Development of an integrative cessation program for co-smokers of cigarettes and cannabis: demand analysis, program description, and acceptability

Abstract

BackgroundTobacco and cannabis use are strongly interrelated, but current national and international cessation programs typically focus on one substance, and address the other substance either only marginally or not at all. This study aimed to identify the demand for, and describe the development and content of, the first integrative group cessation program for co-smokers of cigarettes and cannabis.MethodsFirst, a preliminary study using expert interviews, user focus groups with (ex-)smokers, and an online survey was conducted to investigate the demand for, and potential content of, an integrative smoking cessation program (ISCP) for tobacco and cannabis co-smokers. This study revealed that both experts and co-smokers considered an ISCP to be useful but expected only modest levels of readiness for participation.Based on the findings of the preliminary study, an interdisciplinary expert team developed a course concept and a recruitment strategy. The developed group cessation program is based on current treatment techniques (such as motivational interviewing, cognitive behavioural therapy, and self-control training) and structured into six course sessions.The program was evaluated regarding its acceptability among participants and course instructors.ResultsBoth the participants and course instructors evaluated the course positively. Participants and instructors especially appreciated the group discussions and the modules that were aimed at developing personal strategies that could be applied during simultaneous cessation of tobacco and cannabis, such as dealing with craving, withdrawal, and high-risk situations.ConclusionsThere is a clear demand for a double cessation program for co-users of cigarettes and cannabis, and the first group cessation program tailored for these users has been developed and evaluated for acceptability. In the near future, the feasibility of the program will be evaluated.Trial registrationCurrent Controlled Trials ISRCTN15248397

A review of co‐morbid tobacco and cannabis use disorders: Possible mechanisms to explain high rates of co‐use

“…However, cessation programs that exclusively address tobacco consumption appear to be less effective for individuals who also consume cannabis . In fact, evidence is accumulating that suggests that simultaneous tobacco and cannabis abstinence predicts better treatment outcomes …”

Feasibility of a group cessation program for co-smokers of cannabis and tobacco

“…In addition, participants' high levels of satisfaction (based on their recommendation levels) illustrated acceptability. A more detailed evaluation of intervention acceptability is presented in an earlier publication [22]. We did not find evidence of hospitalisation due to course participation and only three participants indicated that severe problems due to their simultaneous cessation (attempts) were among their reasons for discontinuing the intervention.…”

“…Finally, an information evening was offered. The publication regarding the development of the intervention provides a detailed description of the recruitment process [22].…”

“…While cannabis dependence is usually treated in the psychiatric care system, interventions for tobacco users are part of the general public health system [18,19]. Recently, several reviews and a demand analysis identified a need for interventions tailored to co-smokers of tobacco and cannabis [7,[20][21][22]. To date, one small pilot study evaluated individual cognitive behavioural therapy combined with nicotine replacement therapy (NRT) for co-occurring cannabis and nicotine dependence [23].…”

Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers

“…In addition, concurrent cannabis and tobacco use is associated with poor treatment outcomes during both cannabis (Haney et al, 2013; Moore and Budney, 2001) and tobacco interventions (Patton et al, 2005; Stapleton et al, 2009), with some evidence suggesting that individuals may compensate for abstinence from one substance by increasing their use of the other (Allsop et al, 2012). Although interventions adapted to address concurrent cannabis and tobacco use have shown initial efficacy (Becker et al, 2014; Becker et al, 2013; Gulliver et al, 2015), there is a need for more effective treatment approaches. The current data suggest that a focus on other psychosocial and psychiatric issues may further improve interventions targeted at reducing comorbid tobacco and cannabis use, particularly among women who quit smoking tobacco during pregnancy.…”