What's In It for Me? Motivating the Untreated Abuser to Consider Treatment.

This paper presents findings of a second trial evaluating telephone-based motivational enhancement therapy (MET) to motivate untreated and unadjudicated men who abuse their intimate partners to explore treatment options. Participants' perceptions of how their abuse is negatively affecting them personally are a highlight of the paper. One hundred forty-one adult men were recruited through social marketing and randomly assigned to the intervention (MET) or comparison (Mail) group. The MET condition consisted of two feedback sessions guided by a personalized feedback report on participants' intimate partner violence (IPV) and substance use. The Mail condition included a mailed educational brochure on IPV and substance use. Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, marijuana use, and increasing motivation for treatment seeking particularly for participants who reported more adverse consequences of IPV to themselves. Findings emphasize the importance of including a focus in interventions on IPV's impact on the abusers themselves. The study's virtual participation and success in reaching and retaining a diverse population of male abusers can contribute to transformative justice and communities looking for alternative early interventions for men of color prior to encountering the criminal justice system.

Reaching nontreatment-seeking cannabis users: Testing an extended marijuana check-up intervention.

Some adult cannabis users report negative consequences of use but do not seek treatment. Nonjudgmental, brief interventions incorporating motivational interviewing techniques may be able to reach users who otherwise would not seek treatment and increase their motivation to change use. Previous studies have shown brief interventions with this population are efficacious in reducing use, but the absolute amount of change has not clearly translated into meaningful reductions in associated negative consequences. The current study used a marijuana check-up (MCU) model to attract nontreatment-seeking adults who used cannabis at levels that may have caused negative consequences. The study randomly assigned participants to 2-session (n = 93) and 6-session (n = 93) versions of the intervention and followed them for 12 months. The study designed the extended 6-session condition to build on the efficacy of the previously tested 2-session intervention. The study hypothesized that the opportunity to continue to consider the consequences of cannabis use would have the greatest impact on those who were in earlier stages of readiness for change. We used cognitive behavioral techniques to assist with change efforts when indicated. Results showed significant reductions in the frequency and daily duration of cannabis use at all follow-ups in both intervention conditions. The extended 6-session condition produced greater change only on a measure of the number of periods of the day in which cannabis was used. Reductions in dependence symptoms and problems related to cannabis use occurred in both conditions, but there was no effect of intervention condition. Participants who were less ready to make changes at the outset decreased use and negative consequences the least. Results suggested that some benefit of the extended session format of the check-up in reducing daily use, but the lack of a corresponding reduction in consequences suggested that the original 2-session MCU may be more cost effective.

Treating cannabis use disorder: Exploring a treatment as needed model with 34-month follow-up.

Research has demonstrated that motivational enhancement (MET) and cognitive behavioral therapy (CBT) are some of the most effective interventions for adults with cannabis use disorder (CUD). As few as two sessions of combined MET and CBT has produced abstinence and reductions in cannabis use greater than delayed treatment controls. Despite their efficacy, outcomes in previous studies yielded abstinence rates from cannabis in the range of 20-30% at follow-ups of 6 to 12 months, and CUD remained a chronic condition for many. Additional models of providing treatment "as needed" (PRN), rather than as a single fixed-dose, are necessary to meet the different needs of adults with CUD and reengage those who do not respond to treatment initially or who relapse later. In the current study, 87 adults who met DSM-IV criteria for cannabis dependence were randomly assigned to receive either a fixed-dose of nine sessions of MET/CBT or to a PRN condition that provided a smaller initial dose of treatment, but allowed repeated access to treatment for 28 months. Cannabis use and associated problems were assessed every six months throughout a 34-month period. More than one-third of participants in the PRN condition accessed additional treatment episodes, but the total number of treatment sessions that participants utilized was comparable across conditions. Both treatments yielded significant reductions in cannabis use and associated problems at each follow-up. Contrary to hypotheses, the PRN condition did not yield better outcomes at the longer-term follow-ups. The fixed-dose condition produced greater rates of abstinence at the first follow-up, but otherwise there were no between group differences in outcomes. Future studies should test active approaches to reengaging participants with treatment when initial outcomes are less than optimal.

The Implications of Cannabis Policy Changes in Washington on Adolescent Perception of Risk, Norms, Attitudes, and Substance Use.

There is increasing interest in the effect of legalization (particularly recreational legalization) of cannabis on prevalence of use and related problems. However, there is no consensus about the impact of policy change on cannabis use, particularly among adolescents. Legalization may increase adolescent use through mediating factors such as perceived risk and normative beliefs regarding the use of cannabis. Washington State enacted Initiative 502 on December 2012, which legalized and taxed recreational cannabis for adults aged ⩾21 years. This paper used data from a randomized, controlled intervention trial for cannabis-using adolescents that was recruiting participants in Seattle before and after the policy change to evaluate the following goals: assess differences in substance use, problems, and symptomatology pre- and post-policy change; evaluate several proposed risk factors that may be associated with such differences; and describe participants' understanding of the law and how this understanding may relate to rates of use. Analyses revealed no significant differences pre- to post-policy in rate of substance use. However, there were significant post-policy increases in problems and use disorder symptoms. Despite these differences, there were no significant increases in norms, attitudes, or perceptions of risk. Participants were able to answer most questions regarding policy changes correctly, indicating a good understanding of the policy. Results provided no evidence that policy change influenced heavy-using adolescents' rates of use nor the proposed risk factors associated with problematic use patterns.

Changing social norms: The impact of normative feedback included in motivational enhancement therapy on cannabis outcomes among heavy-using adolescents.

INTRODUCTION: Heavy cannabis use is a problematic behavior, particularly among some adolescents. Adolescents are particularly prone to social influence. As such, injunctive norms (perceptions of others' approval of cannabis use) and descriptive norms (perception of frequency of others' cannabis use) influence cannabis behavior. Given that norms are not always accurate, motivational enhancement therapy aims to reduce cannabis use through normative feedback and correction of normative misconceptions. The purpose of this study was to evaluate the relationships between perceived norms (descriptive and injunctive) and cannabis-related outcomes (use, cannabis-related problems, and cannabis use disorder symptoms) in a heavy cannabis-using adolescent population receiving motivational enhancement therapy. METHODS: Heavy cannabis-using individuals (n=252, 68% male, mean age 13.38, 59% Caucasian) were recruited from six Seattle high schools for a motivational enhancement therapy-based intervention involving normative feedback. RESULTS: Participants perceived higher rates of cannabis use among close friends than other same age teens and reported a higher perception of approval for cannabis use from close friends as compared to perceived approval of other same aged peers. Personal approval and the perceived approval of other same age teens were reduced following the intervention but there was no evidence of change in normative perceptions for close friends following the normative feedback interventions. Changes in normative perceptions were related to decreases in cannabis use and -related outcomes. CONCLUSIONS: Results suggest the importance of normative feedback in changing behavior in adolescent cannabis users, but also highlight the ongoing influence of close friends.

Randomized trial of motivational interviewing plus feedback for soldiers with untreated alcohol abuse.

OBJECTIVE: Alcohol use disorders (AUDs) are prevalent in the military and are a major public health concern. Although efficacious AUD interventions exist, few service members seek treatment. Army-specific barriers to AUD treatment include treatment being recorded on health records, command being notified of participation, and perceptions that seeking treatment would interfere with promotion or retention in the military. This study evaluated a telephone delivered motivational interviewing plus feedback (MIF) intervention designed to attract self-referral and reduce substance use from active-duty military with untreated AUD. METHOD: A randomized controlled trial enrolled 242 Army personnel who met criteria for AUD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and who were not engaged in AUD treatment. Participants were screened and assessed at baseline, 1-week, and 3- and 6-month follow-ups. Participants were randomly assigned to receive 1 session of MIF or psychoeducation (control). All participation occurred over the telephone. Primary outcomes included number of drinks per week, substance use disorder (SUD) diagnosis and consequences, and treatment-seeking behavior. RESULTS: Generalized linear models were used to test group differences in drinking behaviors and substance use problems. Results indicated that all participants significantly reduced their drinking over time. MIF participants reported significantly fewer drinks per week than did control participants. Similarly, alcohol dependence diagnosis was marginally lower among MIF participants than control participants at the 6-month assessment. SUD treatment seeking significantly increased for both conditions. CONCLUSIONS: This novel adaptation of MIF shows promise for decreasing drinking and alcohol dependence among this high-risk sample of non-treatment-seeking soldiers and may complement existing AUD services already provided by the Army. (PsycINFO Database Record

Augmenting brief interventions for adolescent marijuana users: The impact of motivational check-ins.

OBJECTIVE: Brief interventions for adolescent marijuana users offered in schools reach users who would not otherwise present for treatment. The current study builds on previous trials of a school-based, 2-session motivational enhancement therapy (MET) intervention by adding periodic, brief motivational check-ins to reinforce gains and bolster motivation. METHOD: Adolescent participants were randomly assigned to a motivational check-in (MCI; n = 128) or assessment-only check-in (ACI; n = 124) comparison condition. Both conditions received 2 sessions of MET. Participants in the MCI condition then attended 3 MET-based check-in sessions at 4, 7, and 10 months after baseline, whereas the ACI condition participants attended assessment-only check-ins at the same time points. Optional cognitive behavior therapy (CBT) sessions were available as needed for 12 months from baseline in both conditions. RESULTS: Outcomes were assessed at 6, 9, 12, and 15 months after baseline. Participants (59% Caucasian; 68% male; mean age = 15.84) reported using marijuana on an average of 37 of the last 60 days, and 70% met diagnostic criteria for a marijuana use disorder. Both conditions were associated with reduced use and negative consequences that were sustained throughout the 15 months of follow-up. The MCI condition resulted in greater reductions at the 6 months follow-up, but differences between conditions were not found at later follow-ups, and MCI participation did not increase engagement in CBT as predicted. CONCLUSIONS: Results replicated the efficacy of the brief intervention for adolescent marijuana use and provided mixed evidence on the utility of adding repeated check-in sessions. (PsycINFO Database Record

Change in motives among frequent cannabis-using adolescents: Predicting treatment outcomes.

BACKGROUND: Heavy cannabis use has been associated with negative outcomes, particularly among individuals who begin use in adolescence. Motives for cannabis use can predict frequency of use and negative use-related problems. The purpose of the current study was to assess change in motives following a motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) intervention for adolescent users and assess whether change in motives was associated with change in use and self-reported problems negative consequences. METHODS: Participants (n=252) were non-treatment seeking high school student cannabis users. All participants received two sessions of MET and had check-ins scheduled at 4, 7, and 10 months. Participants were randomized to either a motivational check-in condition or an assessment-only check-in. Participants in both conditions had the option of attending additional CBT sessions. Cannabis use frequency, negative consequences, and motives were assessed at baseline and at 6, 9, 12, and 15 month follow-ups. RESULTS: There were significant reductions in motives for use following the intervention and reductions in a subset of motives significantly and uniquely predicted change in problematic outcomes beyond current cannabis use frequency. Change in motives was significantly higher among those who utilized the optional CBT sessions. CONCLUSIONS: This study demonstrates that motives can change over the course of treatment and that this change in motives is associated with reductions in use and problematic outcomes. Targeting specific motives in future interventions may improve treatment outcomes.

A preliminary evaluation of synthetic cannabinoid use among adolescent cannabis users: Characteristics and treatment outcomes.

Little is known regarding the use of synthetic cannabinoids (SC), particularly use among adolescent substance users who may be at higher risk. The present exploratory study seeks to describe SC use and subjective effects among cannabis-using adolescents as well as compare the characteristics of cannabis users who do and do not use SC. Exploratory analyses evaluated cannabis treatment outcomes among SC users and non-users. Participants enrolled in a randomized, controlled intervention for cannabis-using high school students aged 14-19 (N=252) completed questionnaires regarding their use of SC and other substances. Those who used SC in the past 60days reported subjective effects of SC, consequences, and SC use disorder symptoms. Baseline characteristics, alcohol and other drug use, and treatment outcomes of SC users were compared to participants who never tried SC. Within this sample 29% had tried SC, and 6% used SC recently. Although most reported use at a relatively low rate, 43% of recent SC users reported SC use-disorder symptoms. Positive and negative subjective effects of SC were endorsed, with positive subjective effects reported more often. SC use was associated with more cannabis use, but not more alcohol or other (non-SC and non-cannabis) drug use. SC users did not differ from non-users on cannabis treatment outcomes. This exploratory study described SC use, and compared characteristics and treatment outcomes among SC users and non-users. Negative subjective effects of SC were reported as occurring less often, but SC use was associated with use disorder psychopathology. SC use was associated with more problematic cannabis use at baseline, but was not associated with use of other substances or differences in treatment outcome.

Motives for marijuana use among heavy-using high school students: An analysis of structure and utility of the Comprehensive Marijuana Motives Questionnaire.

Motives for marijuana use are important predictors of problematic outcomes associated with marijuana use. Most measures, to date, were developed by adapting alcohol motives measures. However, the Comprehensive Marijuana Motives Questionnaire (CMMQ) was created using a bottom-up approach to evaluate twelve distinct motives for use. The CMMQ was developed and validated in a normative college population. As such, no known study has evaluated the factor structure and utility of the CMMQ in a heavy-using, high school student population. The current study utilized a sample of 252 heavy marijuana-using high school students recruited for a combination motivational enhancement/cognitive behavioral intervention. Results from baseline measures indicated that the factor structure of the CMMQ was maintained in this population. Results from multiple regression analyses revealed distinct relationships with measures of negative consequences of use, including indices of marijuana use, marijuana-related problems, self-efficacy, and internalizing and externalizing symptoms. In particular, the Coping motive was associated with several negative outcomes, which is consistent with previous marijuana and alcohol motives literature. Results suggest that the CMMQ may be useful in assessing marijuana motives among heavy marijuana-using adolescents.

The relationship between general causality orientation and treatment outcome among marijuana-dependent adults.

General causality orientations are motivational styles that are indicative of a person's belief about personal change and their motivation to change. The purpose of the current study was to investigate whether causality orientations were associated with marijuana treatment outcomes in a sample of marijuana-dependent individuals. A total of 74 participants (66% male) were recruited from the Seattle, Washington area and randomly assigned to receive a combination of motivational enhancement and cognitive behavioral therapy or the combination treatment plus additional "check-up" sessions. Follow-up assessments evaluated frequency of use, use-related problems, and marijuana use disorder symptoms through 9months. Causality orientations were relatively stable over time. Posttreatment Autonomy orientations were associated with lower frequency of use and Controlled orientations were associated with a reduction in use, problems, and marijuana use disorder symptoms. Autonomy and Controlled orientations were associated with readiness to change. Results suggest that both autonomous and controlled orientations have implications for response to treatment; perhaps for different reasons. Causality orientations may be a promising avenue of research to predict treatment response and outcome.

Changing motives for use: outcomes from a cognitive-behavioral intervention for marijuana-dependent adults.

BACKGROUND: Motives for use have been identified as important predictors of substance use and related problems; however, little is known about how motives for use change following an intervention and how this change may impact future substance use behaviors. The present study sought to describe change in motives following an intervention for marijuana-dependent adults. Furthermore, investigators examined change in motives as a predictor of treatment outcome. METHOD: The study randomized 74 adults to one of two conditions: both of which received 9-sessions base treatment of cognitive behavioral therapy and motivational enhancement therapy and had access to additional sessions of cognitive behavioral treatment on an as-needed basis. The experimental condition received two additional "check-ups" during the course of follow-up. RESULTS: Significant decreases in reported frequency of motives used were observed following treatment. Changes in Expansion and Coping were associated with differential treatment outcomes. Decreases in Expansion were associated with poorer treatment outcome, while decreases in Coping were associated with better treatment outcome. CONCLUSIONS: The relationship between expansion motives and outcomes was paradoxical. Although there were some inconsistencies in the findings, the results regarding the coping motive were consistent with hypotheses and may have important implications for treatment.

Situational determinants of use and treatment outcomes in marijuana dependent adults.

Research and theory strongly support the importance of situational determinants of substance use as targets for intervention, but few studies have systematically examined situational use characteristics in marijuana dependent adults. The present study describes situational use of marijuana in a population of 87 marijuana dependent adults and reports relationships with outcomes of treatment. Use in negative affective situations was independently associated with psychological distress, maladaptive coping strategies, lower self-efficacy, and poorer outcomes post-treatment. The findings were consistent with research on using drugs to cope with negative affect providing evidence of convergence between two different methods of assessing high risk situations for substance use. The results support continued emphasis on coping with negative affect as a target in treatments for marijuana dependence.

Reaching soldiers with untreated substance use disorder: lessons learned in the development of a marketing campaign for the Warrior Check-Up study.

The Warrior Check-Up, a confidential telephone-delivered intervention, is designed to reach active-duty soldiers with untreated substance-use disorder at a large U.S. military base. This paper describes the development and successful implementation of the study's marketing strategies at the recruitment period's midpoint (2010-2012). Qualitative analyses of focus groups (n = 26) and survey responses (n = 278) describe the process of campaign design. Measures of demographics, media exposure, post-traumatic stress, anxiety and depression gathered from callers (n = 172) are used in quantitative analysis assessing the campaign's success in reaching this population. Implications, limitations, and suggestions for future research are discussed. Department of Defense provided study funding.

A Self-Determination Model of Childhood Exposure, Perceived Prevalence, Justification, and Perpetration of Intimate Partner Violence.

The present research was designed to evaluate self-determination theory as a framework for integrating factors associated with intimate partner violence (IPV) perpetration. The proposed model suggests that childhood exposure to parental violence may influence global motivational orientations which, in turn result in greater cognitive biases (overestimating the prevalence of IPV and justification of IPV) which, in turn, contribute to an individual's decision to use abusive behavior. Participants included 124 men who had engaged in abusive behavior toward an intimate partner. Results provided reasonable support for the proposed model and stronger support for a revised model suggesting that controlled orientation, rather than autonomy orientation, appears to play a stronger role in the association between childhood exposure to parental violence and cognitive biases associated with abusive behavior.

EXPOSURE TO DOMESTIC VIOLENCE AND CHILDHOOD EMOTIONAL ABUSE: Childhood Domestic Violence Exposure among a Community Sample of Adult Perpetrators: What Mediates the Connection?

The association between childhood exposure to domestic violence and later intimate partner violence (IPV) perpetration in adulthood has been well established in the literature. However, the literature examining the factors of exposure that contribute to perpetration in adulthood is fraught with mixed findings, with some studies finding a direct link between childhood domestic violence exposure and later IPV perpetration and others ruling out a link after controlling for other contextual barriers such as community violence and socioeconomic status. This study examined 124 non-treatment-seeking and unadjudicated adult male IPV perpetrators and found exposure to domestic violence in childhood contributes to the normalization of violence, which could predict future adult IPV perpetration. Practice implications are discussed, namely primary and secondary prevention of intimate partner violence.

Social norms and self-efficacy among heavy using adolescent marijuana smokers.

Adolescence is a time in which individuals are particularly likely to engage in health-risk behaviors, with marijuana being the most prevalent illicit drug used. Perceptions of others' use (i.e., norms) have previously been found to be related to increased marijuana use. Additionally, low refusal self-efficacy has been associated with increased marijuana consumption. This cross-sectional study examined the effects of normative perceptions and self-efficacy on negative marijuana outcomes for a heavy using adolescent population. A structural equation model was tested and supported such that significant indirect paths were present from descriptive norms to marijuana outcomes through self-efficacy. Implications for prevention and intervention with heavy using adolescent marijuana users are discussed.

Motives for cannabis use in high-risk adolescent users.

The present investigation examined the relationships between motives for cannabis use and negative consequences associated with cannabis use following a brief intervention. The sample consisted of 205 adolescent cannabis users (66.3% male), who were recruited in high schools and randomly assigned to a brief two-session motivational enhancement therapy (MET) or an educational feedback control (EFC). Results supported the hypothesis that using cannabis to cope with negative affect would predict the number of problems and dependence symptoms related to cannabis use, after controlling for age, gender, years and frequency of cannabis use, and internalizing and externalizing behavior problems. Significant interactions between internalizing behavior problems and the coping motive showed that using to cope was associated with a higher number of cannabis dependence symptoms among adolescents reporting lower levels internalizing behavior problems. Findings support the potential utility of conducting further research to explore the coping motive as an important indicator of problematic cannabis use.

A Telephone Intervention for Substance-Using Adult Male Perpetrators of Intimate Partner Violence.

OBJECTIVE: To preliminarily evaluate telephone-delivered motivational enhancement therapy (MET) in motivating unadjudicated and nontreatment seeking intimate partner violence (IPV) perpetrators, who also use substances, to self-refer into treatment. METHOD: 124 adult men were recruited via a multimedia marketing campaign and were randomly assigned to the intervention (MET) or comparison group following a baseline assessment. Participants in the MET condition received a personalized feedback report on their IPV and substance-use behaviors, consequences, and social norms beliefs. RESULTS: Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, increasing motivation for treatment seeking, and changing perceived norms for IPV and substance abuse (SA). CONCLUSIONS: Applications for brief MET interventions to facilitate voluntary treatment entry among substance-using IPV perpetrators are discussed.