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Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis: the CapOpus randomized trial

Published online by Cambridge University Press:  08 October 2012

C. R. Hjorthøj ,
A. Fohlmann ,
A.-M. Larsen ,
C. Gluud ,
M. Arendt  and
M. Nordentoft
C. R. Hjorthøj*
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
A. Fohlmann
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
A.-M. Larsen
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
C. Gluud
Affiliation:
Copenhagen Trial Unit, Department 33.44, Rigshospitalet, Copenhagen Ø, Denmark
M. Arendt
Affiliation:
Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Denmark
M. Nordentoft
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
*
*Address for correspondence: C. R. Hjorthøj, Ph.D., M.Sc., Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Bispebjerg Bakke 23, Building 13A, DK-2400 Copenhagen NV, Denmark. (Email: Carsten.Rygaard.Hjorthoej@regionh.dk)
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Abstract

Background

Cannabis abuse in psychotic patients is associated with rehospitalizations, reduced adherence and increased symptom severity. Previous psychosocial interventions have been ineffective in cannabis use, possibly because of low sample sizes and short interventions. We investigated whether adding CapOpus to treatment as usual (TAU) reduces cannabis use in patients with cannabis use disorder and psychosis.

Method

A total of 103 patients with psychosis and cannabis use disorder were centrally randomized to 6 months of CapOpus plus TAU (n = 52) or TAU (n = 51). CapOpus consisted mainly of motivational interviewing and cognitive behaviour therapy (CBT). TAU was targeted primarily at the psychotic disorder. The primary outcome was self-reported days with cannabis use in the preceding month.

Results

Pre-randomization cannabis use frequency was 14.9 [95% confidence interval (CI) 12.7–17.1] days/month. Post-treatment, the ratio of days/month with cannabis use in CapOpus versus TAU was 0.76 (95% CI 0.38–1.50) (p = 0.42), and 0.80 (95% CI 0.21–3.10) (p = 0.75) at the 4-month follow-up. From 46.4 (95% CI 36.4–56.3) monthly joints pre-randomization, consumption fell to 27.3 (95% CI 12.6–41.9) joints in CapOpus and 48.2 (95% CI 31.8–64.6) in TAU (p = 0.06). Follow-up amounts were 28.4 (95% CI 13.5–43.2) and 41.6 (95% CI 25.2–58.0) joints (p = 0.23). Several subgroup analyses suggested benefits of CapOpus.

Conclusions

CapOpus did not reduce the frequency, but possibly the amount, of cannabis use. This is similar to the findings of previous trials in this population. Implementation of CapOpus-type interventions is thus not warranted at present but subgroup analyses call for further trials.

Keywords

Cannabisdual diagnosispsychosisrandomized clinical trialschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 7 , July 2013 , pp. 1499 - 1510
Copyright
Copyright © Cambridge University Press 2012 

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