Transcript Marihuana Abuse Treatment Study
MTP Marijuana Treatment Project
The Multi-site Study of the Effectiveness of Brief Treatment for Cannabis Dependence A Cooperative Agreement funded by SAMHSA-CSAT
Primary Research Questions
Are brief treatments more effective than deferred treatment (referral to a waiting list control group)?
Does a 9 session treatment produce better outcomes than a 2 session treatment?
Do these treatments vary in effectiveness in diverse population groups in relation to gender, ethnicity, and employment status?
Rationale for a Multi-site Trial
Marijuana is the most commonly abused illicit substance in the U.S.
Large numbers of chronic users have developed cannabis dependence
Previous small-scale clinical trials have demonstrated the efficacy of brief and extended treatments
Further research is needed to test the robustness of effect and its generalizability to broad populations
MTP Collaborating Sites
Sponsoring Agency
Substance Abuse and Mental Health Services Administration/ Center for Substance Abuse Treatment
Coordinating Center
University of Connecticut, School of Medicine, Farmington, CT
Yale University, New Haven, CT
Clinical Research Units
University of Washington, Seattle, WA
University of Connecticut, School of Medicine, Farmington, CT
The Village, Inc., Miami, FL
Experimental Groups
Brief Treatment Group (N=146)
2 sessions of Motivational Enhancement Therapy
Delivered over a 5-week period
Extended Treatment Group (N=156)
9 sessions: 2 of Motivational Enhancement Therapy, 5 of Cognitive Behavioral Therapy, and 2 of Clinical Case Management
Delivered over a 12-week period
Delayed Treatment Control Group (N=148)
Treatment initiation scheduled 4 months after date of study enrollment
Choice of brief or extended treatment at end of delay period
Study Design
Recrutiment of 450 chronic marijuana users through advertising and referral Screening for Eligibility Enrollment and Informed Consent Baseline Assessment Random Assignment Delayed Treatment Control (DTC) Brief Treatment (BT) Follow-up Evaluation 4, 9, and 15 months Extended Treatment (ET)
Overview of the Cognitive Study
Purpose
To evaluate the effects of short-term (4-months) abstinence on recovery of cognitive functioning
Design
Cognitive assessment battery administered to DTC volunteers at beginning and end of treatment
Treatment responders (abstainers) will be compared with clients who continue to use MJ
Assessment Procedures & Variables
MTP Screening Questionnaire
Demographics
Current alcohol and drug use
Lifetime dependence history
Medical and psychiatric history
Structured Clinical Interview for DSM-IV
DSM-IV criteria for alcohol and drug abuse and marijuana dependence
Assessment Procedures & Variables
Time Line Follow-Back Interview
Weekly summary data for frequency of marijuana, alcohol and other drug use for ‘past 90 days’
Summary of quantity of marijuana, alcohol, cigarette use for ‘past 90 days'
Hazardous use of marijuana for ‘past 90 days’
Addiction Severity Index
Lifetime & current alcohol and drug history
Medical history
Employment and support status
Legal history
Psychiatric history
Assessment Procedures & Variables
Self Report Questionnaires
Beck Depression Inventory
Self Efficacy Questionnaire
Reasons for Quitting
Marijuana Problem Scale
Readiness to Change Questionnaire
Coping Strategies Scales
Ambivalence Measure
State-Trait Anxiety Inventory
Urinalysis
10 Psychoactive Substances
Inclusion/Exclusion Criteria
Meets DSM-IV Diagnosis for Cannabis Dependence Has smoked cannabis on at least 40 of the last 90 days Does not meet DSM-IV dependence criteria for other drugs or alcohol Is not involved in concurrent therapy or 12-step meetings Does not have a medical or psychiatric diagnosis that would interfere with treatment
Inclusion/Exclusion Criteria, cont.
Is within 60 miles of clinic Is able to name one person to serve as a locator Has legal status that allows involvement in the protocol Is not subject to mandatory urine screens Is at least 18 years old Has the ability to speak and understand English
Demographic Characteristics of MTP Participants (N=450) Characteristic Mean Age Sex Male Female Ethnicity European American African American Hispanic American Other 36 68% 32% 69% 17% 12% 02%
Demographic Characteristics of MTP Participants, cont. (N=450) Characteristic Marital Status Not Married Married/Cohabiting Mean Years Education Employed Full Time Part Time Unemployed Student/Retired/Homemaker Mean Number Years/Present Job 60% 40% 14 69% 14% 12% 05% 5
Marijuana Use Characteristics at Baseline (N=450) Characteristic Number of Years of Regular Marijuana Use Number of Years of Problem Marijuana Use Number of Endorsed Marijuana Dependence Symptoms (of 7) Number of Endorsed Marijuana Related Problems (of 19) Mean (SD) 17.94
(7.73) 8.92
(7.64) 5.36
(1.26) 9.38
(3.55)
Marijuana Dependence Symptoms Endorsed at Baseline (N=450) Symptom MJ taken in larger amounts or over a longer period than intended Persistent desire or one or more unsuccessful attempts to cut down or control use A great deal of time spent in activities necessary to get, use, or recover from the effects of MJ Important social, occupational or recreational activities given up because of MJ use 77% 96% 83% 64%
Marijuana Dependence Symptoms Endorsed at Baseline, cont. (N=450) Symptom Continued use despite knowledge of a psychological or physical problem caused or exacerbated by MJ use The need for markedly increased amounts of MJ to achieve the desired effect (tolerance) Experienced withdrawal
Appetite disturbance
Sleep disturbance Night sweats Headaches Irritability 95% 68% 78%
Marijuana Related Problems Endorsed at Baseline (N=450) Marijuana Related Problems Feeling bad about marijuana use To have lower energy level To procrastinate Memory loss To have lower productivity Lowered self-esteem To lack self confidence 90% 86% 86% 76% 75% 74% 68%
Marijuana Related Problems Endorsed at Baseline, cont. (N=450) Marijuana Related Problems Problems between you and your partner Financial difficulties Difficulty sleeping Problems with your family To neglect your family Medical problems Problems between you and your friends 58% 49% 46% 44% 38% 34% 26%
Lifetime Treatment History Reported at Baseline (N=450) % Number of Times Treated in Lifetime Drug Abuse 0 1 2 3 or > Alcohol Abuse 0 1 2 82% 12% 2% 4% 93% 4% 3% Mean (SD) .31
(.94) .17
(.96)
Number of Days of Marijuana Use in the Past 90 Days - Baseline (N=450)
Mean = 80.0
SD = 14.6
200 175 150 125 100 75 50 25 0 25.0
30.0
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0
Number of Days Smoked Marijuana in the Past 90 Days
Number of Joints Smoked Per Day in the Past 90 Days - Baseline (N=450)
Mean = 2.9
SD = 2.3
200 175 150 125 100 75 50 25 0 0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Number of Joints Smoked per Day in Last 90 Days
Number of Hours High Per Day in the Past 90 Days - Baseline (N=450)
Mean = 6.6
SD = 4.6
175 150 125 100 75 50 25 0 0.0
2.5
5.0
7.5
10.0
12.5
15.0
17.5
20.0
22.5
25.0
Number of Hours Felt High in the Past 90 Days
Number of Marijuana Dependence Symptoms Endorsed in the Past 90 Days - Baseline (N=450)
Mean = 5.6
SD = 1.3
160 140 120 100 80 60 40 20 0 2.0
3.0
4.0
5.0
6.0
7.0
Number of Marijuana Dependence Symptoms Endorsed
Number of Marijuana Related Problems Endorsed on the MPS - Baseline (N=450)
Mean = 9.6
SD.= 3.6
160 140 120 100 80 60 40 20 0 0.0
2.5
5.0
7.5
10.0
12.5
15.0
17.5
20.0
Number of Marijuana-Related Problems (of 19)
Marijuana Use Within 1 Hour Prior to Driving in the Past 90 Days - Baseline (N=450)
60 50 40 30 20 10 0 Neve r Less t han Week ly Week ly Daily /Almost D aily Less t han Daily Marijuana Used Within 1 Hour Prior to Driving
Marijuana Use Within One Hour Prior to Working on a Paid Job in the Past 90 Days - Baseline (N=373)
50 40 30 20 10 0 Neve r Less t han Week ly Week ly Daily /Almost D aily Less t han Daily Marijuana Used Within 1 Hour Prior to Working
MTP Treatment Attendance (N=450)
6
Number of Sessions 7 8 9 0 1 2 3 4 5 6 Mean Sessions Attended (SD) % Brief 6.8
21.2
71.9
1.65
(.61) % Extended 8.3
7.1
6.4
7.1
5.1
5.1
4.5
4.5
9.6
42.3
6.03
(3.31)
MTP Follow-up Rates
Post Treatment Follow-up Rate 4-Month Rates: Follow-up Collateral Urine 9-Month Rates: Follow-up Collateral Urine 15-Month Follow-up Rate 21-Month Follow-up Rate 88% 89% 100% 86% 87% 100% 81% 82% 77%
Participants Lost to 4-month Follow-up
Variable % Treatment Assign BT DTC ET % Sex Male Female % Ethnic White Black Hispanic Followed Participants (N=398) 32.2
34.4
33.4
Follow-up Drop-outs (N=52) 34.6
21.2
44.2
67.8
32.2
73.1
26.9
72.1
12.7
15.2
54.9
9.8
35.3
X 2
NS NS 12.58***
Participants Lost to 4-month Follow-up, cont.
Variable Mean Marijuana Severity Score Proportion of days smoked (of last 90 at baseline) Followed Participants (N=398) Follow-up Drop-outs (N=52) 9.57
9.75
88 89 Education Age 14.2
36.3
14.3
34.4
t
NS NS NS NS
Treatment by Time (Baseline, Week 1- Week 16) % of days smoked marijuana per week (N=398) 1 0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
BL W k2 W k4 W k6 W k8 W k10 W k12 W k14 W k16 DTC BT ET
Treatment by Time (BL, Wk1, Wk5, Wk12, Wk16) % of days smoked marijuana per week (N=398) 1 0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
BL 1st Tx End BT End ET 4-Mo F/up DTC BT ET
Intention to Treat Analysis (N=450)
Treatment by Time (BL, Wk1, Wk5, Wk12, Wk16) % of days smoked marijuana per week 1 0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
BL 1st Tx End BT End ET 4-Mo F/up DTC BT ET
Treatment by Time (Baseline, 4-Month Follow-up) SCID Dependence Symptoms (N=398) 7 6 5 4 3 2 1 0 Baseline 4-Month DTC BT ET
Treatment by Time (Baseline, 4-Month Follow-up) Marijuana Problem Scale (N=398) 11 10 9 8 7 6 5 Baseline 4-Month BT DTC ET
Products and Anticipated Accomplishments of MTP
New findings on the clinical characteristics of chronic marijuana users New findings on the effectiveness of brief treatments of marijuana dependence New assessment instruments New treatment interventions Treatment manuals for therapists and primary care practitioners Edited volume of scholarly papers
Research Implications
Development and validation of screening tests and referral procedures
Evaluation of primary care applications of MET brief intervention
Evaluation of brief and extended treatments in CD/behavioral health provider network outpatient settings in terms of
Implementation
Effectiveness
Cost-effectiveness
Unfinished Business
Cost effectiveness study Training package covering: Assessment Diagnosis Therapist skills System issues Long-term outcome evaluation