Brief Counseling For Marijuana Dependence A Manual For Treating Adults
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Brief Counseling For Marijuana Dependence A Manual For Treating Adults
Ellos escuchan.
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Health Information Technology Needs Assessment PPS Reference Guide Care Coordination Agreements and Transitions Working With a DCO Substance Use Disorder Treatment Providers CCBHCs Using Telehealth or Telemedicine Services for New Consumers Person- and Family-centered Care and Peer Support Cultural Competence LEP Services Military and Veterans Resources Governance and Oversight Care Provision, Coordination, and Patient Privacy Developing a Continuity of Operations Plan Addressing Governing Board Requirements Advance Directives for Behavioral Health Semana de Prevencion Acerca de Involucrese Lo mas destacado del 2018 Lo mas destacado del 2017 Reto de prevencion Webinarios Eventos y actividades Presentar Eventos Kit para la planeacion Promocione su evento o actividad Invite a sus socios a participar Comparta los resultados y retroalimentaci?n Obtenga los recursos de prevencion Materiales de promoci?n Brazalete del Kit de materiales Videos Logos y Calcomanias Para paginas web Para imprimir Socios Synar About Synar Requirements Synar’s Success Annual Reports Talk.In the future, you may be asked to respond to a CAPTCHA to access the site for added security. It describes common treatment issues, assessment of marijuana use, motivational interventions, and how to change marijuana use through skill building. Program administrators will learn how to integrate depression treatment into early drug treatment. The guidelines cover screening, assessment, treatment, counseling, cultural competence, and continuing care. It lists symptoms of child abuse and neglect and presents screening questions, behavioral clues, and the role of child protective services. It discusses assessment, transition plans, important services, special populations, and confidentiality. It presents challenges related to substance misuse, post-traumatic stress disorder, depression, and suicide. The guide also discusses screening tools and intervention.
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It provides strategies for breaking the intergenerational cycle and discusses therapeutic issues for counselors. Our payment security system encrypts your information during transmission. We don’t share your credit card details with third-party sellers, and we don’t sell your information to others. Please try again.Please try again.This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Register a free business account If you are a seller for this product, would you like to suggest updates through seller support ? Amazon calculates a product’s star ratings based on a machine learned model instead of a raw data average. The model takes into account factors including the age of a rating, whether the ratings are from verified purchasers, and factors that establish reviewer trustworthiness. Please try again later. We don’t share your credit card details with third-party sellers, and we don’t sell your information to others. Please try again.Please try again.
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Describes common treatment issues, assessment of marijuana use, motivational interventions, and how to change marijuana use through skill building. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Register a free business account If you are a seller for this product, would you like to suggest updates through seller support ? Amazon calculates a product’s star ratings based on a machine learned model instead of a raw data average. It gives an overview of the Brief Marijuana Dependence Counseling Model and Manual, describes the theoretical basis for BMDC treatment. It explains the therapeutic tasks of the BMDC approach, describes the target population, and provides an overview and the suggested sequencing of BMDC sessions. It addresses common treatment issues and presents potential pitfalls in BMDC and guidelines for handling issues that may arise. Some problems identified are not specific to marijuana treatment and may apply generally to substance use disorders or clinical counseling. This course is appropriate for all levels of knowledge. CE Learning Systems maintains responsibility for this program and its content. CE Learning Systems is solely responsible for all aspects of the programs. Approval No. 17-1460. You'll only pay when you're ready to purchase a course. You don't pay anything until you're readySome courses, such asUse the Course Materials tab above for moreSo you alwaysDenver, CO 80202 USA You don't pay. It utilizes the Center for Substance Abuse manual for Brief Counseling for Marijuana Dependence (BCMD) that is based on the research protocol used by counselors in the Marijuana Treatment Project. The one-on-one sessions in the manual present how a counselor can help a client understand certain topics, keep a determination to change, learn new skills, and access needed community supports. The course is practical and applied. Dr. Robert A.
Shearer is a retired professor of Criminal Justice, Sam Houston State University. Prior to teaching Criminal Justice, he taught Educational Psychology at Mississippi State University on campus and in the extension program across rural Mississippi during the civil rights era. He is the author of over sixty professional and refereed articles in Criminal Justice and behavior. He is also the author of Interviewing: Theories, techniques, and practices, 5th edition published by Prentice Hall. Dr. Shearer has also created over a dozen measurement, research, and assessment instruments in Criminal Justice and addictions. His interests continue to be substance abuse program assessment and evaluation. He has taught courses in interviewing, human behavior, substance abuse counseling, drugs-crime-social policy, assessment and treatment planning, and educational psychology. He has also taught several university level psychology courses in the Texas Department of Criminal Justice Institutional Division, led group therapy in prison, trained group therapists, and served as an expert witness in various courts of law. Click here Easy, convenient and cost effective! Groups Discussions Quotes Ask the Author This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most impo This work was reproduced from the original artifact, and remains as true to the original work as possible. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. To see what your friends thought of this book,This book is not yet featured on Listopia.There are no discussion topics on this book yet. Abstract The prevalence of marijuana abuse and dependence disorders has been increasing among adults and adolescents in the United States.
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This paper reviews the problems associated with marijuana use, including unique characteristics of marijuana dependence, and the results of laboratory research and treatment trials to date. It also discusses limitations of current knowledge and potential areas for advancing research and clinical intervention. Marijuana remains the most widely used illicit substance in the United States and Europe ( European Monitoring Centre for Drugs and Drug Addiction, 2006; Substance Abuse and Mental Health Services Administration (SAMHSA), 2007 ). Although some people question the concept of marijuana dependence or addiction, diagnostic, epidemiological, laboratory, and clinical studies clearly indicate that the condition exists, is important, and causes harm ( Budney, 2006; Budney and Hughes, 2006; Copeland, 2004; Roffman and Stephens, 2006 ). Marijuana dependence as experienced in clinical populations appears very similar to other substance dependence disorders, although it is likely to be less severe. Approximately half of the individuals who enter treatment for marijuana use are under 25 years of age. These patients report a distinctive profile of associated problems, perhaps due to their age and involvement in other risky behaviors ( Tims et al., 2002 ). Adolescents who smoke marijuana are at enhanced risk of adverse health and psychosocial consequences, including sexually transmitted diseases and pregnancy, early school dropout, delinquency, legal problems, and lowered educational and occupational aspirations. Some 4.3 percent of Americans have been dependent on marijuana, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000 ), at some time in their lives. Marijuana produces dependence less readily than most other illicit drugs.
Some 9 percent of those who try marijuana develop dependence compared to, for example, 15 percent of people who try cocaine and 24 percent of those who try heroin. However, because so many people use marijuana, cannabis dependence is twice as prevalent as dependence on any other illicit psychoactive substance (cocaine, 1.8 percent; heroin, 0.7 percent; Anthony and Helzer, 1991; Anthony, Warner, and Kessler, 1994 ). During the past decade, marijuana use disorders have increased in all age groups. Contributing factors may include the availability of higher potency marijuana and the initiation of use at an earlier age. Among adults, marijuana use disorders increased despite stabilization of rates of use. An increased prevalence of disorders among young adult African-American and Hispanic men and African-American women appears to account for the overall rise among youth ( Compton, 2004 ). The reasons for the upward trend in disorders among minority young people are not clear. Speculation has pointed to the deleterious effects of acculturation on Hispanic youth; growing numbers of minority youth attending college, where they may experience increased exposure to marijuana use; and environmental and economic factors. For example, young people may turn to marijuana abuse when they have difficulty obtaining tobacco and alcohol, and recent higher prices and stricter governmental policies may restrict minorities’ more than Caucasians’ access to legal psychoactive substances. Paralleling the rise in marijuana use disorders, treatment admissions for primary marijuana dependence have increased both in absolute numbers and as a percentage of total admissions, from 7 percent in 1993 to 16 percent in 2003 ( SAMHSA, 2004 ). The extent of marijuana use and its associated consequences clearly indicate a public health problem that requires systematic effort focused on prevention and intervention.
FIGURE 1 Open in a separate window The percentage of substance abuse treatment admissions that were due to marijuana nearly doubled from 1993 to 2005 ( SAMHSA, 2006 b ) FIGURE 2 Open in a separate window Marijuana accounts for most adolescent drug treatment admissions and progressively smaller proportions of admissions in each successive higher age group ( SAMHSA, 2006 b ) TREATMENT EFFICACY RESEARCH Systematic research on psychosocial treatments for marijuana abuse or dependence began approximately 20 years ago, yet the number of controlled studies remains small. Behavioral treatments, such as motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), and contingency management (CM), as well as family-based treatments have been carefully evaluated and have shown promise. Outpatient treatments for marijuana abuse among adolescents have recently received increasing attention in the scientific literature. Adults Seven published, randomized efficacy trials for primary adult marijuana abuse and dependence have consistently demonstrated that outpatient treatments can reduce marijuana consumption and engender abstinence. The most commonly tested interventions are adaptations of interventions initially developed to treat alcohol or cocaine dependence, in particular MET and CBT (also known as coping skills training). Recently, trials have examined the use of CM to enhance the potency of MET- and CBT-based treatments. The cumulative findings indicate that (1) each of these interventions represents a reasonable and efficacious treatment approach; (2) the combination of MET and CBT is probably more potent than MET alone; and (3) an intervention that integrates all three approaches—MET, CBT, and CM— is most likely to produce positive outcomes, especially as measured by rates of abstinence from marijuana.
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The Motivational Enhancement Therapy and Cognitive Behavioral Therapy Supplement: 7 Sessions of Cognitive Behavioral Therapy for Adolescent Cannabis Users, Volume 2. Family Support Network for Adolescent Cannabis Users, Volume 3. The Adolescent Community Reinforcement Approach for Adolescent Cannabis Users, Volume4. A typical MET regimen consists of one to four 45- to 90-minute individual sessions. Therapists use a nonconfrontational counseling style to guide the patient toward commitment to and action toward change. Therapeutic techniques include using strategic expression of empathy, reflecting, summarizing, affirming, reinforcing self-efficacy, exploring pros and cons of drug use, rolling with resistance, and forging goals and plans to achieve them. An online manual, Brief Counseling for Marijuana Dependence, describes the use of MET intervention with adult marijuana users. CBT focuses on teaching patients skills relevant to quitting marijuana and avoiding or managing other problems that may interfere with good outcomes. Patients learn functional analysis of marijuana use and cravings, self-management planning to avoid or cope with drug use triggers, drug refusal skills, problem-solving skills, and lifestyle management. CBT for marijuana dependence is typically delivered in 45- to 60-minute, weekly individual or group counseling sessions; tested CBT interventions have ranged from 6 to14 sessions. Each session involves analysis of recent marijuana use or cravings, development of planned responses to situations that may trigger use or craving, brief training on a coping skill, role-playing or other interactive exercises, and practice assignments. Brief Counseling for Marijuana Dependence describes the content and conduct of CBT sessions in detail ( Steinberg et al., 2005; see “Web Links to Treatment Manuals”). A series of four trials demonstrated the efficacy of both CBT and MET for adult marijuana dependence ( Table 1 ).
After an initial trial showed promising results for a CBT group intervention ( Stephens, Roffman, and Simpson, 1994 ), a second trial tested a 14-session group CBT intervention against 2 individual MET sessions or a delayed treatment control (DTC) condition ( Stephens, Roffman, and Curtin, 2000 ). At the 4-month followup, the CBT and MET groups had achieved significantly greater rates of abstinence than the DTC group. Days of use, number of uses per day, dependence symptoms, and problems related to use also fell significantly compared with those measures in the DTC group, and gains were generally maintained throughout the 16-month followup. No significant differences were observed between CBT and MET conditions on any of these outcome measures, suggesting that brief motivational interventions may be as effective as longer CBT interventions. However, this study confounded treatment modality (group vs.A similar study showed that a six-session CBT and a one-session MET treatment, both delivered in individual therapy sessions, produced greater rates of abstinence than DTC, but again little difference was observed between the active treatment groups ( Copeland et al., 2001 ). A positive relation between therapist experience and outcome was reported across both treatment conditions. TABLE 1 Randomized Trials for Adult Marijuana Treatment AUTHOR(S) N INTERVENTION OUTCOME MET and CBT Stephens, Roffman, and Simpson, 1994 212 CBT vs.No significant differences between groups. Stephens, Roffman, and Curtin, 2000 291 14-session CBT group treatment vs. 2-session MET treatment vs. DTC Treatment groups showed greater improvement than DTC. No differences in outcomes between treatment groups. Copeland et al., 2001 229 6-session MET vs. 1-session MET vs. DTC Both treatment groups reported better outcomes (higher rates of abstinence, fewer marijuana-related problems) than DTC. Marijuana Treatment Project Research Group, 2004 450 9-session MET-CBT vs. 2-session M ET vs.
DTC Both treatment groups reported better outcomes than DTC. 9-session MET-CBT engendered greater long-term abstinence and reductions in frequency of use than brief MET. Only 37 percent of PRN subjects used continuing care sessions; suggestive evidence that use of PRN increased abstinence. Budney et al., 2006 90 14-session MET-CBT vs. Kadden et al., 2007 240 9-session MET-CBT vs. MET-CBT and MET-only again produced better abstinence outcomes than DTC. However, in this trial, MET-CBT was associated with significantly greater long-term abstinence and greater reductions in frequency of marijuana use compared with MET alone. Findings generalized across three sites and were not dependent on ethnicity or gender. In an effort to enhance outcomes further, researchers have begun to examine the efficacy of CM for treating marijuana dependence ( Budney et al., 2001 ). The marijuana CM intervention adapts the abstinence-based voucher approach originally developed and demonstrated effective for treating cocaine dependence ( Budney and Higgins, 1998; Higgins et al., 1994 ). The vouchers are contingent on marijuana abstinence, confirmed by twice-weekly drug testing, and their value escalates with each consecutive negative drug test. Patients exchange them for prosocial retail items or services that, it is hoped, will serve as alternatives to marijuana use. The MET-CBT plus CM condition produced the highest abstinence rate during treatment. In a second trial conducted to extend these findings ( Budney et al., 2006 ), 90 adults received MET-CBT, MET-CBT plus CM, or CM alone (no counseling). The magnitude of the CM incentives was identical to that used in the prior study. This trial produced three notable outcomes. First, MET-CBT plus CM and CM alone both engendered greater initial rates of abstinence than MET-CBT. Second, MET-CBT plus CM produced outcomes that were similar to those of CM alone during treatment, but superior post-treatment.
During the following year, the MET-CBT plus CM patient group sustained overall positive outcomes somewhat better than those of the CM group, although differences in abstinence rates were not statistically significant at later followups. As in the previous CM trials, patients in the CM and non-CM conditions self-reported similar rates of marijuana use throughout, illustrating the importance of obtaining subjective and objective indices of use. In summary, MET, CBT, and CM each has empirical support for its efficacy, and CM in combination with MET-CBT has demonstrated the most potency in outpatient treatment for adult marijuana dependence, particularly for engendering longer periods of abstinence. Recognizing that many people overcome dependence only after multiple treatment exposures, Stephens and Roffman (2005) developed and initially tested a creative, chronic care model of treatment that they termed “marijuana dependence treatment PRN.” Following an initial four sessions of MET-CBT, participants were given the option of determining the number and schedule of treatment sessions they would attend over a 28-month period. The comparison condition in this trial was the same fixed-dose nine-session MET-CBT intervention used in the large multisite trial mentioned earlier ( Marijuana Treatment Project Research Group, 2004 ). There were three key findings from this trial: (1) A relatively small percentage of participants (37 percent) made use of the continuing care sessions, and (2) the PRN condition overall was not more efficacious than the fixed-dose condition, although (3) the few individuals who attended the greatest number of continuing care sessions (mean of 13.4 sessions) had a high level of 90-day abstinence (approximately 60 percent) at followup. Adolescents and Young Adults Most information on marijuana treatment efficacy among young people derives from trials that have included users of various drugs and have not focused specifically on marijuana use.
Nevertheless, most patients in these studies have been primary marijuana users. Empirical support for group or individual CBT and family-based treatments has begun to emerge ( Waldron and Kaminer, 2004 ). The CBT interventions studied have been similar to those studied for adults in scope and duration. However, they each involve structured, skills-based interventions for family members and are well described in their respective manuals. Significant decreases in drug use and symptoms of dependence were observed following each of the treatments. However, robust between-treatment differences in outcomes were not observed, which unfortunately precludes drawing strong conclusions about their efficacy. Although results were promising compared with prior treatment studies, two-thirds of the youth continued to experience significant substance-related symptoms, suggesting that adolescent treatments can be improved and alternative treatment models should be explored ( Compton and Pringle, 2004 ). As they are doing with treatments for adults, researchers are attempting to enhance youths’ outcomes by adding a CM intervention to MET-CBT-type interventions. Positive results were observed in an initial pilot study of MET-CBT plus a CM intervention that incorporated an abstinence-based voucher program and parent-based CM ( Kamon, Budney, and Stanger, 2005 ). The voucher program was of the same schedule and magnitude as that used in the previously mentioned adult trials by Budney and colleagues. However, participants could earn vouchers only if urine toxicology screens were negative for all drugs tested and if parents reported that, to their knowledge, the adolescent had not used any drugs or alcohol. The parenting intervention included a contract that directed parents to provide tangible incentives for abstinence and to deliver negative consequences for continued use.
Parents also participated in a weekly behavioral training program called Adolescent Transitions ( Dishion and Kavanagh, 2003 ), a treatment of choice for adolescents with conduct disorder. Preliminary data from an initial randomized trial suggest that the MET-CBT plus CM improved rates of marijuana abstinence and effectively maintained abstinence post-treatment compared with MET-CBT combined with weekly parent psychoeducational counseling. The rates of abstinence achieved appeared greater than those reported in prior studies; however, comparison across trials is problematic because of differences in patient characteristics and differences in the way outcomes are measured. Two other tests of CM with adolescents and young adults have produced promising results. A CM abstinence-based voucher program enhanced drug use outcomes and abstinence when added to a potent outpatient therapy (i.e., multisystemic therapy) among juvenile offenders enrolled in drug court ( Henggeler et al., 2006 ). Lastly, adding incentives for treatment attendance to MET increased treatment participation by young adult marijuana abusers involved with the judicial system, but did not lead to increased marijuana abstinence ( Sinha et al., 2003 ). In summary, a number of behaviorally based interventions appear efficacious for treating adolescent marijuana abuse, and combining interventions like MET, CBT, CM, and family-based programs is likely to enhance efficacy. Effectiveness Sufficient evidence has accumulated to conclude that behaviorally based interventions can help many of those who seek treatment for marijuana use disorders. Unfortunately, as with treatment for other dependencies, the rates of “success” are modest. Even with MET-CBT plus CM, the most highly efficacious treatment for adults, only about one-half of those who enroll in treatment achieve an initial 2-week period of abstinence, and among those who do, approximately one-half resume use within a year ( Budney et al.
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