A pilot randomized controlled trial of an integrative psychotherapy incorporating an attachment-based approach for adolescents with cannabis use disorder (TIMCA).

Yara B.; Joachim R.; Lana K.; Farrell F.; Alix G.; Carolina C.; Amine B.; Isabelle V.; Hassan R. · Addictive behaviors reports · 2026

**Background & Methods** This pilot randomized controlled trial enrolled 39 adolescents with cannabis use disorder from two outpatient addiction services in Paris, randomizing them to either TIMCA (n=19)—a 10-session integrative psychotherapy combining motivational interviewing, cognitive-behavioral therapy, and attachment-based therapy with individual and parent-adolescent components—or treatment as usual (TAU, n=20). Outcomes including cannabis use, attachment security, emotion regulation, anxiety, and depressive symptoms were assessed at baseline, mid-treatment, post-treatment, and 1-month follow-up using self-report measures and urine toxicology. **Key Findings** • TIMCA demonstrated high feasibility and acceptability with strong treatment adherence; within-group analyses revealed significant reductions in cannabis use, emotion dysregulation, and depressive symptoms alongside improved attachment security in the TIMCA group. • TAU showed no statistically significant within-group changes, and no significant between-group differences were detected between TIMCA and TAU conditions. • The integrative approach addressing both substance use and attachment-related processes appeared to produce meaningful clinical improvements, particularly in emotion regulation and psychological symptoms. **Dosage & Administration** TIMCA consists of 10 psychotherapy sessions combining motivational interviewing, cognitive-behavioral therapy, and integrated attachment therapy, incorporating both individual and parent-adolescent sessions. Specific session duration and scheduling intervals are not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This pilot study has significant limitations that restrict the strength of conclusions. The small sample size (n=39) lacks power to detect true between-group differences, explaining the absence of statistically significant group differences despite favorable within-group trends in TIMCA. The study employed self-report measures alongside urine toxicology, though validation details are not provided. The brief follow-up period (1-month post-treatment) precludes assessment of sustained effects or relapse rates. Lack of blinding and absence of detailed demographic/baseline comparability data limit internal validity. As an exploratory pilot study, findings represent preliminary evidence (Level 2b) requiring confirmation in adequately powered, longer-term randomized trials before clinical implementation recommendations can be made. The authors appropriately acknowledge these limitations and call for future adequately powered investigations.

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