A pilot randomized clinical trial of Brief Behavioral Treatment for Insomnia to reduce problematic cannabis use among trauma-exposed young adults
Open accessAbstract
Background Insomnia symptoms may be an important etiological factor for substance use disorders; however, whether improving sleep leads to reductions in problematic substance use among at-risk populations remains unclear.Method As such, the current pilot study used a randomized controlled design to test the effects of Brief Behavioral Treatment for Insomnia (BBTI) against a waitlist control among a sample of trauma-exposed young adults with elevated insomnia symptoms who regularly use cannabis (N = 56).Results Intent-to-treat multilevel modeling analyses indicated that BBTI may be more efficacious than waitlist control in reducing self-reported insomnia symptoms, with large effects three months post-treatment (d = 1.34). Further, our initial evidence suggested that BBTI resulted in reductions in cannabis-related problems with medium to large effects at three months post-treatment (d = 0.75). The current pilot analyses indicated BBTI also reduced cravings to use cannabis to reduce negative emotions in response to trauma cues with a large effect size.Conclusion This pilot study suggests BBTI may be efficacious not only in improving insomnia symptoms among cannabis users but also in reducing cannabis-related problems and cravings over three months. Future research should replicate these results in a larger, fully powered sample with improved follow-up rates designed to test temporal mediation using multimethod assessments of insomnia symptoms and problematic cannabis use. Overall, BBTI may be a promising intervention for trauma-exposed cannabis users to improve sleep and reduce cannabis-related problems.
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BBTI reduced trauma-related cravings at 3-month follow-up, with Cohen's d of 1.02.
“and trauma-related cravings (Cohen’s d=1.02) at 3-month follow-up”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [62]
The Results (Main hypotheses, Cravings; page not provided) report reduced craving reactivity to trauma imagery with Cohen’s d=1.02. But the Method (Data analysis) says cravings were assessed at baseline and post-treatment, and the Discussion describes the craving finding as one week post-treatment—not at the three-month follow-up. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe BBTI study was rated moderate quality, limited by high attrition.
“Quality was moderate, limited by high attrition.”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [62]
The Discussion identifies attrition as a study limitation and says it contributed to poor adherence in the BBTI group. The paper does not rate its own quality as moderate; that appears to be the citing authors’ assessment. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBBTI was effective in improving sleep and reducing cannabis problems and trauma-related cravings in older adolescents.
“Brief behavioral therapy for insomnia (BBTI) was effective in improving sleep and reducing cannabis problems and trauma-related cravings in older adolescents”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [62]
The Results report reduced insomnia symptoms, cannabis-related problems, and trauma-cue-related cannabis cravings with BBTI. However, the Methods describe participants as trauma-exposed adults aged 18–30, not specifically older adolescents, and the Discussion calls the pilot findings tentative rather than establishing that BBTI was effective. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBBTI could be an effective standalone treatment or adjunct to other treatments but requires further replication.
“could be an effective standalone treatment or adjunct to other treatments but requires further replication [62].”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [62]
The Discussion (page unavailable) describes BBTI as a potentially efficacious intervention for insomnia symptoms and cannabis-related problems in trauma-exposed cannabis users and explicitly calls for replication in a larger sample. The Methods’ Experimental conditions (page unavailable) describe BBTI delivered as the study intervention, but our copy does not establish its effectiveness as an adjunct to other treatments. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBBTI did not significantly change actual cannabis use.
“although no significant change in actual cannabis use”
BBTI reduced cannabis problems at 3-month follow-up, with Cohen's d of 0.75.
“reducing cannabis problems (Cohen’s d=0.75)”
BBTI produced a large improvement in sleep at 3-month follow-up, with Cohen's d of 1.34 on the insomnia index.
“BBTI had large effects in improving sleep (Cohen’s d= 1.34 on insomnia index)”
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“Brief behavioral therapy for insomnia ( BBTI ) was effective in improving sleep and reducing cannabis problems and trauma-related cravings in older adolescents and could be an effective standalone treatment or adjunct to other treatments but requires further replication [62].”
Influential
- Authors
- Short, N. A., Zvolensky, M. J., & Schmidt, N. B.
- Affiliations
- Florida State University (US)
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Schmidt, Norman B.
- Venue
- Journal of Substance Abuse Treatment
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 131
- Pages
- 108537
- ISSN
- 0740-5472 (ISSN-L)
- PMC
- PMC8664982
- OpenAlex
- W3175948677
- Cited by
- 27
- References
- 51
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 1 · 2020: 1
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Substance Abuse Treatment (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (F31 DA044689-01)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Keywords
- insomnia, problematic cannabis use, cannabis use disorder, trauma exposure, young adults, cannabis craving, sleep interventions, substance use disorders
- MeSH terms
- Behavior Therapy, Cannabis, Humans, Sleep Initiation and Maintenance Disorders, Pilot Projects, Treatment Outcome, Young Adult
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