Cannabis treatment outcomes among legally coerced and non-coerced adults

Abstract

BackgroundTreatment seeking for cannabis dependence in general, and particularly the number of criminal justice referrals to cannabis treatment, has increased over the past decade. This study aims to compare the characteristics, psychosocial functioning and treatment outcome of those legally coerced into cannabis treatment compared to those entering treatment without legal coercion.MethodsThis study is a retrospective audit of the administrative clinical records of 27,198 adults presenting to public Texas treatment programs with cannabis as their primary drug problem between 2000 and 2005.ResultsOf the 69% legally coerced into treatment, there was less psychological distress and greater likelihood of having completed treatment compared with non-coerced clients. Participants who were legally coerced into treatment were also more likely to have received less intensive forms of treatment and to have not used cannabis in the month prior to 90-day post-treatment follow-up.ConclusionMore public health information is needed on cannabis dependence and increased availability of subsidised early and brief interventions in a variety of primary health care settings would reduce the late presentations of the more severely impaired voluntary clients. The limitations of this dataset are discussed.

Mental distress following inpatient substance use treatment, modified by substance use; comparing voluntary and compulsory admissions

“…However, the markedly elevated mental distress levels we observed among all patients with SUDs at admission confirmed findings from previous studies that showed that patients with SUDs experienced high level of mental distress compared to the general population [11]. This observation was also reported in a study that included patients legally coerced into treatment; moreover, patients in the coerced group had higher substance use severity and less mental distress than patients in the VA group, similar to our findings [34]. The high level of mental distress among patients in the VA group might have been an important motivating factor for voluntarily seeking treatment, as suggested in previous studies [49, 50].…”

“…There is a scarcity of follow-up studies that include both measures of substance abuse and mental distress for patients with SUDs [33]. Among patients with SUDs that underwent compulsory admission (CA), most studies examined treatment completion, reductions in substance use and less frequently, improvements in psychological symptoms [34–36]. Thus, a knowledge gap exists.…”

Assessing self-determined motivation for addiction treatment: Validity of the Treatment Entry Questionnaire

“…Clients who are more severely impaired may perceive a greater need for treatment and report greater self-determined motivation to pursue treatment. This interpretation is consistent with research suggesting that those who are legally pressured or mandated to enter treatment are less severely impaired by their substance use (Brecht, Anglin, & Dylan, 2005;Copeland & Maxwell, 2007;Polcin & Beattie, 2007;Rush & Wild, 2003).…”

“…For instance, external contingencies from friends and family may imply a level of a social capital that is not possessed by those experiencing more extreme external forces to enter a treatment program (e.g., a choice between treatment and jail). Alternatively, to the extent that those under a legal mandate to enter treatment are less severely impaired by their substance use than others in treatment (Brecht et al, 2005;Copeland & Maxwell, 2007;Polcin & Beattie, 2007;Rush & Wild, 2003), it is also possible that friends and family had yet to identify a need and advocate for formal treatment. Finally, it is possible that external contingencies placed on treatment entry by friends and family may be experienced differently from those applied by others and may impinge to a lesser extent on one's sense of autonomy to make decisions.…”

Pharmacotherapy and psychotherapy in cannabis withdrawal and dependence

“…Two MET participants reported fewer use days than the other two groups at 7 weeks follow-up. They also reported fewer use days than the information group at 12 months follow-up and fewer dependence symptoms at both 6 It is interesting to note that in a retrospective study comparing coerced and voluntary cannabis patients (n = 27,198 adults), Copeland and Maxwell observed more frequent cannabis abstinence (84%) and more treatment completions (42%) than voluntary patients [42]. These findings suggest that probation-referred patients may already have sufficient motivation to complete programs because of their judiciary difficulties.…”