Randomised pilot study of cannabis cue exposure: reducing cue reactivity while building tolerance

Objective: Cue-exposure therapy should improve emotion regulation (i.e., reduce cravings and develop tolerance for cravings), but its effects may depend on the context in which it is delivered. The aim of this randomised pilot study was to investigate changes in cannabis cue reactivity and ability to tolerate cravings from pre- to post-exposure within two different contexts and indicate if and how a larger randomised controlled trial (RCT) can be conducted. Methods: Twenty-two participants who regularly smoked cannabis in lounge settings were randomly allocated to one of two conditions. In the Same-Context condition, participants underwent the pre-exposure assessment, cue-exposure sessions, and post-exposure assessment in a lounge room. In the Different-Context, participants underwent the pre- and post-exposure assessments in a lounge room, but underwent cue exposure in a therapist's office. Participants chose whether to complete sessions daily (5 days of participation) or intensively (2 days of participation) to maximise study recruitment and retention. Results: Eighteen participants completed the study as required. Only Same-Context participants’ ability to tolerate cravings from pre- to post-exposure statistically significantly improved. Examination of the magnitude of effect sizes and individual data showed that Same-Context participants were more likely to benefit from cue exposure than Different-Context participants (moderate to large effect sizes vs. small to moderate effect sizes). Additionally, cue exposure seemed more effective at building tolerance of cravings (large effect), than reducing them (moderate effect), at least when provided within the Same-Context. Conclusions: Although underpowered to assess for statistical differences, this study provides information for a future RCT and for clinical practice.