Treating Adult Marijuana Dependence: A Test of the Relapse Prevention Model

Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg 24061-0436.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 03/1994; 62(1):92-9. DOI: 10.1037/0022-006X.62.1.92
Source: PubMed


Men (n = 161) and women (n = 51) seeking treatment for marijuana use were randomly assigned to either a relapse prevention (RP; G.A. Marlatt & J.R. Gordon, 1985) or a social support (SSP) group discussion intervention. Data collected for 12 months posttreatment revealed substantial reductions in frequency of marijuana use and associated problems. There were no significant differences between the cognitive-behavioral RP intervention and the SSP group discussion conditions on measures of days of marijuana use, related problems, or abstinence rates. Men in the RP condition were more likely than men in the SSP condition to report reduced use without problems at 3-month follow-up. Posttreatment increases in problems associated with alcohol did not appear to relate to reduced marijuana use. Results are discussed in terms of the need for further research with marijuana-dependent adults and the efficacy of RP.

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    • "Studies Included in the Meta-Analysis Stephens et al. (1994) randomized 212 treatment seeking cannabis-using adults to 10 sessions of (a) cognitive behavioral relapse prevention (RP) or (b) TAU (Roffman, Stephens, Simpson, & Whitaker, 1988; Stephens et al., 1994). There were no significant differences between the two conditions . "
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    ABSTRACT: Narrative reviews conclude that behavioral therapies (BTs) produce better outcomes than control conditions for cannabis use disorders (CUDs). However, the strength and consistency of this effect has not been directly empirically examined. The present meta-analysis combined multiple well-controlled studies to help clarify the overall impact of behavioral interventions in the treatment of CUDs. A comprehensive literature search produced 10 randomized controlled trials (RCTs; n = 2,027) that were included in the final analyses. Analyses indicated an effect of BTs (including contingency management, relapse prevention, and motivational interviewing, and combinations of these strategies with cognitive behavioral therapy) over control conditions (including waitlist [WL], psychological placebo, and treatment as usual) across pooled outcomes and time points (Hedges' g = 0.44). These results suggest that the average patient receiving a behavioral intervention fared better than 66% of those in the control conditions. BT also outperformed control conditions when examining primary outcomes alone (frequency and severity of use) and secondary outcomes alone (psychosocial functioning). Effect sizes were not moderated by inclusion of a diagnosis (RCTs including treatment-seeking cannabis users who were not assessed for abuse or dependence vs. RCTs including individuals diagnosed as dependent), dose (number of treatment sessions), treatment format (either group vs. individual treatment or in-person vs. non-in-person treatment), sample size, or publication year. Effect sizes were significantly larger for studies that included a WL control comparison versus those including active control comparisons, such that BT significantly outperformed WL controls but not active control comparisons.
    Evaluation &amp the Health Professions 04/2014; 38(1). DOI:10.1177/0163278714529970 · 1.91 Impact Factor
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    • "In human subjects acute administration of either compound produces euphoria and feelings of intoxication (Heishman et al., 1997; Jones and Stone, 1970), and both substances decrease response time and accuracy on neuropsychological tests measuring memory, attention, and psychomotor performance (Chait and Perry, 1994; Heishman et al., 1997; Heishman et al., 1988). In addition, daily cannabis users significantly increased self-reported ethanol craving and consumption during a two-week abstinence from marijuana (Peters and Hughes, 2010) and individuals in treatment for CUDs increased the frequency of ethanol use during 12 months following treatment (Stephens et al., 1994). However, there are conflicting data with respect to combined ethanol and cannabis use. "
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    ABSTRACT: Over the past fifty years a significant body of evidence has been compiled suggesting an interaction between the endocannabinoid (EC) system and alcohol dependence. However, much of this work has been conducted only in the past two decades following the elucidation of the molecular constituents of the EC system that began with the serendipitous discovery of the cannabinoid 1 receptor (CB1). Since then, novel pharmacological and genetic tools have enabled researchers to manipulate select components of the EC system, to determine their contribution to the motivation to consume ethanol. From these preclinical studies, it is evident that CB1 contributes the motivational and reinforcing properties of ethanol, and chronic consumption of ethanol alters EC transmitter levels and CB1 expression in brain nuclei associated with addiction pathways. These results are augmented by in vitro and ex vivo studies showing that acute and chronic treatment with ethanol produces physiologically relevant alterations in the function of the EC system. This report provides a current and comprehensive review of the literature regarding the interactions between ethanol and the EC system. We begin be reviewing the studies published prior to the discovery of the EC system that compared the behavioral and physiological effects of cannabinoids with ethanol in addition to cross-tolerance between these drugs. Next, a brief overview of the molecular constituents of the EC system is provided as context for the subsequent review of more recent studies examining the interaction of ethanol with the EC system. These results are compiled into a summary providing a scheme for the known changes to the components of the EC system in different stages of alcohol dependence. Finally, future directions for research are discussed.
    Alcohol (Fayetteville, N.Y.) 03/2012; 46(3):185-204. DOI:10.1016/j.alcohol.2012.01.002 · 2.01 Impact Factor
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    • "CBT component. Cognitive–behavioral strategies effective for CU-related problems (Stephens et al., 1994) were applied in sessions 1, 3–6, 9, and 10. These included interventions aimed at changing maladaptive cognitions, emotions and behaviors of CU and learning alternative skills. "
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    ABSTRACT: To examine the efficacy, 3- and 6-month follow-up effects of a psychological treatment for older adolescents and adults with DSM-IV cannabis use disorders. The program was tailored to the needs of this patient population. A randomized controlled clinical trial of 122 patients aged 16 to 44 years with DSM-IV cannabis dependence as the main substance use diagnosis was conducted. Patients were randomly assigned to either Active Treatment (AT, n = 90) or a Delayed Treatment Control group (DTC, n = 32). Treatment consisted of 10 sessions of therapy, detailed in a strictly enforced manual. Assessments were conducted at baseline, during each therapy session, at post treatment and at follow-up assessments at 3 and 6 months. The treatment retention rate was 88%. Abstinence was achieved in 49% of AT patients and in 13% of those in DTC (p < 0.001; intend-to-treat (ITT) analysis). Further, AT patients improved significantly (p < = 0.001) in the frequency of cannabis use per week, addiction severity, number of disability days, and overall level of psychopathology. Program effects were maintained over a 3-month- (abstinence rate: 51%) and 6-month follow-up (45%) period. The treatment program is effective in obtaining abstinence as well as reducing cannabis use and improves the associated social and mental health burden.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 08/2011; 22(4):267-80. DOI:10.1016/j.euroneuro.2011.07.014 · 4.37 Impact Factor
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