Previous studies have noted particular difficulty in achieving abstinence among those who are marijuana dependent. The present study employed a dismantling design to determine whether adding contingency management (ContM) to motivational enhancement therapy plus cognitive behavioral therapy (MET+CBT), an intervention used in prior studies of treatment for marijuana dependence, would enhance abstinence outcomes. 240 marijuana dependent participants were recruited via advertisements and assigned to either MET+CBT, ContM only, MET+CBT+ContM, or to a casemanagement control condition. All interventions involved 9 weekly 1-hour sessions, except for the ContM-only condition whose sessions lasted about 15 minutes. ContM provided reinforcement for marijuana-free urine specimens, in the form of vouchers redeemable for goods or services. Followup data were collected at posttreatment and at 3-month intervals for 1 year. The two ContM conditions had superior abstinence outcomes: ContM-only had the highest abstinence rates at posttreatment, and the MET+CBT+ContM combination had the highest rates at later follow-ups. The roles of contingency management and coping skills training in the treatment of marijuana dependence are discussed.

The Network Support Project was designed to determine if a treatment could lead patients to change their social network from one that supports drinking to one that supports sobriety. This study reports two-year posttreatment outcomes. Alcohol dependent men and women (N=210) were randomly assigned to one of three outpatient treatment conditions: Network Support (NS), Network Support + Contingency Management (NS+CM), or Case Management (CaseM, a control condition). Analysis of drinking rates indicated that the NS condition yielded up to 20% more days abstinent than the other conditions at two years posttreatment. NS treatment also resulted in greater increases at 15 months in social network support for abstinence, as well as AA attendance, and AA involvement, than did the other conditions. Latent growth modeling suggested that social network changes were accompanied by increases in self-efficacy and coping that were strongly predictive of long-term drinking outcomes. The findings indicate that a network support treatment can effect long-term adaptive changes in drinkers' social networks, and that these changes contribute to improved drinking outcomes in the long-term. KeywordsAlcoholism; Social Support; AA; Cognitive-behavioral treatment; Network Support It has often been noted that the most significant problem related to treatment of alcohol dependence is not the attainment of initial abstinence, but relapse following treatment. Marlatt (1985) estimated that fully one-third of treated individuals relapse in the first 90 days after completion of treatment. In a review of treatment effectiveness, Nathan (1986) reported that one to two years after treatment less than half of patients maintain sobriety. In a review of multisite studies, Miller, Walters and Bennett (2001) noted that approximately 65% of patients continued to drink one year after alcoholism treatment. Despite increased attention to the problem of relapse, few interventions have been able to effectively counter this phenomenon.One approach to this problem has been the development of treatments intended to change drinkers' social networks so that they are more supportive of abstinence and less supportive of drinking. The social network has long been regarded as an important locus of reinforcement for drinking behavior (e.g., Steinglass & Wolin, 1974). Longabaugh and Beattie (Beattie & Longabaugh, 1999;Longabaugh & Beattie, 1986) coined the term "network support for drinking," referring to the degree to which people in one's environment encourage drinking. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptNetwork support for drinking has been found to be predictive of poor treatment outcome (Havassy, Hall & Wasserman, 1991, Longabaugh et al., 1993Project MATCH Research Group, 1997).Alternatively, networks that promote sobriety can also affect drinking rates. The most obvious example of such a network is the fellowship of Alcoholics Anonymous (AA). Several studies support the efficacy of AA or similar groups in reducing alc...

Aims-Achieving abstinence in the treatment of marijuana dependence has been difficult. To date the most successful treatments have included combinations of motivation enhancement treatment (MET) plus cognitive-behavioral coping skills training (CBT) and/or contingency management (ContM) approaches. Although these treatment approaches are theoretically based, their mechanisms of action have not been fully explored. The purpose of the present study was to explore mechanisms of behavior change from a marijuana treatment trial in which cognitive-behavioral treatment (CBT) and contingency management (ContM) were evaluated separately and in combination. Design-A dismantling design was used in the context of a randomized clinical trial.Setting-The setting was an outpatient treatment research facility located in a university medical center.Participants-Participants were 240 adult marijuana smokers, meeting criteria for cannabis dependence.Interventions-Participants were assigned to one of four 9-week treatment conditions: a case management control condition, MET/CBT coping skills training, contingency management (ContM), and MET/CBT+ContM.Measurements-Outcome measures were total 90-day abstinence, recorded every 90 days for 12 months posttreatment.Findings-Regardless of treatment condition, abstinence in near-term follow-ups was best predicted by abstinence during treatment, but long-term abstinence was predicted by use of coping skills and especially by posttreatment self-efficacy for abstinence.Conclusions-It was concluded that the most efficacious treatments for marijuana dependence are likely to be those that increase self-efficacy. KeywordsMarijuana dependence; contingency management; cognitive-behavioral treatment; self-efficacy; coping skills; treatment mechanisms Marijuana is the most widely used illicit drug in the U.S.A. [1]. Despite recent attention to the treatment of marijuana dependence (e.g., [2]), prolonged abstinence has been difficult to Correspondence concerning this article may be addressed to: Mark D. Litt, Ph.D., Division of Behavioral Sciences and Community Health, MC3910, University of Connecticut Health Center, Farmington, CT 06030. Electronic mail should be sent to E-mail: Litt@nso.uchc.edu.. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript achieve [2,3]. There is thus a pressing need to determine what mechanisms of treatment lead to behavior change in this population.Several treatment strategies offer promise in the treatment of marijuana dependence, namely cognitive-behavioral coping skills training (CBT), motivational enhancement (MET), contingency management, or a combination of these. In the largest controlled trial of treatment for marijuana dependence to date, the multi-site Marijuana Treatment Project (MTP) showed results indicating that nine sessions of combined MET and CBT were superior to two sessions of MET, and both were superior to a delayed treatment control group [2]. The highest abstinence rate achieved was 23% at 4-month foll...

The aim of this study was to determine whether a socially focused treatment can effect change in the patient's social network from one that reinforces drinking to one that reinforces sobriety. Alcohol dependent men and women (N = 210) recruited from the community were randomly assigned to 1 of 3 outpatient treatment conditions: network support (NS), network support + contingency management (NS + CM), or case management (CaseM; a control condition). Analysis of drinking rates for 186 participants at 15 months indicated a significant interaction effect of Treatment x Time, with both NS conditions yielding better outcomes than the CaseM condition. Analyses of social network variables at posttreatment indicated that the NS conditions did not reduce social support for drinking relative to the CaseM condition but did increase behavioral and attitudinal support for abstinence as well as Alcoholics Anonymous (AA) involvement. Both the NS variables and AA involvement variables were significantly correlated with drinking outcomes. These findings indicate that drinkers' social networks can be changed by a treatment that is specifically designed to do so, and that these changes contribute to improved drinking outcomes.

Aims-Cognitive-behavioral treatments (CBT) are among the most popular interventions offered for alcohol and other substance use disorders, but it is not clear how they achieve their effects. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. The purpose of this pilot study was to test a treatment in which coping skills were trained in a highly individualized way, allowing us to determine if such training would result in an effective treatment.Design-Participants were assigned randomly to a comprehensive packaged CBT program (PCBT), or to an Individualized Assessment and Treatment Program (IATP). The IATP program employed experience sampling via cellphone to assess coping skills prior to treatment, and provided therapists a detailed understanding of patients' coping strengths and deficits. Setting-Outpatient treatment.Participants-A total of 110 alcohol dependent men and women.Measurements-Participants in both conditions completed experience sampling of situations, drinking and coping efforts prior to, and following, 12 weeks of treatment. Timeline follow-back procedures were also used to record drinking at baseline and posttreatment.Findings-IATP yielded higher proportion days abstinent (PDA) at posttreatment (p < .05) than did PCBT, and equivalent heavy drinking days. IATP also elicited more momentary coping responses, and less drinking, in high risk situations, as recorded by experience sampling at posttreatment. Posttreatment coping response rates were associated with decreases in drinking.Conclusions-The IATP approach was more successful than PCBT at training adaptive coping responses for use in situations presenting high-risk for drinking. The highly individualized IATP approach may prove to be an effective treatment strategy for alcohol dependent patients. KeywordsIndividualized treatment; CBT; experience sampling; coping skills Correspondence concerning this article may be addressed to: Mark D. Litt, Ph.D., Department of Behavioral Sciences and Community Health, MC3910, University of Connecticut Health Center, Farmington, CT 06030. Electronic mail should be sent to Litt@nso.uchc.edu.. NIH Public Access Author ManuscriptAddiction. Author manuscript; available in PMC 2010 November 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptCognitive-behavioral treatments (CBT) are among the most popular treatments offered for alcohol and other substance misuse, but it is not clear how they achieve their effects. It has been assumed that the mechanism of action responsible for the success of CBT is the acquisition and performance of coping skills used to manage high-risk for drinking situations, and to enhance the person's confidence in his or her ability to stay sober. (1) Although greater use of coping skills appears to be related to better outcomes in some studies, it is not clear that coping skills per se are responsible for those outcomes. To make a case for the role of coping in ou...