Adolescent Intervention Research

Martin, G. & Copeland, J. (2008). The Adolescent Cannabis Check-Up: Randomized trial of a brief intervention for young cannabis users. Journal of Substance Abuse Treatment, 34, 407–414. This Australian study builds upon the authors’ Adolescent Cannabis Check-Up (ACCU) feasibility study using a brief motivational enhancement therapy targeting non-treatment seeking cannabis-using adolescents (Martin, Copeland, & Swift, 2005). In this current study, 40 non-treatment seeking adolescent cannabis users were randomly and equally assigned to one of two groups: 1) the treatment (ACCU) group involving a brief (two session) motivational and cognitive behavioral intervention; or 2) a delayed-treatment control (DTC) group. The purpose of this study was to assess the effectiveness of the ACCU treatment on quantity and frequency of cannabis use as well as symptoms of cannabis dependence. Baseline structured assessment interviews were completed on all participants and one week later, the ACCU group returned for a structured feedback and skills session. Three months after the second session was completed, 32 of the original 40 participants returned for a follow-up assessment. At this time, participants from the DTC group were offered opportunities to participate in the ACCU treatment. The 40 adolescent participants, ages 14 to 19 years (mean = 16.5 years), were primarily male (67%), nonindigenous Australians (88%) living with their parents (78%) with 53% in school. The adolescents who used cannabis at least once in the past month, were recruited from the general community, mainly referred by “concerned others” such as parents (33%), youth agencies (25%), or schools (10%). Through media advertising, 25% of the participants “self-referred” either due to “concerned other” coercion, research curiosity, or desire to gain knowledge. Polysubstance use was common among participants: alcohol (93%), ecstasy (53%), amphetamine (45%), and cocaine (18%) reported use in the past 90 days. The mean age of first cannabis use was 12.4 years (range = 6 to 17 years) with progression to daily cannabis use beginning at the mean age of 14.1 years (range = 8 to 17 years). At baseline, 92.5% of the adolescents met DSM-IV diagnostic criteria for cannabis dependence (mean 5.3, range = 0 to 7) based on self-report using Timeline Followback method (Sobell, Sobell, Leo, & Cancilla, 1988), urine sample, items from Global Appraisal of Individual Needs (Dennis, 1999), and Severity of Dependence Scale (Gossop, Griffiths, Powis, & Strang, 1992). At Session two, feedback from the first session results, using a motivational interviewing style, was provided to each adolescent in the ACCU group to help them assess their cannabis use and the role it plays in their lives. Without any pressure to change or labels of problem users, this intervention offered self-assessment and a new perspective on their cannabis use. Because of highly skewed data and significant differences at baseline between the treatment and the control groups (treatment group with significantly more days of cannabis use in the past 90 days than the control group), change scores (baseline values subtracted from follow-up values) of quantity, frequency, and symptoms were analyzed using one-way analyses of variance or Mann-Whitney U. Though not statistically significant, participation in the treatment group was associated with larger reductions in the frequency and quantity of cannabis use at the 3-month follow-up. The most clinically (and only statistically) significant finding was the decrease in dependence symptoms in the ACCU condition group (p = .001). While 100% of the ACCU group (n = 20) met DSM-IV criteria for cannabis dependence at baseline; 65% (n = 13) of this group met the criteria at 3 months post-treatment. Seven participants’ diagnostic status at followup changed from “cannabis dependent” to “nondependent. ” Because the participants were adolescent cannabis users who were not actively seeking treatment, the most important implication for practice, noted by the authors, is that the brief ACCU intervention was positively rated by the adolescents. With approximately 90% reporting “helpful,” “very” or “extremely satisfied,” and not a “waste of time,” these ratings affirmed the nonjudgmental focus of the intervention. Admitting that participants’ satisfaction may not correlate with better outcomes, the authors still propose increased clinical acceptability and use of this intervention to address adolescent cannabis use and dependence. Comment: Though titled “randomized trial,” this study used a convenience sampling of adolescents from the general community, 14 to 19 years old, who used cannabis at least once in the