Correlations and agreement between delta‐9‐tetrahydrocannabinol (THC) in blood plasma and timeline follow‐back (TLFB)‐assisted self‐reported use of cannabis of patients with cannabis use disorder and psychotic illness attending the CapOpus randomized clinical trial

Hjorthøj, Carsten; Fohlmann, Allan; Larsen, Axel; Arendt, Mikkel; Nordentoft, Merete

doi:10.1111/j.1360-0443.2011.03757.x

Cited by 58 publications

(43 citation statements)

References 36 publications

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“…Given the significant cognitive impairments in the sample being studied, a research assistant blind to treatment assignment facilitated the completion of all Timeline Follow-Back surveys using an interview-style approach to help patients adhere to the format, review their previous month of substance use, and answer any questions. The Timeline Follow-Back method has been shown to produce highly accurate estimates of substance use comparable to biological assays (Hjorthøj, Hjorthøj, & Nordentoft, 2012), and has shown adequate reliability and validity in patients with schizophrenia (Hjorthøj, Fohlmann, Larsen, Arendt, & Nordentoft, 2012). In addition, addiction severity was quantified using interviewer severity ratings (0 = least severe, 9 = most severe), for alcohol and drugs separately, based on the Addiction Severity Index (McLellan, Luborsky, Woody, O'Brien, 1980).…”

Section: Methodsmentioning

confidence: 99%

Patterns of Substance Use During Cognitive Enhancement Therapy: An 18-Month Randomized Feasibility Study

Eack

Hogarty

Bangalore

et al. 2016

Journal of Dual Diagnosis

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Objective Substance use problems are common among people with schizophrenia, as are significant cognitive impairments. Because of potential shared neurobiological pathways, it is possible that cognitive remediation interventions may be associated with improvements in both substance use and cognition. This study examined the impact of cognitive remediation on alcohol and cannabis use, and the cognitive correlates of changes in substance use among outpatients with schizophrenia. Methods Individuals with schizophrenia who were receiving outpatient services at a psychiatric clinic and had moderate or higher addiction severity scores (N = 31) were randomized to 18 months of cognitive enhancement therapy (n = 22) or usual care (n = 9). Cognitive enhancement therapy is a cognitive remediation approach that integrates computer-based training in attention, memory, and problem-solving with a group-based social cognition curriculum. Usual care was provided to all participants and consisted of routine psychiatric care. Primary outcomes included days of alcohol and cannabis use, assessed with the Timeline Follow-Back method every six months and modeled using penalized quasi-likelihood growth curves. Results Participants were on average 38.23 (SD = 13.44) years of age, had been ill for 14.19 (SD = 11.28) years, were mostly male (n = 22, 71%), and about half were Caucasian (n = 16, 52%). Temporal patterns of substance use days were highly variable and followed non-linear trajectories. Intent-to-treat analyses indicated that, compared to patients only receiving usual care, those receiving cognitive enhancement therapy were significantly less likely to use alcohol (OR = .22, 95% CI [.05, .90], p = .036), but not cannabis (OR = 1.89, 95% CI [.02, 142.99], p = .774) over time, and they reduced their alcohol use at significantly accelerated rates (OR = 1.02, 95% CI [1.01, 1.03], p = .003) . Changes in cognition were variably associated with substance use outcomes, although improvements in visual learning and reasoning and problem-solving were both consistently related to reduced alcohol and cannabis use. Conclusions Cognitive remediation may be effective for improving some substance use problems in schizophrenia. Visual learning and problem-solving deficits may be particularly important targets of such interventions, given their association with reduced alcohol and cannabis use. This study is registered at clinicaltrials.gov under #NCT01292577.

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Section: Methodsmentioning

confidence: 99%

Patterns of Substance Use During Cognitive Enhancement Therapy: An 18-Month Randomized Feasibility Study

Eack

Hogarty

Bangalore

et al. 2016

Journal of Dual Diagnosis

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“…Social adjustment was assessed using the Social Adjustment Scale-II (Schooler, Weissman, & Hogarty, 1979), Major Role Adjustment Inventory (Hogarty et al, 1974), and the Global Assessment Scale (Endicott, Spitzer, Fleiss, & Cohen, 1976) Symptomatology was assessed using the Brief Psychiatric Rating Scale (Overall & Gorham, 1962), Wing Negative Symptom Scale (Wing, 1961), Raskin Depression Scale (Raskin, Schulterbrandt, Reatig, & McKeon, 1969), and Covi Anxiety Scale (Lipman, 1982). Finally, previous 30-day substance use was assessed using the Timeline Follow-Back interview (Sobell & Sobell, 1992), which has been shown to be a reliable and valid measure of substance use in psychosis (Hjorthøj, Fohlmann, Larsen, Arendt, & Nordentoft, 2012). …”

Section: Methodsmentioning

confidence: 99%

Cognitive Enhancement Therapy in substance misusing schizophrenia: Results of an 18-month feasibility trial

Eack

Hogarty

Greenwald

et al. 2015

Schizophrenia Research

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Substance use is a frequent problem in schizophrenia, and although many substance misusing patients with the disorder also experience considerable cognitive impairments, such individuals have been routinely excluded from clinical trials of cognitive remediation that could support their functional and addiction recovery. This study conducted a small-scale feasibility trial of Cognitive Enhancement Therapy (CET) in substance misusing schizophrenia patients to assess the feasibility and efficacy of implementing comprehensive neurocognitive and social-cognitive remediation in this population. A total of 31 schizophrenia outpatients meeting addiction severity criteria for alcohol and/or cannabis use were randomized to 18 months of CET or usual care. Feasibility findings indicated high degrees of satisfaction with CET, but also presented significant challenges in the recruitment and retention of substance misusing patients, with high levels of attrition (50%) over the study period, primarily due to positive symptom exacerbation. Intent-to-treat efficacy analyses showed large and significant improvements in neurocognition (d = .86), social cognition (d = 1.13), and social adjustment (d = .92) favoring CET. Further, individuals treated with CET were more likely to reduce alcohol use (67% vs. 25%) during treatment (p = .021). These results suggest that once engaged and stabilized, CET is a feasible and potentially effective treatment for cognitive impairments in patients with schizophrenia who misuse alcohol and/or cannabis. Substance misusing patients who are able to engage in treatment may be able to benefit from cognitive remediation, and the treatment of cognitive impairments may help improve substance use outcomes among this underserved population.

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“…Other evidence has suggested that asking psychotic patients about their use of cannabis is, at least in some situations, more accurate than urine or blood testing. 36 Finally, our sample is representative of subjects accessing the adult psychiatric services who, therefore, experience their AOP between age 18 and 65 years. Thus, we are excluding those who have their illness onset in the early teens, a time when many adolescents are likely to first try cannabis.…”

Section: Limitationsmentioning

confidence: 99%

Daily Use, Especially of High-Potency Cannabis, Drives the Earlier Onset of Psychosis in Cannabis Users

Forti

Sallis

Allegri

et al. 2013

Schizophrenia Bulletin

402

265

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Cannabis use is associated with an earlier age of onset of psychosis (AOP). However, the reasons for this remain debated. Methods: We applied a Cox proportional hazards model to 410 first-episode psychosis patients to investigate the association between gender, patterns of cannabis use, and AOP. Results: Patients with a history of cannabis use presented with their first episode of psychosis at a younger age (mean years = 28.2, SD = 8.0; median years = 27.1) than those who never used cannabis (mean years = 31.4, SD = 9.9; median years = 30.0; hazard ratio [HR] = 1.42; 95% CI: 1.16-1.74; P < .001). This association remained significant after controlling for gender (HR = 1.39; 95% CI: 1.11-1.68; P < .001). Those who had started cannabis at age 15 or younger had an earlier onset of psychosis (mean years = 27.0, SD = 6.2; median years = 26.9) than those who had started after 15 years (mean years = 29.1, SD = 8.5; median years = 27.8; HR = 1.40; 95% CI: 1.06-1.84; P = .050). Importantly, subjects who had been using high-potency cannabis (skunk-type) every day had the earliest onset (mean years = 25.2, SD = 6.3; median years = 24.6) compared to never users among all the groups tested (HR = 1.99; 95% CI: 1.50-2.65; P < .0001); these daily users of highpotency cannabis had an onset an average of 6 years earlier than that of non-cannabis users. Conclusions: Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users.

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Correlations and agreement between delta‐9‐tetrahydrocannabinol (THC) in blood plasma and timeline follow‐back (TLFB)‐assisted self‐reported use of cannabis of patients with cannabis use disorder and psychotic illness attending the CapOpus randomized clinical trial

Cited by 58 publications

References 36 publications

Patterns of Substance Use During Cognitive Enhancement Therapy: An 18-Month Randomized Feasibility Study

Patterns of Substance Use During Cognitive Enhancement Therapy: An 18-Month Randomized Feasibility Study

Cognitive Enhancement Therapy in substance misusing schizophrenia: Results of an 18-month feasibility trial

Daily Use, Especially of High-Potency Cannabis, Drives the Earlier Onset of Psychosis in Cannabis Users

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