Marijuana Treatment Project 4

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.

Inclusion Criteria:

- at least 18 yrs old

- meet Diagnostic and Statistical Manual IV (DSM-IV) criteria for Cannabis Dependence

- be willing to accept random assignment to any of the 4 treatment conditions

Exclusion Criteria:

- acute medical/psychiatric problems that require inpatient treatment (e.g., acute
psychosis, severe depression, suicide/homicide risk)

- reading ability below the fifth grade level

- lack of reliable transportation

- excessive commuting distance.