Treating cannabis use disorder in young adults with text-delivered peer network counseling: A large, multi-site, randomized clinical trial.

Background: Approximately nine percent of U.S. young adults (18 to 25 years old) have a cannabis use disorder (CUD) and are at risk for poor s health outcomes. Treatment alters use, but young adults are less likely to seek help than older users. The changing landscape of cannabis legalization within the U.S. may influence use and help-seeking.

Methods: Peer Network Counseling-txt (PNC-txt) was developed as a brief, text-delivered, Motivational Interviewing informed substance use intervention uniquely focusing on peer relations as the primary mechanism for behavioral change. We will test 3 hypotheses covering: 1) efficacy of PNC-txt, 2) peer relations as a treatment mediator, and 3), the context of efficacy, comparing states in which cannabis is legal and one state in which it is not. 1,000 young adults, 500 from Colorado and 500 from Tennessee, who meet criteria for Cannabis Use Disorder and current cannabis use by THC metabolites in a urine screen, will be randomly assigned to PNC-txt or waitlist control condition. Participants assigned to PNC-txt will receive automated text conversations 4 days per week over 4 weeks, for a total of 160 texts. Booster messages are also available as needed for participant support. Text conversations are tailored according to data provided at baseline and throughout the intervention. Self-report and biological indicators (urine screen) of cannabis use will be measured at 1, 3 and 6-months postbaseline.

Results: Results from this study will provide evidence regarding the contexts in which PNC-txt influences cannabis use in young adults. As of this writing 950 participants have been randomized. Baseline characteristics of participant cannabis use and associations with mental health, peer relations, and activity space data will be presented.

Conclustions: This large, multi-site text-delivered randomized clinical trial will provide insight into the opportunities and challenges of treating CUD via mobile health (mHealth) interventions.