2023/01/27 by Gray, Kevin M., Tomko, Rachel L., McRae-Clark, Aimee L. +2
#ACCENT #ACCENT study #ARCHITECT #CFI #CUD #CUD Severity #Chi-Square #EOT #GFI #Goodness of Fit Test #HADS #Kline #Lavaan #MLE #MVN #NAC #NIDA #NIH #National Institute of Drug Abuse #National Institute of Health #PROMIS #Pearson #Q-Q plot #QOL #R #RMSEA #SE #SEM #SPSS #SRMR #SUD #TLI #abstinence #anxiety #basline #bootstrapping #cannabis #cannabis problems #cannabis use #cannabis use disorder #cannabis-related problems #clinical trial #configural #configural invariance #construct #conventional #correlation #correlational residuals #corrlational #covariance #cravings #creatinine-corrected #data-model fit #depression #devtools #direct effects #distal #distal outcomes #end-of-treatment #fit assessment #fit index #fit indices #follow-up #functional improvements #gender #gender differences #harm reduction #hospital anxiety and depression scale #indirect effects #interaction #longitudinal #marijuana cravings questionnaire #marijuana problems scale #maximum liklihood #mechanisms #mechanisms of change #mediation #men #metric #metric invariance #mid-treatment #model fit #multigroup analysis #multivariate normality #normality #obsessive compulsive cannabis use scale #outcomes #overgeneralization #parameter estimate #path analysis #path diagram #prediction #problems #progression #proximal #proximal outcomes #quality of life #quantitative #quantitative analysis #rigidity #semTools #severity #standardized error #standardized parameter estimate #structural equation modeling #substance use #substance use disorder #substance use disorders #temporal #temporal precedence #therapy #treatment #treatment outcomes #treatment progression #two-step process #unconventional #univariate normality #unstandardized parameter estimate #urine cannabinoid #use #withdrawal #women
paper · doi:10.17605/osf.io/nswbk
The exclusive focus on abstinence, rigid parameters, and lack of population moderation studies limits evidence of mechanisms of behavior change (MOBCs) that explain functional improvements in cannabis use disorder (CUD) treatments. We aimed to surpass these limitations by examining: 1) two untested non-abstinent MOBCs, 2) end-of-treatment (EOT; i.e., proximal) outcomes simultaneously functioning as MOBCs for follow-up (i.e., distal) outcomes, and 3) gender-moderated outcome predictors and MOBCs. Treatment-seeking individuals with CUD (n = 186; 70.1% male; 57.2% White) between ages 18-50 (M = 30.90, SD = 8.95) participated in a 12-week multi-site clinical trial with a four-week follow-up. We collected self-reported data and creatinine-corrected cannabinoid urine concentrations. We modeled treatment progression using moderated multigroup longitudinal path analyses to examine: H1) if mid-treatment, non-abstinent MOBCs (craving and use reductions) mediated the direct effect of CUD severity at the screening visit on proximal outcomes (anxiety, depression, and cannabis-related problems), H2) if proximal outcomes mediated the direct effect of mid-treatment MOBCs on a four-week distal outcome (quality of life challenges), and H3) if gender moderated these effects. We found that craving reduction may be a MOBC for the full and men samples. In women, depression may concurrently function as a proximal outcome and MOBC for quality of life challenges (distal outcome). Further, gender-moderated outcome predictors and MOBCs; for men, it may be craving reduction, and for women, reduced cannabis use. These nontraditional, differential explanations of functional improvements suggest that our understanding of CUD treatments may be more nuanced than currently indicated in the literature.