mtp marijuana treatment project the multi-site study of the effectiveness of brief treatment for...
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MTPMarijuana Treatment Project
The Multi-site Study of the Effectivenessof Brief Treatment for Cannabis Dependence
A Cooperative Agreement funded by
SAMHSA-CSAT
Are brief treatments more effective than deferred treatment (referral to a waiting list control group)?
Does a 9 session treatment produce better outcomes than a 2 session treatment?
Do these treatments vary in effectiveness in diverse population groups in relation to gender, ethnicity, and employment status?
Primary Research Questions
Rationale for a Multi-site Trial
Marijuana is the most commonly abused illicit substance in the U.S.
Large numbers of chronic users have developed cannabis dependence
Previous small-scale clinical trials have demonstrated the efficacy of brief and extended treatments
Further research is needed to test the robustness of effect and its generalizability to broad populations
MTP Collaborating Sites
Sponsoring Agency Substance Abuse and Mental Health Services Administration/ Center for
Substance Abuse Treatment
Coordinating Center University of Connecticut, School of Medicine, Farmington, CT
Yale University, New Haven, CT
Clinical Research Units University of Washington, Seattle, WA University of Connecticut, School of Medicine, Farmington, CT The Village, Inc., Miami, FL
Experimental Groups
Brief Treatment Group (N=146) 2 sessions of Motivational Enhancement Therapy Delivered over a 5-week period
Extended Treatment Group (N=156) 9 sessions: 2 of Motivational Enhancement Therapy,
5 of Cognitive Behavioral Therapy, and 2 of Clinical Case Management
Delivered over a 12-week period
Delayed Treatment Control Group (N=148) Treatment initiation scheduled 4 months after date of study
enrollment Choice of brief or extended treatment at end of delay period
Study Design
D e la y e dT r e a tm e nt C o ntr o l
(D T C )
F o llo w -up E v a lua t io n4 , 9 , a nd 1 5 m o nths
B r ie fT r e a tm e nt
(B T )
E xte nd e dT r e a tm e nt
(E T )
R a nd o m A ss ig nm e nt
B a se line A sse ssm e nt
E nr o llm e nta nd
Info r m e d C o nse nt
S c r e e n ing fo r E lig ib ility
R e c r ut im e nt o f 4 5 0 c hr o nic m a r ijua na use r s thr o ug ha d v e r t is ing a nd r e fe r r a l
Overview of the Cognitive Study
Purpose To evaluate the effects of short-term (4-months)
abstinence on recovery of cognitive functioning
Design Cognitive assessment battery administered to
DTC volunteers at beginning and end of treatment Treatment responders (abstainers) will be
compared with clients who continue to use MJ
Assessment Procedures & Variables
MTP Screening Questionnaire Demographics Current alcohol and drug use Lifetime dependence history Medical and psychiatric history
Structured Clinical Interview for DSM-IV DSM-IV criteria for alcohol and drug abuse and
marijuana dependence
Time Line Follow-Back Interview Weekly summary data for frequency of marijuana, alcohol and
other drug use for ‘past 90 days’ Summary of quantity of marijuana, alcohol, cigarette use for ‘past
90 days' Hazardous use of marijuana for ‘past 90 days’
Addiction Severity Index Lifetime & current alcohol and drug history Medical history Employment and support status Legal history Psychiatric history
Assessment Procedures & Variables
Assessment Procedures & Variables
Self Report Questionnaires Beck Depression Inventory Self Efficacy Questionnaire Reasons for Quitting Marijuana Problem Scale Readiness to Change Questionnaire Coping Strategies Scales Ambivalence Measure State-Trait Anxiety Inventory
Urinalysis 10 Psychoactive Substances
Inclusion/Exclusion Criteria
Meets DSM-IV Diagnosis for Cannabis Dependence
Has smoked cannabis on at least 40 of the last 90 days
Does not meet DSM-IV dependence criteria for other drugs or alcohol
Is not involved in concurrent therapy or 12-step meetings
Does not have a medical or psychiatric diagnosis that would interfere with treatment
Is within 60 miles of clinic
Is able to name one person to serve as a locator
Has legal status that allows involvement in the protocol
Is not subject to mandatory urine screens
Is at least 18 years old
Has the ability to speak and understand English
Inclusion/Exclusion Criteria, cont.
Demographic Characteristics of MTP Participants (N=450)
Characteristic
Mean Age 36
SexMaleFemale
68%32%
EthnicityEuropean AmericanAfrican AmericanHispanic AmericanOther
69%17%12%02%
Demographic Characteristics of MTP Participants, cont. (N=450)
Characteristic
Marital StatusNot MarriedMarried/Cohabiting
60%40%
Mean Years Education 14
EmployedFull TimePart TimeUnemployedStudent/Retired/Homemaker
69%14%12%05%
Mean Number Years/Present Job 5
Marijuana Use Characteristics at Baseline (N=450)
Characteristic Mean (SD)
Number of Years of RegularMarijuana Use
17.94(7.73)
Number of Years of ProblemMarijuana Use
8.92(7.64)
Number of Endorsed MarijuanaDependence Symptoms (of 7)
5.36(1.26)
Number of Endorsed Marijuana-Related Problems (of 19)
9.38(3.55)
Marijuana Dependence Symptoms Endorsed at Baseline (N=450)
Symptom
MJ taken in larger amounts or over a longerperiod than intended
77%
Persistent desire or one or more unsuccessfulattempts to cut down or control use
96%
A great deal of time spent in activities necessaryto get, use, or recover from the effects of MJ
83%
Important social, occupational or recreationalactivities given up because of MJ use
64%
Marijuana Dependence Symptoms Endorsed at Baseline, cont. (N=450)
Symptom
Continued use despite knowledge of apsychological or physical problem caused orexacerbated by MJ use
95%
The need for markedly increased amounts of MJto achieve the desired effect (tolerance)
68%
Experienced withdrawal Appetite disturbance Sleep disturbance Night sweats Headaches Irritability
78%
Marijuana Related Problems Endorsed at Baseline (N=450)
Marijuana Related Problems
Feeling bad about marijuana use 90%
To have lower energy level 86%
To procrastinate 86%
Memory loss 76%
To have lower productivity 75%
Lowered self-esteem 74%
To lack self confidence 68%
Marijuana Related Problems Endorsed at Baseline, cont. (N=450)
Marijuana Related Problems
Problems between you and your partner 58%
Financial difficulties 49%
Difficulty sleeping 46%
Problems with your family 44%
To neglect your family 38%
Medical problems 34%
Problems between you and your friends 26%
Lifetime Treatment History Reported at Baseline (N=450)
Number of TimesTreated in Lifetime
% Mean(SD)
Drug Abuse012
3 or >
82%12% 2% 4%
.31(.94)
Alcohol Abuse012
93% 4% 3%
.17(.96)
Number of Days of Marijuana Use in the Past 90 Days - Baseline (N=450)
Number of Days Smoked Marijuana in the Past 90 Days
90.0
85.0
80.0
75.0
70.0
65.0
60.0
55.0
50.0
45.0
40.0
35.0
30.0
25.0
Fre
quen
cy200
175
150
125
100
75
50
25
0
Mean = 80.0SD = 14.6
Number of Joints Smoked Per Day in the Past 90 Days - Baseline (N=450)
Number of Joints Smoked per Day in Last 90 Days
18.016.014.012.010.08.06.04.02.00.0
Fre
quen
cy200
175
150
125
100
75
50
25
0
Mean = 2.9SD = 2.3
Number of Hours High Per Day in the Past 90 Days - Baseline (N=450)
Number of Hours Felt High in the Past 90 Days
25.022.520.017.515.012.510.07.55.02.50.0
Fre
quen
cy
175
150
125
100
75
50
25
0
Mean = 6.6SD = 4.6
Number of Marijuana Dependence Symptoms Endorsed in the Past 90 Days - Baseline (N=450)
Number of Marijuana Dependence Symptoms Endorsed
7.06.05.04.03.02.0
Fre
quen
cy
160
140
120
100
80
60
40
20
0
Mean = 5.6SD = 1.3
Number of Marijuana Related Problems Endorsed on the MPS - Baseline (N=450)
Number of Marijuana-Related Problems (of 19)
20.017.515.012.510.07.55.02.50.0
Fre
quen
cy160
140
120
100
80
60
40
20
0
Mean = 9.6SD.= 3.6
Marijuana Use Within 1 Hour Prior to Driving in the Past 90 Days - Baseline (N=450)
Marijuana Used Within 1 Hour Prior to Driving
Daily/Almost Daily
Less than Daily
Weekly
Less than Weekly
Never
Per
cent
60
50
40
30
20
10
0
Marijuana Use Within One Hour Prior to Working on a Paid Job in the Past 90 Days - Baseline (N=373)
Marijuana Used Within 1 Hour Prior to Working
Daily/Almost Daily
Less than Daily
Weekly
Less than Weekly
Never
Per
cent
50
40
30
20
10
0
MTP Treatment Attendance (N=450)
Number of Sessions % Brief % Extended
0 6.8 8.31 21.2 7.12 71.9 6.43 7.14 5.15 5.16 4.57 4.58 9.69 42.3
Mean Sessions Attended(SD)
1.65(.61)
6.03(3.31)
6
MTP Follow-up Rates
Post Treatment Follow-up Rate 88%
4-Month Rates:Follow-upCollateralUrine
89%100%86%
9-Month Rates:Follow-upCollateralUrine
87%100%81%
15-Month Follow-up Rate 82%
21-Month Follow-up Rate 77%
Participants Lost to 4-month Follow-up
Variable FollowedParticipants
(N=398)
Follow-upDrop-outs
(N=52)
X2
% Treatment AssignBTDTCET
32.234.433.4
34.621.244.2
NS
% SexMaleFemale
67.832.2
73.126.9
NS
% EthnicWhiteBlackHispanic
72.112.715.2
54.99.8
35.3
12.58***
Participants Lost to 4-month Follow-up, cont.
Variable FollowedParticipants
(N=398)
Follow-upDrop-outs
(N=52)
t
Mean MarijuanaSeverity Score
9.57 9.75 NS
Proportion of days smoked(of last 90 at baseline)
88 89 NS
Education 14.2 14.3 NS
Age 36.3 34.4 NS
Treatment by Time (Baseline, Week 1- Week 16) % of days smoked marijuana per week (N=398)
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
% o
f D
ays
Sm
oked
per
Wee
k
DTCBTET
Treatment by Time (BL, Wk1, Wk5, Wk12, Wk16) % of days smoked marijuana per week (N=398)
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
BL 1st Tx End BT End ET 4-Mo F/up
% o
f D
ays
Sm
oked
per
Wee
k
DTCBTET
Intention to Treat Analysis (N=450) Treatment by Time (BL, Wk1, Wk5, Wk12, Wk16) % of days smoked marijuana per week
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
BL 1st Tx End BT End ET 4-Mo F/up
% o
f D
ays
Sm
oked
per
Wee
k
DTCBTET
Treatment by Time (Baseline, 4-Month Follow-up) SCID Dependence Symptoms (N=398)
0
1
2
3
4
5
6
7
Baseline 4-Month
SC
ID D
epen
denc
e S
ympt
oms
DTCBTET
Treatment by Time (Baseline, 4-Month Follow-up) Marijuana Problem Scale (N=398)
5
6
7
8
9
10
11
Baseline 4-Month
Num
ber
of P
robl
ems
End
orse
d
BTDTCET
Products and Anticipated Accomplishments of MTP
New findings on the clinical characteristics of chronic marijuana users
New findings on the effectiveness of brief treatments of marijuana dependence
New assessment instrumentsNew treatment interventionsTreatment manuals for therapists and primary care
practitionersEdited volume of scholarly papers
Research Implications
Development and validation of screening tests and referral procedures
Evaluation of primary care applications of MET brief intervention
Evaluation of brief and extended treatments in CD/behavioral health provider network outpatient settings in terms of
ImplementationEffectivenessCost-effectiveness