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Ethics code: ID IDIR.IAU.B.REC.1399.060
1- Islamic Azad University
2- Allameh Tabatabai University
3- Malayer University
4- Institute for Cognitive Science Studies (ICSS)
2- Allameh Tabatabai University
3- Malayer University
4- Institute for Cognitive Science Studies (ICSS)
Abstract: (17 Views)
Introduction
Cannabis Use Disorder (CUD) is a condition where individuals struggle to control their cannabis consumption despite negative consequences. Fluctuations in cravings may predict drug relapses, making them a strong predictor of relapse. Acute cannabis use has been associated with impairments in information storage, manipulation, and working memory, suggesting that enhancing cognitive function could be a pivotal treatment strategy for CUD. Current treatment options are limited and primarily focus on psychosocial interventions such as motivational interviewing, cognitive behavioral therapy, and crisis management. Cognitive rehabilitation, which aims to improve cognitive functions through repeated practice, shows promising benefits for substance use disorders. Cognitive training utilizing Stop-Signal Tasks may enhance GABA-mediated neurotransmission in the cortex, indicating potential neural plasticity and improved inhibitory control. Motivational interviewing seeks to boost motivation to cease or reduce cannabis use, enhance self-efficacy, and facilitate planning for change within an empathetic, nonjudgmental environment. In light of these considerations and the need for innovative treatments for CUD, this study investigated the effects of cognitive rehabilitation and motivational interviewing on reducing cravings and enhancing cognitive functions among male cannabis users.
Method
This study employed an experimental design comprising three groups with pre-test, post-test, and follow-up assessments, focusing on male cannabis users in Tehran in 2021. The G*Power software was utilized to determine the sample size. Participants were randomly assigned to one of three groups, each consisting of fifteen individuals: motivational interviewing, cognitive rehabilitation, and control.
The study included male cannabis users who met specific inclusion criteria. Participants were required to abstain from using any other substances and to have no medical or psychiatric disorders. Additionally, they were not permitted to be on any medications related to medical or psychiatric conditions. Individuals who were absent for more than two sessions during the intervention or who expressed reluctance to continue were excluded from the study. Various assessment tools were employed, including a pictorial task to measure craving (induction), the n-back task, the Go/No-Go task, and the Iowa gambling task. Motivational interviewing was conducted over eight weekly sessions, each lasting 90 minutes, over two months. The structure of the motivational interviewing sessions adhered to the guidelines established by Zolasquez et al. (2001) (see Table 1).
Cognitive rehabilitation training was conducted using stop-signal response inhibition software in ten 45-minute sessions over two months. Following data collection, the data were analyzed using SPSS version 27.
Result
Evaluating the effectiveness of cognitive rehabilitation and motivational interviewing on the addictive and cognitive indicators among cannabis users was employing multivariate covariance analysis (see Table 2). The demographic results indicated that 16.7% of participants were married, while 55% possessed a diploma. The average age of participants was 25.05 ± 2.88 years, and the duration of cannabis use was 6.57 ± 3.18 years.
Assumptions for parametric tests were evaluated. Upon confirming the normal distribution and homogeneity of variances, the assumption of homogeneity of regression was assessed. The results indicated that the interaction between the pre-test auxiliary variables and the post-test dependent variables across the experimental and control group factor levels was insignificant (p < 0.05), thereby confirming the assumption of regression homogeneity.
Continuing with covariance analysis, we examined differences among the three groups across the three distinct scenarios (see Table 3). The findings revealed that significant differences existed among the cognitive rehabilitation, motivational interviewing, and control groups concerning at least one of the dependent variables. Specifically, there were noteworthy variations in risky decision-making, information processing speed, craving, and working memory across the three-time points (F = 13.23, p = 0.001). We conducted univariate covariance analysis to investigate these differences further (see Table 4).
The results indicated that cognitive rehabilitation and motivational interviewing significantly influenced the investigated variables compared to the control group. These findings suggest that both interventions contribute to a reduction in cravings and an enhancement in risky decision-making, working memory, response inhibition, and processing speed among men with CUD. However, no significant differences were observed between the cognitive rehabilitation and motivational interviewing groups concerning any of the investigated variables.
Conclusion
This study evaluated the impact of cognitive rehabilitation and motivational interviews on reducing cravings and improving cognitive functions in male cannabis users. Both interventions significantly reduced cravings and enhanced decision-making, working memory, response inhibition, and processing speed. However, no significant differences were found between the two interventions.
Existing studies have employed various treatments for cannabis dependence disorder, including motivational interviewing, cognitive rehabilitation, and contingency management. Motivational interviewing is widely accepted for treating substance use disorders, including cannabis use disorder. In contrast, cognitive rehabilitation is less frequently applied. Nevertheless, this study demonstrated that both interventions exhibit comparable effectiveness.
Research has shown the effectiveness of cognitive rehabilitation for individuals with various addictive or cognitive disorders occurring concurrently with cannabis use. Improvements in the cognitive functions of cannabis users through cognitive rehabilitation may enhance their executive functions, leading to better control over addictive behaviors and reduced cravings. Since craving is a primary predictor of relapse in cannabis users, decreasing it may help reduce the likelihood of relapse.
Moreover, since most cannabis users are young individuals, technology-based treatments, such as cognitive rehabilitation programs, are likely to be more acceptable to them. This may increase adherence to these treatments. This factor may explain the lack of significant differences in outcomes between cognitive rehabilitation and motivational interviewing in this study, particularly as a substantial proportion of participants were young adolescents.
Furthermore, due to the limited number of studies comparing the effectiveness of cognitive rehabilitation and motivational interviewing specifically for cannabis users, the findings of this study may also be compared to similar research involving these interventions for other substance use disorders.
Ethical Considerations
This article is derived from a PhD thesis in General Psychology at Islamic Azad University—Boroujerd Branch, with ethics ID IDIR.IAU.B.REC.1399.060.
Authors' Contributions
All authors contributed equally to the research in this study.
Acknowledgments
We sincerely thank all participants for their invaluable assistance in conducting this study.
Conflicts of Interest
All authors declare that they have no conflicts of interest in this study.
Cannabis Use Disorder (CUD) is a condition where individuals struggle to control their cannabis consumption despite negative consequences. Fluctuations in cravings may predict drug relapses, making them a strong predictor of relapse. Acute cannabis use has been associated with impairments in information storage, manipulation, and working memory, suggesting that enhancing cognitive function could be a pivotal treatment strategy for CUD. Current treatment options are limited and primarily focus on psychosocial interventions such as motivational interviewing, cognitive behavioral therapy, and crisis management. Cognitive rehabilitation, which aims to improve cognitive functions through repeated practice, shows promising benefits for substance use disorders. Cognitive training utilizing Stop-Signal Tasks may enhance GABA-mediated neurotransmission in the cortex, indicating potential neural plasticity and improved inhibitory control. Motivational interviewing seeks to boost motivation to cease or reduce cannabis use, enhance self-efficacy, and facilitate planning for change within an empathetic, nonjudgmental environment. In light of these considerations and the need for innovative treatments for CUD, this study investigated the effects of cognitive rehabilitation and motivational interviewing on reducing cravings and enhancing cognitive functions among male cannabis users.
Method
This study employed an experimental design comprising three groups with pre-test, post-test, and follow-up assessments, focusing on male cannabis users in Tehran in 2021. The G*Power software was utilized to determine the sample size. Participants were randomly assigned to one of three groups, each consisting of fifteen individuals: motivational interviewing, cognitive rehabilitation, and control.
The study included male cannabis users who met specific inclusion criteria. Participants were required to abstain from using any other substances and to have no medical or psychiatric disorders. Additionally, they were not permitted to be on any medications related to medical or psychiatric conditions. Individuals who were absent for more than two sessions during the intervention or who expressed reluctance to continue were excluded from the study. Various assessment tools were employed, including a pictorial task to measure craving (induction), the n-back task, the Go/No-Go task, and the Iowa gambling task. Motivational interviewing was conducted over eight weekly sessions, each lasting 90 minutes, over two months. The structure of the motivational interviewing sessions adhered to the guidelines established by Zolasquez et al. (2001) (see Table 1).
Cognitive rehabilitation training was conducted using stop-signal response inhibition software in ten 45-minute sessions over two months. Following data collection, the data were analyzed using SPSS version 27.
Result
Evaluating the effectiveness of cognitive rehabilitation and motivational interviewing on the addictive and cognitive indicators among cannabis users was employing multivariate covariance analysis (see Table 2). The demographic results indicated that 16.7% of participants were married, while 55% possessed a diploma. The average age of participants was 25.05 ± 2.88 years, and the duration of cannabis use was 6.57 ± 3.18 years.
Assumptions for parametric tests were evaluated. Upon confirming the normal distribution and homogeneity of variances, the assumption of homogeneity of regression was assessed. The results indicated that the interaction between the pre-test auxiliary variables and the post-test dependent variables across the experimental and control group factor levels was insignificant (p < 0.05), thereby confirming the assumption of regression homogeneity.
Continuing with covariance analysis, we examined differences among the three groups across the three distinct scenarios (see Table 3). The findings revealed that significant differences existed among the cognitive rehabilitation, motivational interviewing, and control groups concerning at least one of the dependent variables. Specifically, there were noteworthy variations in risky decision-making, information processing speed, craving, and working memory across the three-time points (F = 13.23, p = 0.001). We conducted univariate covariance analysis to investigate these differences further (see Table 4).
The results indicated that cognitive rehabilitation and motivational interviewing significantly influenced the investigated variables compared to the control group. These findings suggest that both interventions contribute to a reduction in cravings and an enhancement in risky decision-making, working memory, response inhibition, and processing speed among men with CUD. However, no significant differences were observed between the cognitive rehabilitation and motivational interviewing groups concerning any of the investigated variables.
Conclusion
This study evaluated the impact of cognitive rehabilitation and motivational interviews on reducing cravings and improving cognitive functions in male cannabis users. Both interventions significantly reduced cravings and enhanced decision-making, working memory, response inhibition, and processing speed. However, no significant differences were found between the two interventions.
Existing studies have employed various treatments for cannabis dependence disorder, including motivational interviewing, cognitive rehabilitation, and contingency management. Motivational interviewing is widely accepted for treating substance use disorders, including cannabis use disorder. In contrast, cognitive rehabilitation is less frequently applied. Nevertheless, this study demonstrated that both interventions exhibit comparable effectiveness.
Research has shown the effectiveness of cognitive rehabilitation for individuals with various addictive or cognitive disorders occurring concurrently with cannabis use. Improvements in the cognitive functions of cannabis users through cognitive rehabilitation may enhance their executive functions, leading to better control over addictive behaviors and reduced cravings. Since craving is a primary predictor of relapse in cannabis users, decreasing it may help reduce the likelihood of relapse.
Moreover, since most cannabis users are young individuals, technology-based treatments, such as cognitive rehabilitation programs, are likely to be more acceptable to them. This may increase adherence to these treatments. This factor may explain the lack of significant differences in outcomes between cognitive rehabilitation and motivational interviewing in this study, particularly as a substantial proportion of participants were young adolescents.
Furthermore, due to the limited number of studies comparing the effectiveness of cognitive rehabilitation and motivational interviewing specifically for cannabis users, the findings of this study may also be compared to similar research involving these interventions for other substance use disorders.
Ethical Considerations
This article is derived from a PhD thesis in General Psychology at Islamic Azad University—Boroujerd Branch, with ethics ID IDIR.IAU.B.REC.1399.060.
Authors' Contributions
All authors contributed equally to the research in this study.
Acknowledgments
We sincerely thank all participants for their invaluable assistance in conducting this study.
Conflicts of Interest
All authors declare that they have no conflicts of interest in this study.
Keywords: Cannabis, cognitive rehabilitation, craving, motivational interviewing, working memory, response inhibition, risky decision-making.
Type of Study: Research |
Received: 2024/12/5 | Accepted: 2025/03/4
Received: 2024/12/5 | Accepted: 2025/03/4
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