marijuana used among the participants’ peers.
“This is a study of peer network counseling as a standalone treatment for CUD. We’re testing to see how this works on a large sample across two different states with different laws and policies and drug-use culture. But we have evidence from those papers that this is helping,” Mason said.
The research begins with awareness this text-delivered counseling program will work for some and not for others. But it’s innovative in that it functions via communication the 18-25 age group uses every day — cellphone texts.
“It’s not a magic bullet, and for some they will definitely need more intensive treatment. For some this is going to be enough. For some they might just keep this sort of in their back pocket and use it for a when-they-need-it type of thing. So there’s a lot of different trajectories that could happen,” Mason said. “We’re not flowing people into treatment. We’re trying to deliver it here via the texting program.”
What it doesn’t do is point fingers or throw shade.
“It’s a nonjudgmental program. It’s built on other successful interventions that try to activate the participants to their own motivation,” Mason said. “What is it that you want to do, your goals in the future? And how is your current behavior addressing that, and what do you think about that?
“So we’re not telling them what to do or it’s bad. We’re sort of laying out what they told us privately in the survey that they answered, and then we’re feeding it back to them. That’s the basic model: feedback and reflection, not judgmental. Focusing on their peers and where they go, that’s the essence of it,” he said.
With the grant, Mason and Coatsworth will enroll 1,000 young adults into the clinical trial — 500 from Tennessee and 500 from Colorado. Participants will be followed for six months, providing survey and biological data. Recruitment and enrollment of the participants are expected to begin in April 2020.