Marijuana Treatment Project 4
Condition: Marijuana Dependence
MeSH terms: Marijuana Abuse
Study type: Interventional

Summary: 
      Marijuana is the most commonly used illicit drug in the US, but treatment for marijuana
      dependence is not fully effective. In the current proposal we are exploring the idea that
      more tailored teaching of coping skills may result in improved outcomes for
      marijuana-dependence than those seen thus far. Participants will be 275 men and women meeting
      criteria for marijuana dependence and randomly assigned to 9 sessions of treatment in one of
      4 treatment conditions: Standardized MET plus CB (SMET-CB); SMET+ CM (SMET-CB-CM); IATP; or
      IATP + CM (IATP-CM). Patients in all treatments will engage in ES via cell-phone for two
      weeks prior to treatment, for a weekly period during treatment, for another week after
      treatment has ended, and for two weekly periods at months 8 and 14. In the IATP conditions,
      the information gathered from the pretreatment and during-treatment ES periods will provide
      data for a functional analysis of patients' drug use and urges to use. It is hypothesized
      that IATP conditions will yield significantly better coping skills acquisition than SMET-CB
      conditions, both at posttreatment and at extended follow-ups, and that change in coping
      skills will predict better outcomes for the IATP conditions
    

Detailed description: 
      Marijuana is the most commonly used illicit drug in the US, but treatment for marijuana
      dependence is not fully effective. The most effective treatments to date have employed
      motivational enhancement (MET) plus cognitive-behavioral coping skills treatment (CB) and
      contingency management (CM) for abstinence. This proposal is a competitive renewal of our
      recently completed study to enhance coping and self-efficacy to improve marijuana outcomes in
      the long term. In the current proposal we are exploring the idea that more tailored teaching
      of coping skills may result in improved outcomes for marijuana-dependence than those seen
      thus far. The Individualized Assessment and Treatment Program (IATP) for marijuana dependent
      patients will employ experience sampling (ES) to determine the strengths and weaknesses of
      each patient in drug-use situations so that treatment can be tailored accordingly. Results
      from a pilot study indicated that IATP for alcohol dependent patients yielded better drinking
      outcomes at posttreatment than a packaged CB program (PCBT), that IATP patients reported
      greater use of coping skills than PCBT participants, and that posttreatment reports of coping
      skills were related to posttreatment drinking. Participants will be 275 men and women meeting
      criteria for marijuana dependence and randomly assigned to 9 sessions of treatment in one of
      4 treatment conditions: Standardized MET plus CB (SMET-CB); SMET+ CM (SMET-CB-CM); IATP; or
      IATP + CM (IATP-CM). Patients in all treatments will engage in ES via cell-phone for two
      weeks prior to treatment, for a weekly period during treatment, for another week after
      treatment has ended, and for two weekly periods at months 8 and 14. In the IATP conditions,
      the information gathered from the pretreatment and during-treatment ES periods will provide
      data for a functional analysis of patients' drug use and urges to use. Therapists will use
      the information to address specific cognitions, affects, and behaviors that are adaptive and
      maladaptive, and will tailor a specific coping skills program with the patient.
      During-treatment experience sampling will allow adjustment of the treatment goals and
      procedures, making the treatment adaptive. In the SMET-CB conditions the experience sampling
      data will not be used in therapy, but will still provide in-vivo measures of drinking and
      coping skills. It is hypothesized that IATP conditions will yield significantly better coping
      skills acquisition than SMET-CB conditions, both at posttreatment and at extended follow-ups,
      and that change in coping skills will predict better outcomes for the IATP conditions. It is
      further predicted that the addition of CM to both IATP and SMET-CB will enhance short-term
      and long-term outcomes. The results will have implications for improved tailoring of
      treatment to patients' strength and deficits, and for the validity of the training of coping
      skills for relapse prevention. The data collected will shed light on the ways in which
      patients in treatment use coping skills in real-time contexts. Finally, the use of repeated
      ES periods will allow us to determine how treatment impacts thoughts, feelings and behaviors,
      and how these in turn affect outcome in the long and short term.
    

Intervention name(s): Contingency Management; Individualized Assessment & Treatment; Cognitive-Behavioral Treatment
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Reinforcement provided contingent upon demonstration of negative drug tests; Tailored Cognitive-Behavioral Treatment based on detailed records of patient behavior; Standard psychoeducational approach to coping skills training
Other intervention name(s): Positive Reinforcement; IATP; CBT
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Marijuana Dependence; Individualized treatment; Motivational Enhancement Treatment; Cognitive-Behavioral Treatment; Contingency Management