Coping skills training and contingency management treatments for marijuana dependence: exploring mechanisms of behavior change

Abstract

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...

Social cognitive predictors of treatment outcome in cannabis dependence

“…They are also in line with previous reports on the role of self-efficacy in substance use treatment outcome more broadly (Adamson et al, 2009;Kadden and Litt, 2011) and specifically in cannabis treatment outcome (Litt et al, 2008;Stephens et al, 1995). The current study sought to extend this literature by testing the unique contribution of three subtypes of refusal self-efficacy and, of those, only emotional relief refusal self-efficacy was related to treatment outcomes.…”

“…No medications have been approved for the treatment of cannabis dependence (Justinova et al, 2013). Psychological therapies are the first line of treatment (Davis et al, 2015;Litt et al, 2008). Cognitive-behavioural therapy (CBT) is among the most effective (Babor and The Marijuana Treatment Project Research Group, 2004;Budney et al, 2006;Carroll et al, 2006;Hoch et al, 2014).…”

Development and validation of the Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ) in adult cannabis users in treatment

“…This could be achieved through behavioral strategies aimed at building a patient's repertoire of coping skills, or focusing treatment on comorbid mood or anxiety disorders (DeMarce, et al, 2005). While the cross-sectional associations 16 reported here cannot establish that a change in self-efficacy would result in a change in cannabis use or dependence, there is evidence suggesting that effective psychosocial treatments primarily operate through improving self-efficacy (Litt et al, 2008).…”

Auto-eficácia para abstinência e tentação para uso de drogas ilícitas: uma revisão sistemática

“…O preditor de abstinência mais significativo (p<0,001), ao longo dos períodos de seguimento, foi a AE medida pré e pós intervenção, quando comparado com outros fatores como prontidão para mudança e estratégias de enfrentamento. Com o objetivo de explorar o efeito desses fatores no sucesso dos tratamentos, a amostra foi restrita à dependência de maconha, aspecto que incrementa sua validade interna e reforça a necessidade de pesquisar cada SPA separadamente na investigação de mecanismos de mudança como a AE para abstinência (Litt, Kadden, Kabela-Cormier & Petry, 2008). Jason et al (2007) aplicaram a AASE para álcool e a DASE para drogas em geral, e não fizeram uso das escalas de tentação correspondentes.…”

“…Outros dois artigos (Lozano et al, 2006;Litt et al, 2008) Apesar dos distintos delineamentos, é possível observar que, nas quatro produções agrupadas nesta categoria, em todas as amostras a AE foi preditiva de abstinência. Litt et al (2008) concluem que tanto a AE quanto a abstinência devem ser focadas no tratamento, pois mudanças em uma leva a mudanças na outra.…”