%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 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 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