1 understanding the consequences, associated risk and protective factors and available strategies...
TRANSCRIPT
1
Understanding the Consequences, Associated Risk and Protective
Factors and Available Strategies for Preventing Non-Medical Marijuana
UseKristen Quinlan, Ph.D.
Linda Barovier, M.S.
June 15, 2011
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Welcome & Introductions
ME
NY
PA
VT NH
NJ
MA
CTRI
DEMD
3
Learning Objectives
Training participants will be able to identify:
• Short- and long-term consequences of non-medical marijuana use
• Risk and protective factors most strongly associated with non-medical use of marijuana and progression onto consequences
• Effective strategies available to reduce non-medical marijuana use and its consequences and how to locate them
4
Background
• Kristen Quinlan, Ph.D. (CAPT NE Regional Evaluator), Renee Boothroyd, Ph.D., and Karen Friend, Ph.D. reviewed a body of literature containing over 200 articles, including numerous meta-analyses and summarized relevant findings.
• Regional Epidemiologist May Yamate reviewed numerous data sources concerning consequences and consumption patterns associated with marijuana.
• CAPT staff collaborated with National Institute on Drug Abuse epidemiologists to identify current data or research gaps.
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• Six States within the Northeast Region (mostly in New England) are among the top ten nationally for marijuana use.
• These same States rank among the lowest in perception of risk of harm for marijuana use.
• States throughout the region report erosion of norms at the societal, community, and family levels that seriously impede their efforts to prevent onset or reduce use.
Who Cares and Why?
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CA
NV
WY
MNND
SD
MT
ID
AZ
WA
IA
IL
WI
FL
ME
NM
CO
UT
OR
NE
KS
OK
MO
TX LA
AR
MS AL GA
KY
TN
SC
NC
VA
WV
OHIN
MI
AK
HI
NY
PA
VTNH
NJ
MA
CT RI
DE
MD
DC
Past-Month Marijuana Use Among Persons Aged 12 to 20
NV
WA
FL
NM
UT
OR
OK
MOKY
TNNC
WV
ME
VT
MA
WY
ND
CA
NE
TX
MN
IA
MS AL GA
IN
NY
PANJ
CT
Percentages of Persons
7.82 – 10.86
7.18 – 7.81
6.30 – 7.17
5.72 – 6.29
4.47 – 5.71
FL
SC
MT
IDNH
OHIN
MI
WI
LA
AR
SC
VACO
AZ
AK
SD
NE
KS
OK
TX
AR
TN
IL
Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
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ME
NY
PA
VT NH
NJ
MA
CTRI
DEMD
Perception of Great Risk Among Persons Aged 12 to 17
Highlights
• Adolescents who perceived great risk from smoking marijuana once a month were much less likely to have used marijuana in the past month than those who perceived moderate to no risk.
• Adults who first used marijuana before age 12 were twice as likely as adults who first used marijuana at age 18 or older to be classified as having significant mental illness in the past year
ME
VTNH
NY
CT
DEMD
PA
NJ
RI
MA
Percentages of Persons
38.70 - 44.50
36.05 – 38.69
32.59 – 36.04
29.61 – 32.58
24.08 – 29.60
Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
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Consequences of Non-Medical Marijuana Use
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Myths About Harm from Marijuana
It’s used medically
–how can it be bad for you?
It just makes people silly– like in Cheech & Chong
movies.
It doesn’t cause any serious health consequences.
It helps with
focus and
concentration.
Which have you heard?
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Marijuana Consequences
• There are both short- and long-term effects of use, including:
– Acute psychiatric symptoms or mental health effects– Cognitive impairment – Risk of injury or harm – Dependence
• More research is needed because existing research is mixed and often includes other variables that confound the findings.
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Short-Term Consequences of Marijuana Use
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Short-Term Consequences
• Acute psychiatric reactions (especially in new users)
• Driving impairment and potential for injury
• Risk of other injury
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Acute Psychiatric Reactions
• Anxiety and psychotic symptoms—most commonly in new users (Hall & Degenhart, 2009)– 22% of new users reported acute anxiety or panic
attacks immediately following use
• Acute marijuana intoxication may also be associated with impaired judgment and risky behavior (Jacobus, Bava, Cohen-Zion, Mahmood & Tappert, 2009)– Examples: Unprotected sexual intercourse, driving
while impaired or intoxicated
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Driving Impairment and Risk of Injury
• Use impacts many of the processes required for safe driving, including tracking, reaction time, and attention (as cited in MacDonald, 2003; Kalant, 2004)
• Marijuana’s effect on driving skills seems to indicate that THC concentrations of 7-10ng/ml may produce similar impairment to blood alcohol concentrations of .05% (Groternhermen et al., 2007).
• Reports on drugged driving and various federal or state efforts (Per Se laws) to reduce this consequence are available from your state liaison.
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Risk of Other Injury
• Examinations of the relationship between marijuana use and unintentional, non-traffic-related injury have generated mixed results, likely because of the many confounding variables associated with use.
• In one study of 60,000 patients, marijuana users were more likely to be admitted to the hospital due to injury from all causes than non- or former users (Gerberich, Sidney, Braun, Tekawa, Tolan, Quesenberry, 2003)
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Long-Term Consequences of Marijuana Use
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Long-Term Consequences
• Cognitive impairment• Psychosocial adjustment• Crime and violence• Mental health effects• Respiratory system effects• Birth defects• Dependence
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Cognitive Impairment - Adults
• Chronic users have shown impairments in visual search skills, which are necessary for everyday tasks like reading or safely driving a vehicle (Huestegge, Radach, & Kunert, 2009).
• Experimental studies have shown that chronic adult users experience problems with attention, learning, and memory following brief periods of abstinence (as cited in Jacobus et al., 2009).
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Cognitive Impairment - Adolescents
Although more longitudinal studies are needed to elucidate the relationship between marijuana use and adolescent brain development, experimental studies have consistently shown that heavy adolescent users experience problems with attention, learning, memory, and processing speeds, and that these deficits continue beyond one month of abstinence (as cited in Jacobus et al., 2009).
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Psychosocial Adjustment
Heavy use of marijuana prior to age 21 may lead to psychosocial difficulties such as lower levels of income, lower levels of educational attainment, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction at age 25 (Fergusson & Boden, 2008).
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Psychosocial Adjustment
Research has pointed to a dose-response relationship, which means that as marijuana use increases, so do problems in psychosocial adjustment (Fergusson & Boden, 2008).
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Crime and Violence
Generally, links between marijuana and violence are recognized, but studies attempting to make causal connections have met with mixed results (MacDonald, 2003; Macdonald et al, 2008; Pedersen & Skardhamar, 2009).
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Mental Health Effects - Schizophrenia
Longitudinal studies have clearly demonstrated that marijuana use increases the likelihood that schizophrenia will develop in at-risk individuals, with more frequent use linked to increased risk of diagnosis (as cited in Degenhardt & Hall, 2006).
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Mental Health Effects – Depression & Suicide
• There are links between depression and marijuana use, but the evidence is not as strong as that seen between marijuana use and psychosis (as cited in Moore et al., 2007).
• A link between suicide and marijuana use exists as well, but causation remains unclear (as cited in Moore et al., 2007).
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Mental Health Effects – Panic Disorder
Research has also suggested links between marijuana and panic disorder. In a large community survey, lifetime marijuana use was found to be associated with a panic disorder history, even after controlling for confounds like alcohol or nicotine dependence (Zvolensky, Johnson, Cougle, & Bonn-Miller, 2010).
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Effects on the Respiratory System - Bronchitis
• Regular, heavy smokers of marijuana report chronic cough, throat irritation, and other symptoms of chronic bronchitis (as cited in Kalant, 2004).
• Damages to the respiratory system may occur after only a short period of heavy cannabis use (Kalant, 2004; Taylor, Poulton, Moffitt, Ramankutty, & Sears, 2000).
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Effects on the Respiratory System – Cancer Related
• Marijuana smoke and tobacco smoke contain many of the same carcinogens (Tetrault, Crothers, Moore, Mehra, Concato,& Fiellin, 2007).
• Most researchers agree that chronic, heavy use of marijuana increases cancer risk (as cited in Kalant, 2004).
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Birth Defects
• Use of marijuana during pregnancy has been associated with low birth weight, mild developmental abnormalities, and future hyperactivity and impulsivity (as cited in Hall & Degenhardt, 2009).
• Epidemiological studies have been unable to find evidence that marijuana causes birth defects, largely because those using marijuana during pregnancy are also more likely to use alcohol, tobacco, and other illicit drugs and are less likely to seek or receive appropriate prenatal care (as cited in Hall & Degenhardt, 2009).
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Dependence
• It is estimated that 8.5% of the U.S. population will experience a marijuana-use disorder during their lifetime (Stinson, Ruan, Pickering, & Grant, 2006).
• Longitudinal studies have indicated that initiating use during adolescence leads to an increased risk of future dependence—it is estimated that of those who initiate use during adolescence, one in six will go on to become marijuana dependent.
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Dependence
• Daily or weekly use also strongly predicts future dependence (as cited in Hall & Degenhardt, 2009; Kalant, 2004).
• Withdrawal symptoms can include anxiety, restlessness, insomnia, appetite disruptions, stomach pain, and mood disturbance. Withdrawal symptoms can appear after only two weeks of daily use (as cited in Ashton, 2001).
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Summary
• Use of marijuana does have significant consequences.
• Areas where more research is needed include: – The extent to which marijuana use actually causes …
• Crime and violence• Levels of depression elevated enough to lead to
suicide– Actual risk of birth defects for children born to women
who otherwise had prenatal care but used marijuana
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Risk and Protective Factors for Non-Medical Marijuana Use and Progression onto Consequences
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Discussion – Experiences
How have you assessed the role
r/p factors play in your
community?
What r/p factors do think play a role in your
community?
Are any community resources are devoted to
these r/p factors?
How ready is
the commun
ity to address any of these
r/p factors?
COMMUNITY EXPERIENCES
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Conceptual Framework
DOMAINS - The information contained in this webinar is divided into the following prevention domains:
• Community/environment
• School
• Family
• Peer
• Individual
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Conceptual Framework
STRENGTH OF ASSOCIATION as demonstrated in the literature was divided into the following categories:
• Strong – consistent evidence of relationships in longitudinal or meta-analyses
• Moderate – show smaller effect size and/or sometimes drop out when accounting for other variables
• Insufficient Evidence* - inadequately studied (i.e., fewer than 1-2 peer reviewed published studies, no longitudinal analyses)
• Weak*
*Note: information on risk or protective factors with insufficient evidence or weak associations are described in the literature review but are not described here.
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How Findings Might Be Used
Direct limited resources to target those risk/protective factors with the strongest association with non-medical use (defined as those with strong or moderate associations with use)
• Inform the selection of priority risk/protective factors
• Identify related strategies with strongest impact and best fit
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Strong Associations
These factors have a clear, strong to moderate relationship to use/intention to use.
• This relationship consistently persists even after accounting for a host of other variables that have been shown to relate to use.
• The relationship has been supported by meta-analytic work and/or by several longitudinal and cross-sectional studies.
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Risk & Protective Factors with Strongest Association with Use
COMMUNITY DOMAIN
Availability or opportunities for
use
SCHOOL DOMAIN
Academic failure
FAMILY DOMAIN
Family use/history of use
Parental monitoring
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Risk & Protective Factors with Strongest Association with Use
PEER DOMAIN
Peer norms
Perceptions of peer use
INDIVIDUAL DOMAIN
Intention to use
Personal attitudes toward use
Prior use alcohol/tobacco
Anti-social behavior
Age/early initiation of use
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Community Domain
Availability/opportunities to use
• For adolescents, perceptions of availability influence both lifetime and past-month use (Fagan et al., 2007).
• Receiving marijuana offers consistently puts adolescents of any age at risk of initiating use (Tang & Orwin, 2009).
• For adolescents, marijuana use increases more rapidly in urban areas or larger cities than in rural communities (Martino, Ellickson and McCafffrey 2008).
41
Young Adult Access
• 2002 – 2009 regional data on18-25 year olds requested from Center for Behavioral Health Statistics and Quality
• Method and source of obtaining marijuana for NE Region– Bought it: 38% - 47%
• Friend: 74% - 86%
– Got it for free or shared it: 52% - 62%• Friend: 88% - 92%
• Results by individual state are too small to report
• Where (location) young adults obtained marijuana—numbers too small to report
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School Domain
Academic failure/academic achievement
• There is a clear connection between marijuana use and academic performance.
• Below average school performance is associated with the development of a marijuana use disorder nearly a decade later (Hayatbakhsh et al., 2009).
• Causation is difficult to determine, as marijuana use and academic performance are engaged in a “complex positive feedback loop” (Ryan, 2010).
43
Family Domain
Family marijuana use/family history of marijuana use
– Parental use plays a critical role in initiation of use for younger adolescents (Tang & Orwin, 2009).
– When parental use is elevated (i.e., dependence), it continues to play an important role in offspring use well past adolescence (Merikangas, 2008).
44
Family Domain
Parental monitoring/clear standards
• Longitudinal studies suggest that parental monitoring may be most important for adolescents younger than 14 (Tang & Orwin, 2009).
• Parental monitoring may continue to protect against use through the transition from high school to college – perhaps because early parental monitoring heightens opportunities for prosocial involvement (White et al., 2006).
45
Peer Domain
Peer norms & peer use
• Normative beliefs about peer use have a robust effect on substance use in general (Connell et al., 2009) and on marijuana use specifically (Stephens et al., 2009).
• Perceived peer use was a stronger predictor of use than parental attitudes or perception of risk in a population of 13-18 year old students (Chabrol et al., 2006)
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Individual Domain
• Intention to use– Longitudinal research has demonstrated a clear and
strong connection between intention to use and future use (Perez, 2010; Stephens et al., 2009).
• Attitudes toward use– Attitudes toward use have a clear and direct relationship
with use (Stephens et al., 2009). – Attitudes toward use (including perceived risk) may be
some of the strongest predictors of current and future marijuana use.
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Individual Domain
• Prior use of alcohol/tobacco
– Historically, the link between prior use of alcohol and tobacco and current and future marijuana use has been well documented (Graves et al., 2005; Gorman & Derzon, 2002; Derzon, 2010). This has also been confirmed in longitudinal studies (Tang & Orwin, 2009).
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Individual Domain
• Antisocial behavior
– Antisocial behavior (including fighting, truancy, and stealing) is associated with initiation of marijuana use (Guxens et al., 2007) and with the future development of a marijuana use disorder (Hayatbakshs et al., 2009).
• Early age of initiation
– Early age of onset is clearly and consistently linked to future marijuana use and marijuana use disorders (Creemers et al., 2009, and many others).
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Moderate Associations
These factors may show smaller effect sizes, and/or the relationship of these factors to use may drop out after accounting for other factors in some studies, but appear significant in others.
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Risk & Protective Factors Moderately Associated with Use
COMMUNITY DOMAIN
Community norms favorable to use
Community disorganization
SCHOOL DOMAIN
Use or norms supporting use in
school environment
Low school attachment or
bonding
FAMILY DOMAIN
Family management practices
Family bonding/parental
attachment
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Community Domain
• Community norms favorable to use
– There is some evidence that community-level norms affect student substance use in general (Van Horn, Hawkins, Arthur, Catalano, 2007) and marijuana use specifically (Fagan et al., 2007).
• Note: There have been some inconsistent findings. Additional scrutiny of measures employed may help clarify findings.
52
Community Domain
• Community disorganization
– Residential instability has been shown to play a part in escalating marijuana use for adolescents living in or around cities (Martino et al., 2008).
– Adults living in neighborhoods with a maladjusted neighborhood income are significantly more likely to engage in marijuana use (Galea, Ahern, Tracy, & Vlahov, 2007).
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Community Domain
• Community disorganization (continued)
– Neighborhood quality may impact marijuana use for adolescents only indirectly, through individual-level factors (i.e., poorly modulated affect and behavior) (Ridenour et. al., 2009).
– Others have found that community disorganization and high transition were not significantly related to adolescents’ lifetime or monthly marijuana use (Fagan et al., 2007).
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School Domain
• School environment
– School-level marijuana use may be an important predictor of use for older, but not younger (below 8th grade), adolescents (Mrug et al., 2010; Kuntsche et al., 2006).
– School environments where marijuana use is seen as normative impact rates of other students’ use, particularly for students with many marijuana-using friends (Kuntsche et al., 2006).
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School Domain
• Lack of attachment/Low bonding to school
– Incorporates a feeling of “belonging” to one’s school, feeling safe at ones school, and a feeling of being valued by ones teachers.
– After accounting for friend’s drug use, the direct effect of school attachment on marijuana use/intention to use is significantly reduced (Henry, 2008).
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Family Domain
• Family conflict/poor family management/parental attachment
– Poor family management may be related to marijuana use only for younger adolescents (6th grade) (Fagan et al., 2009).
– Some researchers suggest that family bonding impacts use more indirectly, through poor attachment to school and involvement with deviant peers (Henry, 2008).
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Areas Where More Research is Needed
Family Attitudes Toward Use
Role of Peer Delinquency Religiosity
Refusal Skills & Communication
Skills
Role and importance of
social competency
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Risk/Protective Factors Summary
• Some risk and protective factors are more strongly associated with progression onto consequences than others
• Communities may want to consider the relative strength of association related to the risk or protective factors as part of planning and prioritization
• Detailed analyses of risk and protective factors contained in the Literature Review
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Strategies to Prevent Non-Medical Marijuana Use and
Progression onto Consequences
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Discussion - Strategies
What experiences have you
had with targeting
resources to support strategies/intervention
s?
To what extent you tried to implement evidence based
strategies in the past?
What types of challenges have arisen with implementing
strategies in the past?
Have you had
experiences (good or bad) with
any specific
strategies?
Experiences with Non-Medical
Marijuana
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Conceptual Framework
• The information presented in this webinar is organized according to five prevention domains.
• We use three strategy categories to describe where strategies fall along a continuum of evidence.
• We will use check mark rating to depict relative strength of evidence associated with specific strategies (3 check marks= most evidence; 1 check mark= least evidence)
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How Findings Might Be Used
• Weigh the strength of strategies to guide selection of priority risk/protective factors that have available strategies that meet evidence-based criteria
• Identify related strategies with strongest impact and best fit
63
Categories of Effectiveness
• Evidence of Direct Effects on Substance Abuse – Most effective according to the literature WITH evidence of effectiveness with marijuana, specifically
• Theoretical Support – support for effects with substance use generally but NOT marijuana, specifically
• Limited Theoretical Support – evidence of effectiveness in literature but NOT for marijuana specifically and/or inconsistent findings in the literature
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Evidence of Direct Effects on Substance Use and
Marijuana
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Evidence of Direct Effects on Substance Use and Marijuana
• Gold Standard: Most effective strategies from the literature as of December 2010– Strategy is supported by at least two studies from the
peer-reviewed prevention literature, AND – At least one of these studies reported results
specifically for marijuana
• These strategies meet CSAP’s evidence-based criteria of “reported (with positive effects on the primary targeted outcomes) in peer-reviewed journals.”
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Most Effective Strategies
COMMUNITY DOMAINCommunity Norms
•Use of mass media to change norms•Use of high functioning coalitions
FAMILY DOMAINAll family domain risk or protective factors•Parental training•Improve family management and
communications•Improve social and personal competence
INDIVIDUAL DOMAIN~Attitudes towards use~Expectancies•Decrease favorable attitudes•Use of motivational enhancement therapy•Individual level programs to change norms
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Community Domain
• Risk/Protective Factor– Community norms favorable toward drug use
• Strategy/Practice/Focus– Use of mass media to increase public concern about use
and change normative perceptions
• Summary of the Supporting Literature (see literature review for specific citations)– May work to reduce marijuana use (particularly among
high sensation seekers) if message is carefully targeted with high levels of reach and frequency, and the strategy is not used in isolation.
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Community Domain (cont.)
• Risk/Protective Factor– Community norms favorable toward drug use
• Strategy/Practice/Focus– Use of community coalitions to affect change
• Summary of the Supporting Literature (see literature review for citations)– Coalitions have demonstrated effectiveness for substance
use in general and marijuana use specifically, but need to possess high levels of functionality and broad/deep sector representation (including evaluation expertise).
69
Family Domain
• Risk/Protective Factor– Virtually all family-related risk or protective factors
• Strategy/Practice/Focus– Parental training, communications and management skills,
bonding and social/personal competence
• Summary of the supporting research (see literature review for specific citations) – Family interventions must be theory based,
developmentally appropriate, and use interactive techniques to build both parents’ and adolescents’ skills
70
Individual Domain
• Risk/Protective Factor– Attitudes toward use/expectancies
• Strategy/Practice/Focus– Reduce favorable attitudes toward use
• Summary of the Supporting Literature– Global attitudes toward use may be more closely related to
marijuana use itself than perception of harm and should be targeted in prevention programming (Stephens et al., 2009 and Fearnow-Kenney et al., 2002).
71
Individual Domain (cont.)
• Risk/Protective Factor– Attitudes toward use/intention to use marijuana
• Strategy/Practice/Focus– Motivational enhancement therapy
• Summary of the Supporting Research– Motivational Enhancement Therapy uses the principles of
motivational interviewing, a therapeutic technique designed to elicit change (Walker et al., 2007), and is at least as effective as other types of treatments on marijuana use.
72
Individual Domain (cont.)
• Risk/Protective Factor– Attitudes toward use/norms that support use
• Strategy/Practice/Focus– Individual level programs to change norms
• Summary of the Supporting Research (see literature review for specific citations)– Normative beliefs directly impact both use and intentions to
use for substance use in general and marijuana use specifically, and are thought to be a staple of a good universal prevention program
– Need to be substance specific
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Theoretical Support for Reduced Substance Use
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Theoretical Support for Reduced Substance Use
• These strategies have theoretical support for reduced substance use but don’t meet the “gold standard”– May have effects on substance use in general but are
NOT specifically studied for marijuana– May be better suited for efforts to reduce multiple
substances or the more generic “illicit drugs” category
• These strategies also meet CSAP’s evidence-based criteria of “reported (with positive effects on the primary targeted outcomes) in peer reviewed journals.”
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Theoretical Support
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Theoretical Support (cont.)
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Community Domain
• Risk/Protective Factor – Neighborhood quality, community disorganization, low
neighborhood functioning, high level of transitions and mobility, low community attachment
• Strategy/Practice/Focus– Increasing community connection/enhanced socialization/
bonding
• Summary of Supporting Research – Programs that offer opportunities for positive social
involvement are generally met with increased success in substance use prevention(Hansen et al., 2010).
78
School Domain
• Risk/Protective Factor– Academic failure/academic achievement
• Strategy/Practice/Focus– Academic skill enhancement– Goal setting and achievement of goals
• Summary of Supporting Research– Programs that stress school-level change and the
attainment of academic skills may be particularly important for substance use prevention (Hansen, 2010).
79
School Domain (cont.)
• Risk/Protective Factor– School environment/school level use
• Strategy/Practice/Focus– Changing school climate
• Summary of supporting research– Training teachers to promote positive school climates and
to more effectively manage classrooms was associated with increased program effectiveness at reducing substance use (Hansen, 2010).
80
Peer Domain
• Risk/Protective Factor– Peer attitudes towards drug use/peer use/perceptions of
peer use
• Strategy/Practice/Focus– Peer leadership
• Summary of Supporting Research– Peer-led programs have shown efficacy in reducing
alcohol use and appear to be at least as effective as those led by adults
– Further study is needed
81
Individual Domain
• Risk/Protective Factor– Norms that support use
• Strategy/Practice/Focus– Media literacy
• Summary of the Supporting Research – Media literacy programs help participants become more
critical media consumers across a variety of media forms (e.g., magazines, newspapers, television, video games, the Internet) and has been effective in other health prevention efforts (e.g., alcohol use) (Austin & Johnson, 1997).
82
Individual Domain (cont.)
• R/P Factor– Attitudes toward use/perception of harm
• Strategy/Practice/Focus– Changing perception of harm
• Summary of the Supporting Research– Perception of harm impacts intention to use (Stephens et al.,
2009) – Learning about the consequences of substance use impacts
overall use BUT the content must be well-covered and the intervention must be well-crafted and combined with other skill-based components (as cited in Brounstein, Zweig, and Gardner, 1998; Hansen et al., 2010).
83
Individual Domain (cont.)
• Risk/Protective Factor– Religiosity; pro-social behavior
• Strategy/Practice/Focus– Alternative activities (including volunteer work)
• Summary of the Literature– Programs that offer alternative activities are generally more
effective than those that do not (Hansen et al., 2010) but may NOT be more effective than social and life skills training programs in preventing substance use (as cited by Carmona & Stewart, 1996). Alternative activities may be most effective for high-risk youth (as cited by Carmona and Stewart, 1996).
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Limited Theoretical Support
85
Limited Theoretical Support
• Strategies NOT specifically studied for marijuana, and/or
• Come from a discipline other than substance abuse prevention that may utilize other standards of evidence/effectiveness, and/or
• May have inconsistent findings
• These strategies may be worthy candidates for “innovation” or evaluation focused funding.
86
Limited Theoretical Support
87
Locating Specific Strategies
On Registries:
• Use parameter searches to narrow population or implementation conditions
• Use key word search to describe core of the strategy component(s) (e.g., changing norms, perception of peer use) + term “marijuana”
– It may take a few efforts to structure the key word search
• Focus on description of strategy component (especially. if key word search is NOT an option)
88
Using Registries
• An informed consumer needs to research several elements to decide whether to consider using a program or practice, such those on SAMSHA’s Nationally Recognized Evidence-Based Program or Practice (NREPP) registry http://www.nrepp.samhsa.gov/
– What are the research ratings related to reliability, validity, fidelity, missing data, confounding variables and data analysis?
– Is the training and TA on the intervention sufficient for implementation fidelity?
89
Strategies Summary
• The current state of the literature provides general guidance and direction; it doesn’t point definitively to specific strategies or interventions
• More research is needed to define: – Specific impacts of a strategy on marijuana use (as
opposed to broader “illicit drug use” category)– The impact of specific components of a strategy/
intervention
• Literature review provides much greater detail and should be used as a companion document
90
How Will You Use this Information?
Train coalition members
Mobilize stakeholders
to act
Include information on
website or newsletter
Not sure yet
91
Closing
Questions or comments?
CAPT Northeast Resource Team
c/o EDC
55 Chapel Street
Newton, MA 02458
Kristen Quinlan, Ph.D.
Linda Barovier