%0 Journal Article %J Psychol Addict Behav %D 2015 %T Computer-assisted behavioral therapy and contingency management for cannabis use disorder. %A Budney, Alan J %A Stanger, Catherine %A Tilford, J Mick %A Scherer, Emily B %A Brown, Pamela C %A Li, Zhongze %A Li, Zhigang %A Walker, Denise D %K Adult %K Cognitive Therapy %K Female %K Humans %K Male %K Marijuana Abuse %K Middle Aged %K Motivation %K Motivational Interviewing %K Psychotherapy, Brief %K Substance-Related Disorders %K Therapy, Computer-Assisted %K Treatment Outcome %K Young Adult %X

Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), that is, motivational enhancement therapy, cognitive-behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% Black, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials.

%B Psychol Addict Behav %V 29 %P 501-11 %8 2015 Sep %G eng %N 3 %R 10.1037/adb0000078 %0 Journal Article %J J Subst Abuse Treat %D 2015 %T Maintenance Check-ups Following Treatment for Cannabis Dependence. %A Walker, Denise D %A Stephens, Robert S %A Towe, Sheri %A Banes, Kelsey %A Roffman, Roger %K Adult %K Cognitive Therapy %K Continuity of Patient Care %K Female %K Follow-Up Studies %K Humans %K Male %K Marijuana Abuse %K Middle Aged %K Motivational Interviewing %K Random Allocation %K Treatment Outcome %X

Substance use disorders, including cannabis use disorders and associated negative consequences, are best considered chronic and in need of continuing care. In contrast, most treatment efficacy studies evaluate a fixed number of intervention sessions at a single point in time. The present study evaluated the efficacy of posttreatment maintenance check-ups (MCUs) in maintaining and improving outcomes following nine sessions of motivational enhancement treatment/cognitive behavioral treatment (MET/CBT). Adults dependent on cannabis (n=74) were randomly assigned to the MCU or a no check-up (NCU) condition and followed up at 3- and 9-months. MCU sessions occurred 1 and 4months following the completion of the base treatment. Additional MET/CBT sessions were available to participants throughout the follow-up period. The MCUs specifically encouraged treatment re-entry for those showing ongoing signs of disorder. Participants in the MCU condition reported significantly greater abstinent rates at both follow-ups and were using on fewer days at the 3-month but not the 9-month follow-up. Contrary to hypotheses, MCU participants did not attend more additional treatment and differences in rates of cannabis use emerged prior to the first MCU session. Future research with longer follow-up periods and longer monitoring of outcomes is needed to fully evaluate the utility of MCUs or other forms of continuing care.

%B J Subst Abuse Treat %V 56 %P 11-5 %8 2015 Sep %G eng %R 10.1016/j.jsat.2015.03.006 %0 Journal Article %J Addict Behav %D 2014 %T Situational determinants of use and treatment outcomes in marijuana dependent adults. %A Blevins, Claire E %A Stephens, Robert S %A Walker, Denise D %A Roffman, Roger A %K Adaptation, Psychological %K Adult %K Cognitive Therapy %K Female %K Humans %K Male %K Marijuana Abuse %K Motivation %K Regression Analysis %K Risk Factors %K Self Efficacy %K Treatment Outcome %X

Research and theory strongly support the importance of situational determinants of substance use as targets for intervention, but few studies have systematically examined situational use characteristics in marijuana dependent adults. The present study describes situational use of marijuana in a population of 87 marijuana dependent adults and reports relationships with outcomes of treatment. Use in negative affective situations was independently associated with psychological distress, maladaptive coping strategies, lower self-efficacy, and poorer outcomes post-treatment. The findings were consistent with research on using drugs to cope with negative affect providing evidence of convergence between two different methods of assessing high risk situations for substance use. The results support continued emphasis on coping with negative affect as a target in treatments for marijuana dependence.

%B Addict Behav %V 39 %P 546-52 %8 2014 Mar %G eng %N 3 %R 10.1016/j.addbeh.2013.10.031 %0 Journal Article %J J Consult Clin Psychol %D 2013 %T Indicated prevention for college student marijuana use: a randomized controlled trial. %A Lee, Christine M %A Kilmer, Jason R %A Neighbors, Clayton %A Atkins, David C %A Zheng, Cheng %A Walker, Denise D %A Larimer, Mary E %K Adolescent %K Adult %K Feedback, Psychological %K Female %K Follow-Up Studies %K Humans %K Male %K Marijuana Smoking %K Motivation %K Psychotherapy, Brief %K Students %K Treatment Outcome %K Universities %K Young Adult %X

OBJECTIVE: Marijuana is the most frequently reported illicit substance used on college campuses. Despite the prevalence, few published intervention studies have focused specifically on addressing high-risk marijuana use on college campuses. The present study evaluated the efficacy of an in-person brief motivational enhancement intervention for reducing marijuana use and related consequences among frequently using college students.

METHOD: Participants included 212 college students from 2 campuses who reported frequent marijuana use (i.e., using marijuana at least 5 times in the past month). Participants completed Web-based screening and baseline assessments and upon completion of the baseline survey were randomized to either an in-person brief intervention or an assessment control group. Follow-up assessments were completed approximately 3 and 6 months post-baseline. Marijuana use was measured by number of days used in the past 30 days, typical number of joints used in a typical week in the last 60 days, and marijuana-related consequences.

RESULTS: Results indicated significant intervention effects on number of joints smoked in a typical week and a trend toward fewer marijuana-related consequences compared with the control group at 3-month follow-up.

CONCLUSION: This study provides preliminary data on short-term effects of a focused marijuana intervention for college students at reducing marijuana use during the academic quarter.

%B J Consult Clin Psychol %V 81 %P 702-9 %8 2013 Aug %G eng %N 4 %R 10.1037/a0033285 %0 Journal Article %J Subst Use Misuse %D 2013 %T Reaching soldiers with untreated substance use disorder: lessons learned in the development of a marketing campaign for the Warrior Check-Up study. %A Walton, Thomas O %A Walker, Denise D %A Kaysen, Debra L %A Roffman, Roger A %A Mbilinyi, Lyungai %A Neighbors, Clayton %K Adult %K Community-Institutional Relations %K Female %K Focus Groups %K Humans %K Interviews as Topic %K Male %K Marketing %K Mental Disorders %K Middle Aged %K Military Personnel %K Patient Acceptance of Health Care %K Program Development %K Program Evaluation %K Substance-Related Disorders %K United States %K United States Department of Defense %X

The Warrior Check-Up, a confidential telephone-delivered intervention, is designed to reach active-duty soldiers with untreated substance-use disorder at a large U.S. military base. This paper describes the development and successful implementation of the study's marketing strategies at the recruitment period's midpoint (2010-2012). Qualitative analyses of focus groups (n = 26) and survey responses (n = 278) describe the process of campaign design. Measures of demographics, media exposure, post-traumatic stress, anxiety and depression gathered from callers (n = 172) are used in quantitative analysis assessing the campaign's success in reaching this population. Implications, limitations, and suggestions for future research are discussed. Department of Defense provided study funding.

%B Subst Use Misuse %V 48 %P 908-21 %8 2013 Jul %G eng %N 10 %R 10.3109/10826084.2013.797996 %0 Journal Article %J J Stud Alcohol Drugs %D 2013 %T Social identity as a moderator of the association between perceived norms and marijuana use. %A Neighbors, Clayton %A Foster, Dawn W %A Walker, Denise D %A Kilmer, Jason R %A Lee, Christine M %K Adult %K Data Collection %K Female %K Humans %K Male %K Marijuana Abuse %K Marijuana Smoking %K Peer Group %K Risk Factors %K Social Identification %K Students %X

OBJECTIVE: This study extends previous examinations of social influences and marijuana use in considering how heavy marijuana users view themselves relative to their peers. We were specifically interested in evaluating whether (a) heavy-using marijuana users would identify more strongly with other users than with typical students, (b) identification with other marijuana users would be more strongly associated with own use, and (c) the association between perceived norms and marijuana use would be moderated by identification with peers.

METHOD: Participants were 107 heavy (five or more times per month) marijuana users who completed an online survey assessing perceived norms for marijuana use, identification with typical students and other marijuana-using students, and marijuana use (frequency of use, joints per week, and hours high).

RESULTS: Participants unexpectedly identified more strongly with typical students rather than with other marijuana-using students. Identification with other marijuana users was, however, associated with more use. In addition, perceived norms were associated with more use but primarily among those who identified more with other users but not with typical students.

CONCLUSIONS: Heavy marijuana users may be reluctant to identify themselves as users and may prefer to think of themselves as typical students. This may provide clinical opportunities to highlight discrepancies. In addition, identification with other users and lack of identification with typical students may be risk factors for heavier use and good indicators of candidacy for norms-based interventions. In sum, the present findings extend our understanding of the influence of social identity among young adult marijuana users and suggest novel directions for intervention strategies.

%B J Stud Alcohol Drugs %V 74 %P 479-83 %8 2013 May %G eng %N 3 %0 Journal Article %J Addiction %D 2012 %T Brief motivational feedback and cognitive behavioral interventions for prevention of disordered gambling: a randomized clinical trial. %A Larimer, Mary E %A Neighbors, Clayton %A Lostutter, Ty W %A Whiteside, Ursula %A Cronce, Jessica M %A Kaysen, Debra %A Walker, Denise D %K Adult %K Biofeedback, Psychology %K Cognitive Therapy %K Cost of Illness %K Female %K Gambling %K Humans %K Internal-External Control %K Male %K Patient Compliance %K Treatment Outcome %K Young Adult %X

AIMS: The purpose of the current study was to evaluate feasibility and efficacy of two promising approaches to indicated prevention of disordered gambling in a college population.

DESIGN: Randomized clinical trial with assignment to a personalized feedback intervention (PFI), cognitive-behavioral intervention (CBI) or assessment-only control (AOC). PFI was delivered individually in a single session and included feedback regarding gambling behavior, norms, consequences and risk-reduction tips, delivered in a motivational interviewing style. CBI was delivered in small groups over four to six sessions and included functional analysis and brief cognitive correction, as well as identification of and alternatives for responding to gambling triggers.

SETTING: College campus.

PARTICIPANTS: At-risk or probable pathological gamblers (n = 147; 65.3% male; group assignment: PFI, n = 52; CBI, n = 44; AOC, n = 51).

MEASUREMENTS: Self-reported gambling quantity, frequency, consequences, psychopathology, normative perceptions and beliefs.

FINDINGS: Relative to control, results at 6-month follow-up indicated reductions in both interventions for gambling consequences (PFI d = 0.48; CBI d = 0.39) and DSM-IV criteria (PFI d = 0.60; CBI d = 0.48), reductions in frequency for PFI (d = 0.48). CBI was associated with reduced illusions of control, whereas PFI was associated with reduced perceptions of gambling frequency norms. Reductions in perceived gambling frequency norms mediated effects of PFI on gambling frequency.

CONCLUSIONS: A single-session personalized feedback intervention and a multi-session cognitive-behavioral intervention may be helpful in reducing disordered gambling in US college students.

%B Addiction %V 107 %P 1148-58 %8 2012 Jun %G eng %N 6 %R 10.1111/j.1360-0443.2011.03776.x %0 Journal Article %J Drug Alcohol Depend %D 2011 %T An initial trial of a computerized behavioral intervention for cannabis use disorder. %A Budney, Alan J %A Fearer, Stephanie %A Walker, Denise D %A Stanger, Catherine %A Thostenson, Jeff %A Grabinski, Michael %A Bickel, Warren K %K Adult %K Cognitive Therapy %K Computer-Assisted Instruction %K Female %K Humans %K Male %K Marijuana Abuse %K Motivation %K Young Adult %X

The most potent outcomes for cannabis use disorders have been observed with a combination of three evidence-based interventions, motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), and abstinence-based contingency-management (CM). Access to this intervention remains limited because of cost and service availability issues. This report describes the initial stages of a project designed to develop and test a computer-assisted version of MET/CBT/CM that could address many of the current barriers to its dissemination. A nonrandomized, 12-week comparison study assigned 38 adults seeking treatment for a cannabis use disorder to either therapist-delivered (n=22) or computer-delivered (n=16) MET/CBT/CM. Attendance, retention, and cannabis use outcomes did not differ significantly between groups, and there were no indications of superior outcomes favoring therapist delivery. Participants provided positive ratings of the computer-delivered sessions. These preliminary findings suggest that computer-assisted delivery of MET/CBT/CM is acceptable to outpatients and does not adversely impact compliance or outcomes achieved during treatment with MET/CBT/CM for cannabis use disorders. Assessment of post-treatment outcomes and replication in randomized trials are needed to determine reliability and longer term effects. As observed in a growing number of studies, computerized therapies have the potential to increase access to, reduce costs, and enhance fidelity of providing evidence-based treatments without sacrificing and possibly enhancing effectiveness.

%B Drug Alcohol Depend %V 115 %P 74-9 %8 2011 May 1 %G eng %N 1-2 %R 10.1016/j.drugalcdep.2010.10.014 %0 Journal Article %J Psychol Addict Behav %D 2011 %T Motives for cannabis use in high-risk adolescent users. %A Fox, Courtney L %A Towe, Sheri L %A Stephens, Robert S %A Walker, Denise D %A Roffman, Roger A %K Adaptation, Psychological %K Adolescent %K Female %K Humans %K Male %K Marijuana Abuse %K Marijuana Smoking %K Motivation %K Risk Factors %X

The present investigation examined the relationships between motives for cannabis use and negative consequences associated with cannabis use following a brief intervention. The sample consisted of 205 adolescent cannabis users (66.3% male), who were recruited in high schools and randomly assigned to a brief two-session motivational enhancement therapy (MET) or an educational feedback control (EFC). Results supported the hypothesis that using cannabis to cope with negative affect would predict the number of problems and dependence symptoms related to cannabis use, after controlling for age, gender, years and frequency of cannabis use, and internalizing and externalizing behavior problems. Significant interactions between internalizing behavior problems and the coping motive showed that using to cope was associated with a higher number of cannabis dependence symptoms among adolescents reporting lower levels internalizing behavior problems. Findings support the potential utility of conducting further research to explore the coping motive as an important indicator of problematic cannabis use.

%B Psychol Addict Behav %V 25 %P 492-500 %8 2011 Sep %G eng %N 3 %R 10.1037/a0024331 %0 Journal Article %J Psychol Addict Behav %D 2011 %T Randomized controlled trial of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: a further test of the teen marijuana check-up. %A Walker, Denise D %A Stephens, Robert %A Roffman, Roger %A Demarce, Josephine %A Lozano, Brian %A Towe, Sheri %A Berg, Belinda %K Adolescent %K Behavior Therapy %K Female %K Humans %K Interview, Psychological %K Male %K Marijuana Abuse %K Marijuana Smoking %K Motivation %K Psychotherapy, Brief %K Treatment Outcome %X

Cannabis use adversely affects adolescents and interventions that are attractive to adolescents are needed. This trial compared the effects of a brief motivational intervention for cannabis use with a brief educational feedback control and a no-assessment control. Participants were randomized into one of three treatment conditions: Motivational Enhancement Therapy (MET), Educational Feedback Control (EFC), or Delayed Feedback Control (DFC). Those who were assigned to MET and EFC were administered a computerized baseline assessment immediately following randomization and completed assessments at the 3- and 12-month follow-up periods. Participants in the DFC condition were not assessed until the 3-month follow-up. Following the completion of treatment sessions, all participants were offered up to four optional individual treatment sessions aimed at cessation of cannabis use. The research was conducted in high schools in Seattle, Washington. The participant s included 310 self-referred adolescents who smoked cannabis regularly. The main outcome measures included days of cannabis use, associated negative consequences, and engagement in additional treatment. At the 3-month follow-up, participants in both the MET and EFC conditions reported significantly fewer days of cannabis use and negative consequences compared to those in the DFC. The frequency of cannabis use was less in MET relative to EFC at 3 months, but it did not translate to differences in negative consequences. Reductions in use and problems were sustained at 12 months, but there were no differences between MET and EFC interventions. Engagement in additional treatment was minimal and did not differ by condition. Brief interventions can attract adolescent cannabis users and have positive impacts on them, but the mechanisms of the effects are yet to be identified.

%B Psychol Addict Behav %V 25 %P 474-84 %8 2011 Sep %G eng %N 3 %R 10.1037/a0024076 %0 Journal Article %J Psychol Addict Behav %D 2011 %T Social norms and self-efficacy among heavy using adolescent marijuana smokers. %A Walker, Denise D %A Neighbors, Clayton %A Rodriguez, Lindsey M %A Stephens, Robert S %A Roffman, Roger A %K Adolescent %K Adolescent Behavior %K Cross-Sectional Studies %K Diagnostic and Statistical Manual of Mental Disorders %K Female %K Health Behavior %K Humans %K Male %K Marijuana Abuse %K Marijuana Smoking %K Models, Psychological %K Peer Group %K Randomized Controlled Trials as Topic %K Self Efficacy %K Self Report %K Social Conformity %K Social Facilitation %K Young Adult %X

Adolescence is a time in which individuals are particularly likely to engage in health-risk behaviors, with marijuana being the most prevalent illicit drug used. Perceptions of others' use (i.e., norms) have previously been found to be related to increased marijuana use. Additionally, low refusal self-efficacy has been associated with increased marijuana consumption. This cross-sectional study examined the effects of normative perceptions and self-efficacy on negative marijuana outcomes for a heavy using adolescent population. A structural equation model was tested and supported such that significant indirect paths were present from descriptive norms to marijuana outcomes through self-efficacy. Implications for prevention and intervention with heavy using adolescent marijuana users are discussed.

%B Psychol Addict Behav %V 25 %P 727-32 %8 2011 Dec %G eng %N 4 %R 10.1037/a0024958 %0 Journal Article %J J Interpers Violence %D 2010 %T Evaluating the impact of intimate partner violence on the perpetrator: the Perceived Consequences of Domestic Violence Questionnaire. %A Walker, Denise D %A Neighbors, Clayton %A Mbilinyi, Lyungai F %A O'Rourke, Allison %A Zegree, Joan %A Roffman, Roger A %A Edleson, Jeffrey L %K Adult %K Aggression %K Humans %K Interpersonal Relations %K Male %K Middle Aged %K Motivation %K Risk Factors %K Risk Reduction Behavior %K Sexual Partners %K Spouse Abuse %K Surveys and Questionnaires %K Young Adult %X

Surprisingly, little is known about how IPV perpetrators perceive the conse quences of their violent behavior. This article describes the development and evaluation of the Perceived Consequences of Domestic Violence Questionnaire (PCDVQ). The PCDVQ is a 27 item self report instrument designed to assess the consequences of intimate partner violence (IPV) as perceived by the perpetrator. Data from 124 nontreatment seeking, male, IPV perpetrators recruited from the community provided support for the internal consistency of the PCDVQ. Participants reported an average of 9.97 (SD = 4.57) consequences. Scores on the PCDVQ significantly predicted motivation for change, beta =.19, t(113) = 2.03, p < .05, and treatment seeking, chi(2)(df = 1) = 10.79, p < .01, odds ratio = 1.27 (95% CI: 1.10 1.46). Clinical implications of this instrument are discussed.

%B J Interpers Violence %V 25 %P 1684-98 %8 2010 Sep %G eng %N 9 %R 10.1177/0886260509354592 %0 Journal Article %J Violence Against Women %D 2010 %T Normative misperceptions of abuse among perpetrators of intimate partner violence. %A Neighbors, Clayton %A Walker, Denise D %A Mbilinyi, Lyungai F %A O'Rourke, Allison %A Edleson, Jeffrey L %A Zegree, Joan %A Roffman, Roger A %K Attitude %K Female %K Humans %K Interviews as Topic %K Male %K Motivation %K Prevalence %K Sexual Partners %K Social Behavior %K Spouse Abuse %K Surveys and Questionnaires %X

This research was designed to evaluate the applicability of social norms approaches to interventions with male perpetrators of intimate partner violence (IPV). Participants included 124 nonadjudicated IPV perpetrating men recruited from the general population who completed assessment of their own IPV behaviors via telephone interviews and estimated the prevalence of behaviors in other men. Results indicated that IPV perpetrators consistently overestimated the percentage of men who engaged in IPV and that their estimates were associated with violence toward their partner over the past 90 days. Findings provide preliminary support for incorporating social norms approaches into clinical applications.

%B Violence Against Women %V 16 %P 370-86 %8 2010 Apr %G eng %N 4 %R 10.1177/1077801210363608