Avatar Intervention for Cannabis Use disorder in Individuals with Severe Mental Disorders: Results from a one-year pilot clinical trial (Preprint)

BACKGROUND The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD. OBJECTIVE This pilot clinical trial aimed to evaluate until 1 year follow-up efficacy of avatar intervention for CUD on 32 participants with a dual diagnosis of SMD and CUD. METHODS Over the course of the 8 therapy sessions, participants were given the opportunity to enter a dialogue with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. In addition to the clinical evaluations conducted prior to and after the intervention, follow-up visits occurred 3, 6 and 12 months after the last session. RESULTS Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d =0.804, p<0.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384, p=0.031). Moreover, improvements were observed for severity of CUD, cannabis related negative consequences, motivation to change cannabis use and in the strategies employed to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms. CONCLUSIONS Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention. CLINICALTRIAL Clinicaltrials.gov NCT03585127