Contingency intervention for reduction of cannabis in early psychosis

ISRCTN ISRCTN33576045
DOI https://doi.org/10.1186/ISRCTN33576045
Secondary identifying numbers HTA 09/144/50
Submission date
20/10/2011
Registration date
28/11/2011
Last edited
29/08/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Mental and Behavioural Disorders
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Cannabis use increases the problems that people with severe mental health problems face. For example, young people with psychosis who use cannabis are more likely than those who do not to have difficulty recovering from their initial symptoms of psychosis, to relapse once they have recovered, to commit crimes, and less likely to work. Their need to rely on welfare benefits and frequent use of expensive services such as hospital has implications for society as a whole. Early intervention services (EISs) are a type of mental health team now available throughout England, They aim to improve prognosis for young people with early psychosis, reducing the likelihood that they will relapse and helping them achieve their goals, which may include getting back to work or education. Almost half the young people on EIS caseloads use cannabis, so that it is an important obstacle to recovery. Many young people who have developed a psychotic illness have some motivation for reducing their cannabis use. However, we do not have a really effective treatment available for helping them to do so. It has proved difficult to design treatments that work for drug use among people who have psychotic illnesses. Our aim is to try out a new approach called Contingency Management that is increasingly used in drug services but has not been studied a lot among people with psychosis.

Who can participate?
The participants in our study will be people aged between 18 and 39 who are currently under the care of an early intervention service for psychosis, and who have used cannabis in the past 6 months. They will be men and women.

What does the study involve?
The study will compare two approaches to helping people reduce their cannabis use. Group A will receive both a new approach called Contingency Management and a short educational package. Contingency Management involves receiving voucher rewards, to be spent in local shops, on condition of attending appointments and providing urine samples free from cannabis. Rewards increase with increasing weeks of abstinence over a 3 month period. The educational package is intended to help people to decide whether or not they wish to carry on using cannabis. Group B will receive the educational package only.
We will then compare Group A and Group B, assessing over an 18 month period which group is more likely to relapse, to use cannabis, to have more severe symptoms of psychosis, and to be in work or education.

What are the possible benefits and risks of participating?
The main benefit to participants will be if the study treatments, especially that received by Group A, turns out to help people to reduce their cannabis use. This may have significant benefits for their health and progress towards their goals in life. The participants in Group A will also benefit from receiving voucher rewards if they can avoid using cannabis. There are few significant risks: the vouchers will not be exchangeable for alcohol, but it is possible that some participants may find ways of informally trading them for money to purchase substances.

Where is the study run from?
The lead centre is the Mental Health Sciences Unit at University College London. There will be n initial study in three London Boroughs – Camden, Islington and Hackney – and in Coventry and Warwickshire NHS Foundation Trust, linked to the University of Warwick. If this goes well, we will add further teams to a full-scale study, based around UCL, the University of Warwick, the University of East Anglia and King’s College London.

When is the study starting and how long is it expected to run for?
We expect the study to start in January 2012. Over the first 18 months, we will carry out an initial study to test whether we can recruit participants and whether the study treatments are acceptable to patients and staff. If it goes well, more centres will be added to make it a full study. The total study period will be four and a half years, ending in July 2016.

Who is funding the study?
The study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme

Who is the main contact?
Prof. Sonia Johnson
s.johnson@ucl.ac.uk

Contact information

Prof Sonia Johnson
Scientific

Mental Health Sciences Unit
University College London
Charles Bell House
67-73 Riding House Street
London
W1W 7EY
United Kingdom

Email s.johnson@ucl.ac.uk

Study information

Study designFeasibility pilot individually randomised controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)GP practice
Study typeQuality of life
Participant information sheet ISRCTN33576045_PIS_12May14_V4.doc
Scientific titleRandomised controlled trial of the clinical and cost-effectiveness of a contingency management intervention for reduction of cannabis use and of relapse in early psychosis
Study acronymCIRCLe
Study objectivesTime to relapse will be significantly greater in a group of early intervention service users who receive psychoeducation combined with contingency management (voucher rewards for evidence of abstinence) than in a group who receive the psychoeducation only.

More details can be found at: http://www.nets.nihr.ac.uk/projects/hta/0914450
Protocol can be found at: http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0018/55170/PRO-09-144-50.pdf
Ethics approval(s)Not provided at time of registration
Health condition(s) or problem(s) studiedPsychotic illnesses including schizophrenia, schizo-affective disorder and bipolar disorder with psychotic symptoms
InterventionExperimental group: Contingency management involving voucher rewards for abstinence demonstrated by urinalysis together with psychoeducation delivered by care coordinators.

Control group: Psychoeducation only
Intervention typeOther
Primary outcome measureTime to relapse is assessed as admission to acute mental health care over 18 months
Secondary outcome measures1. Presence of cannabis on urinalysis at 3 months and at 18 months of follow up
2. Positive symptom severity measured by Positive and Negative Syndrome Scale (PANSS) at 3 months and 18 months
3. Engagement in work or study is assessed by participant self report at 3 months and 18 months
Overall study start date01/09/2010
Completion date31/10/2017

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
Upper age limit39 Years
SexBoth
Target number of participants544 including 68 participants in feasibility pilot study
Total final enrolment551
Key inclusion criteria1. Under the care of an early intervention service for psychosis
2. Diagnostic criteria for EIS entry require a first psychotic episode significantly impairing functioning and lasting more than a week
3. Problematic cannabis use is operationalised as having used cannabis at least once in at least 12 of the previous 24 weeks
4. Aged 18-39, male and female participants
Key exclusion criteriaInsufficient English to complete the study assessments
Date of first enrolment01/06/2012
Date of final enrolment31/03/2016

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

University College London
London
W1W 7EY
United Kingdom

Sponsor information

University College London (UK)
University/education

c/o Dr Nick McNally
Director of Research Support
Joint University College London Hospitals/ University College London/ Royal Free Hospital Biomedical Research Unit
25 Grafton Way
London
WC1E 6DB
England
United Kingdom

Website http://www.ucl.ac.uk/joint-rd-unit/
ROR logo "ROR" https://ror.org/02jx3x895

Funders

Funder type

Government

Health Technology Assessment Programme
Government organisation / National government
Alternative name(s)
NIHR Health Technology Assessment Programme, HTA
Location
United Kingdom

Results and Publications

Intention to publish date01/05/2018
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryData sharing statement to be made available at a later date
Publication and dissemination planPlanned publication of study results in a peer reviewed journal. Submission of a report to funders in November 2017.
IPD sharing planThe current data sharing plans for the current study are unknown and will be made available at a later date.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 22/10/2016 Yes No
Participant information sheet version V4 12/05/2014 05/01/2017 No Yes
Results article results 15/08/2019 16/08/2019 Yes No
Other publications report 01/08/2019 29/08/2019 Yes No

Additional files

ISRCTN33576045_PIS_12May14_V4.doc
Uploaded 05/01/2017

Editorial Notes

29/08/2019: Publication reference added.
16/08/2019: Publication reference and total final enrolment number added.
05/01/2017: The methods of measurement have been added to the secondary outcome measures. In addition, the participant information sheet, participant level data availability and publication and dissemination plan have been added.
04/01/2017: The overall trial dates have been updated from 01/01/2011 - 30/06/2016 to 01/09/2010 - 31/10/2017 and the recruitment dates have been updated from 01/01/2011 - 30/06/2016 to 01/06/2012 - 31/03/2016.
25/10/2016: Publication reference added.