Individualized Assessment and Treatment for Marijuana Dependence: Treatment Mechanisms, United States, 2013-2016

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 study was intended to deliver a treatment to enhance coping and self-efficacy to improve marijuana outcomes in the long term. Researchers are explored 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 employed experience sampling (ES) to determine the strengths and weaknesses of each patient in drug-use situations so that treatment could be tailored accordingly. Participants were 198 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 engaged 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 provided data for a functional analysis of patients' drug use and urges to use. Therapists used the information to address specific cognitions, affects, and behaviors that were adaptive and maladaptive, and tailored a specific coping skills program with the patient. During-treatment experience sampling allowed monitoring of the treatment goals and procedures, making the treatment adaptive. In the SMET-CB conditions the experience sampling data were not used in therapy, but still provides in-vivo measures of drug use and coping skills. It was hypothesized that IATP conditions would yield significantly better coping skills acquisition than SMET-CB conditions, both at posttreatment and at extended follow-ups, and that change in coping skills would predict better outcomes for the IATP conditions. It was further predicted that the addition of CM to both IATP and SMET-CB would enhance short-term and long-term outcomes. The results would have implications for improved tailoring of treatment to patients' strength and deficits, and for the validity of the training of coping skills for cannabis 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 researchers to determine how treatment impacts thoughts, feelings and behaviors, and how these in turn affect outcome in the long and short term.