Maximizing the Efficacy of Cognitive Behavior Therapy and Contingency Management
Condition: Marijuana Dependence
MeSH terms: Marijuana Abuse
Study type: Interventional
Phase: Phase 2

Summary: 
      Cognitive-behavioral coping skills therapy (CBT) is a widely used and recognized treatment
      that has been empirically validated for a range of substance use disorders, often with
      emergent effects and continuing improvement even after treatment ends. Treatment retention
      and compliance are associated with enhanced treatment outcomes in CBT. Contingency management
      (CM) also has very strong support and is associated with rapid, robust effects on targeted
      outcomes. Despite their many strengths, neither CBT nor CM is universally effective. It is
      now essential to seek strategies to maximize and extend the effectiveness of these two
      approaches and to better understand how these treatments exert their effects.
    

Detailed description: 
      The investigators propose to evaluate targeted strategies to maximize the effectiveness of
      CBT and CM, respectively. To maximize the effectiveness of CBT, the investigators will
      evaluate the benefit of adding CM, with reinforcement for session attendance and homework
      completion, to standard individual CBT for outpatient marijuana abusers, in order to expose
      participants to more skill training and opportunities for practice of skills. To maximize the
      effectiveness and durability of CM, we will evaluate the benefit of integrating it with
      skills training, specifically designed to reduce drop off effects, in order to extend CM's
      benefits beyond the active treatment period. We propose to conduct a Stage II trial which
      will: (1) Evaluate the efficacy of four conditions for 160 marijuana dependent outpatients:
      (a) Standard CBT, (b) CBT with CM reinforcement for attendance and completing homework
      (CBT+CM/adherence), (c) CM for abstinence alone (CM/abstinence), (d) CM for abstinence
      integrated with CBT (CM/abstinence+CBT), and (2) Evaluate the longer-term durability and / or
      delayed emergence of treatment effects after termination of the study treatments through a
      one-year follow-up. Secondary aims will be to conduct (a) detailed process studies to
      evaluate whether the proposed enhancements affect proximal and distal outcomes as
      hypothesized and (b) economic analyses. Study treatments will last 12 weeks.
    

Intervention name(s): Standard CBT; CBT+CM/adherence; CM/abstinence; CM/abstinence+CBT
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Manualized delivery of CBT by trained clinicians; CBT and Clinical Management for attendance and completing homework; Contingency Management; Contingency Management for abstinence in addition to manualized CBT delivered by a trained clinician
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: behavior modification; cognitive behavioral therapy; combination therapy; drug abuse therapy; drug addition; human therapy evaluation; psychotherapy; clinical trial phase II; coping; drug and alcohol abstinence; longitudinal human study; outcomes research; outpatient care; psychological reinforcement; therapy compliance; behavior and social research tag; human subjects; neuropsychological test; patient oriented research