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Intervention Summary

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Brief Marijuana Dependence Counseling

Brief Marijuana Dependence Counseling (BMDC) is a 12-week intervention designed to treat adults with a diagnosis of cannabis dependence. Using a client-centered approach, BMDC targets a reduction in the frequency of marijuana use, thereby reducing marijuana-related problems and symptoms. BMDC is based on the research protocol used by counselors in the Center for Substance Abuse Treatment's Marijuana Treatment Project conducted in the late 1990s. A treatment manual provides guidelines for counselors, social workers, and psychologists in both public and private settings. BMDC is implemented as a 9-session multicomponent therapy that includes elements of motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), and case management.

Descriptive Information

Areas of Interest Substance abuse treatment
Outcomes Review Date: February 2007
1: Marijuana use
2: Marijuana-related problems
3: Complete marijuana abstinence
4: Marijuana dependence and abuse symptoms
Outcome Categories Drugs
Social functioning
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Outpatient
School
Geographic Locations Urban
Implementation History BMDC was developed through the Center for Substance Abuse Treatment's Marijuana Treatment Project and builds on numerous past studies that have used MET, CBT, and other treatment components to improve client outcomes. This intervention was used in a clinical trial for treatment for marijuana dependence in Munich, Germany, as well as in several statewide programs in the United States (e.g., Connecticut, Florida).
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: Yes
Adaptations The manual for this intervention has been translated into German.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: February 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Babor, T. F., & the Marijuana Treatment Project Research Group. (2004). Brief treatments for cannabis dependence: Findings from a randomized multisite trial. Journal of Consulting and Clinical Psychology, 72(3), 455-466.  Pub Med icon

Supplementary Materials

Babor, T. F., Steinberg, K. L., McRee, B., Vendetti, J., & Carroll, K. M. (2002). Treating marijuana dependence in adults: A multisite, randomized clinical trial. New Directions for Evaluation, 94, 17-30.

Steinberg, K. L., Roffman, R. A., Carroll, K. M., Kabela, E., Kadden, R., Miller, M., et al. (2002). Tailoring cannabis dependence treatment for a diverse population. Addiction, 97(Suppl. 1), 135-142.  Pub Med icon

Steinberg, K. L., Roffman, R. A., Carroll, K. M., McRee, B., Babor, T. F., Miller, M., et al. (2005). Brief counseling for marijuana dependence: A manual for treating adults. (DHHS Publication No. [SMA] 05-4022). Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.

Stephens, R. S., Roffman, R. A., & Curtin, L. (2000). Comparison of extended versus brief treatments for marijuana use. Journal of Consulting and Clinical Psychology, 68, 898-908.  Pub Med icon

Outcomes

Outcome 1: Marijuana use
Description of Measures The Timeline Followback interview was used to measure the frequency and pattern of marijuana and other drug consumption. The interview used calendar prompts for the previous 90 days and was modified to identify when during the day (midnight-6 a.m., 6 a.m.-noon, noon-6 p.m., 6 p.m.-midnight) the participant smoked marijuana.
Key Findings Four months after starting treatment, participants in nine-session BMDC averaged a 58.8% reduction in the percentage of days on which they used marijuana, compared with a 35.7% reduction among participants in a two-session program and a 15.9% reduction among clients awaiting services. Effect sizes were medium to large (Cohen's d = 0.59 and 1.14, respectively).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)
Outcome 2: Marijuana-related problems
Description of Measures A combination of measures were used to asses clients' marijuana dependence and abuse symptoms, including items from the Structured Clinical Interview for the DSM-IV (SCID) and the Marijuana Problems Scale (MPS), consisting of 19 self-reported problems associated with marijuana use.
Key Findings Four months after starting treatment, participants in nine-session BMDC displayed fewer dependence symptoms than participants in a two-session program and clients awaiting services; effect sizes were medium to large (Cohen's d = 0.52 and 0.90, respectively). Participants in BMDC also displayed fewer symptoms of marijuana abuse than participants in a two-session program and clients awaiting services; effect sizes were medium to small (Cohen's d = 0.53 and 0.41, respectively).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)
Outcome 3: Complete marijuana abstinence
Description of Measures Complete 90-day abstinence from marijuana was based on client self-reports using the Timeline Followback method and was confirmed through urinalysis.
Key Findings Four months after starting treatment, 22.6% of the participants in nine-session BMDC achieved complete abstinence, compared with 8.6% of the participants in a two-session program and 3.6% of the clients awaiting services (p < .001). Fifteen months after starting treatment, 22.7% of BMDC participants reported at least 90 days of abstinence, compared with 12.5% of participants in a two-session program (p < .001).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 4: Marijuana dependence and abuse symptoms
Description of Measures The percentage of clients with no dependence or abuse symptoms was measured using selected items from the Structured Clinical Interview for DSM-IV (SCID). Three categories of clients were assessed in this manner: abstinent, improved, or not improved.
Key Findings Rates of improvement averaged 8% for participants in both the nine-session BMDC and a two-session program, compared with slightly less than 4% for clients awaiting services.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 1.9 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
68.4% Male
31.6% Female
69.3% White
17.3% Hispanic or Latino
12.2% Black or African American
1.2% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Marijuana use 3.5 3.5 2.5 3.0 4.0 4.0 3.4
2: Marijuana-related problems 3.0 3.0 2.5 2.5 3.5 3.5 3.0
3: Complete marijuana abstinence 4.0 3.5 2.5 2.0 4.0 4.0 3.3
4: Marijuana dependence and abuse symptoms 0.0 3.0 2.5 2.0 4.0 0.0 1.9

Study Strengths

The study was well controlled and well designed. The intervention reliably performed better than the delayed treatment condition and the briefer treatment on most measures at most time points. The study used the best available methods of measuring self-reported marijuana use.

Study Weaknesses

It is unclear why urinalysis results were not reported as a separate outcome. The investigators provided insufficient data on reliability and statistical methods for assessing the client improvement (outcome 4) measure. Namely, the authors constructed this outcome using a categorical recoding of the SCID, and this variable has unknown or unspecified psychometric properties. Also, the authors did not present inferential tests for analyzing between-group differences.

Readiness for Dissemination
Review Date: February 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Brief Marijuana Dependence Counseling [VHS]

Steinberg, K. L., Roffman, R. A., Carroll, K. M., McRee, B., Babor, T. F., Miller, M., et al. (2005). Brief counseling for marijuana dependence: A manual for treating adults. (DHHS Publication No. [SMA] 05-4022). Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5 2.5 2.8 2.9

Dissemination Strengths

The implementation materials present a user-friendly blueprint for the intervention protocol and strategies. The treatment manual includes forms, activity sheets, notes to clinicians, and scripts to facilitate implementation and clearly describes the steps required to prepare for implementation. A session rating form and supervision outlines and techniques are provided to support quality assurance.

Dissemination Weaknesses

This intervention assumes that therapists are competent in motivational enhancement therapy. However, no information is provided for assessing therapist competencies prior to training in this intervention. Little information is provided on ongoing training and support resources. Session rating forms do not include any baseline or target performance scores for counselors.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Implementation manual Free Yes
Training video Free No
Customized training Varies depending on site needs No
Consultation Varies depending on site needs No
Fidelity rating sheets Free No
Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation or research, contact:
Karen Steinberg, Ph.D.
(860) 679-3712
ksteinberg@uchc.edu

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