Researchers from Colorado State University and the University of Tennessee Knoxville have received a $3.2 million grant from the National Institute on Drug Abuse to test a text-delivered counseling program for young adults ages 18 to 25 who have cannabis use disorder.

Because it will enroll young adults in Tennessee and Colorado, this first-of-its-kind study will also examine the role of legalization of marijuana on treatment outcomes as well as cost effectiveness and educational outcomes. Recreational marijuana use is legal in Colorado, but not in Tennessee.

The two lead researchers involved are Doug Coatsworth, a professor in CSU’s Department of Human Development and Family Studies, and 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.

Coatsworth and Mason have collaborated on other projects and saw this as a unique opportunity to test this novel intervention in two distinct settings; one in which cannabis has been legalized and another where it has not.

About cannabis use disorder

Cannabis use disorder (CUD) is a diagnosis given for problematic marijuana use. Approximately 1.8 million young adults aged 18 to 25 had a cannabis use disorder in the past year.

“Young adults in the United States have the highest rate of cannabis use disorder compared to other age groups and are the least likely to seek traditional treatment,” Mason said.

“Unfortunately, engaging young adults in treatment for CUD is very challenging,” he added. “Creative approaches such as integrating mobile technology with evidence-based treatments are needed. Text-delivered treatments increase access and privacy, which can lessen treatment stigmatization.”

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.

Earlier intervention

Originally, Mason developed and tested a brief in-person intervention called Peer Network Counseling. PNC is based on 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. Mason is now focusing on marijuana use among young adults.

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.

“The rate of cannabis use among Colorado’s college-age youth is among the highest of any state in the U.S.,” Coatsworth said. “We want to know if providing PNC-txt might reach some users who would not use other resources and if this approach can be effective.”

Initial successes

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.

With this new 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.

Successful study results will establish PNC-txt as an evidence-based treatment that has been supported by multiple published clinical trials and will enable Mason to work on disseminating the program to other populations and settings.

The Department of Human Development and Family Studies is part of CSU’s College of Health and Human Sciences.