Adolescent Cannabis Users, Motivational Enhancement and Cognitive Behavioral Therapy

Introduction and Organization
This manual is designed to help train substance abuse treatment counselors to conduct a brief five-session treatment intervention for adolescents with cannabis use disorders presenting for outpatient treatment. It combines two sessions of motivational enhancement therapy provided individually and three sessions of cognitive behavioral therapy provided in a group format. The program is referred to as MET/CBT5. Although this will be one of the first applications of these approaches to adolescent treatment, related brief intervention approaches with adults have proved very effective (Bien, Miller & Tonigan, 1993; Miller et al., 1995; Miller & Rollnick, 1991; Siegal, Rapp, Fisher, Cole & Wagner, 1993; Stark & Kane, 1985; Stephens, Roffman & Simpson, 1994; Zweben, Pearlman & Li, 1988). In the CYT study, the approach was also an efficient intervention because its personalized feedback report was based on the intake assessments already done as part of the research protocol.

The treatment described in this manual was designed to address the problem of marijuana use by adolescents. Section I reviews the scope, effects, and patterns of the marijuana problem. Section II provides a brief overview of the Cannabis Youth Treatment project for which this manual was developed. Section III covers the scientific basis for this intervention. Section IV provides step-by-step procedures for actually implementing this treatment protocol.
Scope and Significance of the Marijuana Problem.

Although marijuana use has dropped slightly in the past few years, it is still the most widely used and most readily available illicit psychoactive substance in the United States (Office of Applied Studies, 2000). In 1998, the rate of marijuana use during the month preceding the survey was more than twice that of all other drugs combined (8.3 percent vs. 4.0 percent) and higher than the rate of getting drunk (7.7 percent). Moreover, the rates of marijuana use for 8th graders are twice as high as the rates in 1992. The rate of daily use of marijuana is higher than the rate of daily use of alcohol, and that rate has not gone down (Monitoring the Future, 1999). Furthermore, similar trends in marijuana use are reported in regional surveys of junior and senior high school students (Godley et al., 1996; Hartwell et al., 1996; Markwood, McDermiet & Godley, 2000). Marijuana use has historically been inversely related to an adolescent’s perceived risk of using it (Johnson, Hoffman & Gerstein, 1996), and currently this perception among 12th graders is at the lowest point since 1982 (Monitoring the Future, 1999). Unfortunately, these perceptions do not match the facts.

Relative to nonusers, adolescents who used marijuana (and typically alcohol) weekly were 3 to 47 times more likely to have a host of problems including symptoms of dependence, emergency room admissions, dropping out of school, behavioral problems, fighting, non-drug-related legal problems, other legal problems, and being arrested. Unfortunately, fewer than 1 in 10 adolescents with past-year symptoms of dependence received treatment (Dennis & McGeary, 1999; Dennis, Godley & Titus, 1999). From 1992 to 1997, the number of adolescents presenting to publicly funded treatment for marijuana problems increased more than 200 percent; in 1997, 81 percent of adolescents admitted had a primary, secondary, or tertiary problem with marijuana (Dennis, Dawud-Noursi & Muck, in press; Office of Applied Studies, 1999). Marijuana is also the leading substance mentioned in adolescent emergency room admissions and autopsy reports and is believed to be one of the major contributing factors to violent deaths and accidents among adolescents; it has been reported to be involved in as many as 30 percent of adolescent motor vehicle crashes, 20 percent of adolescent homicides, 13 percent of adolescent suicides, and 10 percent of other unintentional injuries ...