Cannabis use disorder (CUD) is the most common illicit substance use disorder and individuals with CUD have high rates of comorbid anxiety disorders. Comorbidity between CUD and anxiety disorders is of public health relevance given that although motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for CUD, outcomes are worse for patients with elevated anxiety. The current study tested the acceptability and efficacy of the integration of a transdiagnostic anxiety CBT (i.e., treatment of patients with any anxiety disorder) with MET-CBT (integrated cannabis and anxiety reduction treatment, or ICART) for CUD compared to MET-CBT alone. Treatment-seeking cannabis users (56.4% male, M age = 23.2, 63.3% non-Hispanic White) with CUD and at least one comorbid anxiety disorder were randomly assigned to ICART (n = 27) or MET-CBT (n = 28). Patients in the ICART condition attended significantly more treatment sessions than those in the MET-CBT condition. Patients in the ICART condition were more likely to be abstinent post-treatment than those in MET-CBT. Further, treatment produced decreases in cannabis use and related problems. Notably, therapy type did not moderate the impact of treatment on frequency of use and related * Correspondence may be sent to Julia D.

Cannabis is the most commonly used illicit substance and many users report difficulty quitting. Situations involving stress and negative affect are the most difficult in which to abstain during quit/reduction attempts. Further, cannabis users with elevated social anxiety experience greater cannabis-related impairment than individuals with more normative levels of social anxiety. Yet, although most persons with cannabis-related problems are interested in quitting and endorse negative emotional symptoms, the vast majority do not seek in-person treatment. Thus, the current study tested the utility of an online personalized feedback intervention (PFI) that integrates feedback regarding cannabis with strategies to manage negative affect (PFI-NAC). Current (past month) cannabis using undergraduates (who used cannabis weekly, on average) were randomly assigned to the 1-session PFI-NAC (n = 37) or an assessment-only control (n = 26) and completed a 2-week follow-up assessment. After controlling for baseline negative affect and cannabis use frequency, social anxiety interacted with condition to predict follow-up cannabis use frequency. Specifically, among those with moderate or high levels of social anxiety, those in PFI-NAC reported less use at follow up than controls; this was not the case among those with lower social anxiety. Results of this pilot study indicate a 1-session intervention that teaches simultaneously teaching skills to manage negative affect and cannabis may benefit some cannabis users with moderate to high social anxiety. Future work with larger samples and a wider range of cannabis users, with longer follow-up assessments, are important next steps.

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