Erector spinae plane block and N-rays.

Black adults in the United States are a health disparities group for more severe cannabis use behaviors and outcomes (; ; ; ). For example, although Black individuals are just as likely as White individuals to use cannabis (past year use: 24.5% vs 23.1%, respectively; ()), Black individuals experience greater rates of cannabis use disorder (CUD) than most other racial groups (). Greater vulnerability to CUD may be related to differences in use patterns. Specifically, Black adults who use cannabis report more frequent use compared to other racial and ethnic groups who use cannabis (; ; ). Moreover, in terms of cannabis use modality, Black adults are more likely to endorse using blunts (i.e., hollowed out cigars filled with cannabis and tobacco) than other racial and ethnic groups (; ; ). Blunt use likely contributes to health disparities among Black adults given this pattern of behavior is associated with increased exposure to carcinogens and toxins () and is related to greater risk for CUD (; ). Notably, the rate of CUD has decreased among non-Hispanic White individuals who use cannabis, yet it has remained stable among Black individuals (; ; ). These data are alarming because CUD is associated with more severe psychosocial risk, including poly-substance use, psychiatric problems, and legal problems (). Psycho-sociocultural models of substance use posit that Black individuals may use substances, such as cannabis, in part, to manage psychological distress associated with minoritized status stressors, including racism (; ). Cannabis use can be conceptualized as a false safety behavior (FSB), or as ‘action taken to prevent, escape from, or reduce the severity of a perceived threat’ and negative affect associated with these threats (). FSBs are often used to provide temporary relief from anxiety (e.g., avoiding anxiety-provoking situations; ), yet contribute to the maintenance of elevated anxiety symptoms, as well as anxiety disorders (; ; ). It is theorized that FSB use interferes with the development of adaptive beliefs and behaviors concerning anxiety-provoking stimuli, which maintains anxiety and related negative affect (). FSB use is common among individuals who use cannabis and is related to more severe cannabis-related problems (), and using cannabis to cope with negative affect, such as anxiety (i.e., cannabis being used as a FSB), is a common motivation for cannabis use (; ). Further, Black adults are more likely to report FSB use to manage anxiety or stress than White adults () and using cannabis to cope is especially associated with cannabis-related problems among Black compared to White adults (). This process is important because more frequent FSB use (whether substance use related or other maladaptive behavior) is related to more severe cannabis-related problems, coping-motivated cannabis use, and negative affect among predominantly White samples (; ). In part, Black adults may rely on FSBs, including but not limited to cannabis use, to manage symptoms of anxiety and related negative affect that arise from stressors associated with (1) social determinants of health (i.e., racism, healthcare access; ; ), (2) sociocultural factors (i.e., medical mistrust, mental illness stigma, cannabis norms), and (3) the interaction between these factors (; ). Such factors may be particularly relevant within the context of FSB use, as they have been linked to anxiety disorders among Black adults (). Rigorous, controlled research has found that FSB elimination treatments can be efficacious, producing medium to large effects in the remission of anxiety disorders and associated negative affect-related symptoms (; ; ). Within the context of cannabis use, studies have found that 12 sessions of in-person FSB elimination training () integrated with Motivational Enhancement Therapy-Cognitive Behavioral Therapy (MET-CBT; ) was associated with a statistically significant higher likelihood to test negative for tetrahydrocannabinol (THC) compared to a MET-CBT for CUD only condition in a predominantly White sample (). Further, among patients with more severe baseline cannabis use/problems, the integrated treatment was related to fewer post-treatment cannabis use/problems than MET-CBT ().