MIAMI – A triple combination of behavioral therapies yields the best abstinence rates among heavy users of marijuana, Dr. Ahmed M. Elkashef said at the annual conference of the American Society of Addiction Medicine.
This optimal combination of cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and contingency management (CM) may not be realistic in clinical settings with limited resources, however, said Dr. Elkashef, chief of the clinical/medical branch of the division of pharmacotherapies and medical consequences of drug abuse, National Institute on Drug Abuse, Rockville, Md.
A combination of CBT and MET or MET alone is a secondary option. Studies have demonstrated their efficacy, but success rates were lower. Other researchers have shown that CM alone with vouchers can also help heavy marijuana users.
“In general, behavioral interventions do work, and if you can combine two or three of them, you can get better results,” Dr. Elkashef said. Family intervention and parent education can be added when working with adolescents.
Experts are still battling the perception that marijuana use is less serious than use of other substances. “Is it really that serious? Should we be concerned about [heavy marijuana use]? This perception in the field is dangerous,” Dr. Elkashef said.
“The need is from the patient–they see problems with [their addiction] and a need to get off the drug.” Surveys indicate that this population is receptive to treatment. A majority of heavy users of marijuana express interest in programs to help them stop smoking, Dr. Elkashef said.
In the study that found the triple combination optimal, researchers assigned 240 marijuana-dependent individuals to CM only, MET and CBT, or a combination of all three (Addict. Behav. 2007;32:1220–36[doi:10.1016/j.addbeh.2006.08.009]). All participants had nine weekly 1-hour sessions, except the CM-only group, which met for 15 minutes weekly. Although the CM-only group had the best abstinence rates post treatment, by 1 year abstinence rates were greatest in the CBT/MET/CM group.
The same triple combination is supported by another study in which researchers compared two brief interventions and a delayed-treatment control among 450 adults meeting DSM-IV criteria for cannabis dependence (J. Consult. Clin. Psychol. 2004;72:455–66). Marijuana use and associated consequences were best reduced by nine sessions of CBT, MET, and CM, compared with two sessions of MET, which in turn was more effective than delayed treatment. “The combination did much better over time in giving clean urines [than did] MET by itself,” Dr. Elkashef said.