Feasibility and Preliminary Efficacy of Ecological Momentary Assessment and Personalized Network Feedback in Young Adults with Cannabis Use Problems: A Pilot Randomized Controlled Trial

Background and aims. Interventions for cannabis use problems could improve through personalization with ecological momentary assessment (EMA) and derived personalized feedback including idiographic networks. To study preliminary efficacy and feasibility, this pilot preclinical randomized controlled trial compared a short version of treatment as usual (TAU) to the same with the add-on of EMA and personalized feedback.Design. We conducted a pilot parallel two-arm randomized controlled trial.Setting. Data were collected at the University of Amsterdam, the Netherlands (March to November 2023).Participants. We included participants aged 18-30, with good English proficiency, owning smartphones, using cannabis flower at least weekly, and wanting help to stop or diminish use. Current treatment for or diagnosis of a substance use or psychotic disorder were exclusion criteria. We recruited through flyers, social media, peer-to-peer recruitment, and the University of Amsterdam lab. We used block randomization stratified by gender; participants were blind to condition.Intervention. Both groups received TAU, additionally, the experimental group received EMA and personalized feedback (TAU+).Measurements. Main outcomes were self-reported cannabis use and cannabis use disorder (CUD) DSM-5 symptoms. Secondary outcomes were mental health variables. Predictors were time, condition, and their interaction. Semi-structured interviews were conducted with TAU+ participants and practitioners giving the intervention and analyzed with thematic analysis.Findings. 90 participants were screened, 76 were randomized, 13 per group were included (target sample size), other randomized participants either declined participation/had to be excluded or were in the waiting list. Two experimental and one control participants dropped out (23 participants included in the analyses). Average cannabis grams smoked per day, days smoking cannabis, and CUD symptoms decreased in both groups (p < .001). However, only TAU+ participants maintained the change for the three main outcome measures at three-months follow-up (p = .038, .035, .056 respectively). Both interventions diminished depression, stress, and negative emotions. No adverse events occurred. Participants reported high perceived usefulness, ease of use and motivation regarding the personalized feedback, but some difficulties and negative emotions in answering EMA. Practitioners’ interview results suggested the need to simplify the tool for practitioners and give more training on communicating feedback. Conclusions. Adding personalized EMA and feedback to TAU seems feasible and may reduce relapse rates in problematic cannabis use compared to TAU alone. A larger trial is needed to support these results.