Motivational enhancement therapy for adolescent marijuana users: A preliminary randomized controlled trial.

This study's aims were (a) to investigate the feasibility of a school-based motivational enhancement therapy (MET) intervention in voluntarily attracting adolescents who smoke marijuana regularly but who are not seeking formal treatment and (b) to evaluate the efficacy of the intervention in reducing marijuana use. Ninety-seven adolescents who had used marijuana at least 9 times in the past month were randomly assigned to either an immediate 2-session MET intervention or to a 3-month delay condition. Two thirds of the sample characterized themselves as in the precontemplation or contemplation stages of change regarding marijuana use. Participants' marijuana use and associated negative consequences were assessed at baseline and at a 3-month follow-up. Analyses revealed that both groups significantly reduced marijuana use at the 3-month follow-up ( p = .001); however, no between-group differences were observed. Despite the absence of a clear effect of MET, this study demonstrated that adolescents could be attracted to participate in a voluntary marijuana intervention that holds promise for reducing problematic levels of marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-related changes in reasons for using alcohol and marijuana from ages 18 to 30 in a national sample.

This study used up to seven waves of data from 32 consecutive cohorts of participants in the national longitudinal Monitoring the Future study to model changes in self-reported reasons for using alcohol and marijuana by age (18 to 30), gender, and recent substance use. The majority of stated reasons for use decreased in prevalence across young adulthood (e.g., social/recreational and coping with negative affect reasons); exceptions included age-related increases in using to relax (alcohol and marijuana), to sleep (alcohol), because it tastes good (alcohol), and to get high (marijuana). Women were more likely than men to report drinking for reasons involving distress (i.e., to get away from problems), while men were more likely than women to endorse all other reasons. Greater substance use at age 18 was associated with greater likelihood of all reasons except to experiment and to fit in. A better understanding of developmental changes in reasons for use is important for understanding normative changes in substance use behaviors and for informing intervention efforts involving underlying reasons for use. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents.

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of extended versus brief treatments for marijuana use.

Adult marijuana users (N?=?291) seeking treatment were randomly assigned to an extended 14-session Cognitive–behavioral group treatment (relapse prevention support group; RPSG), a brief 2-session individual treatment using motivational interviewing (individualized assessment and intervention; IAI), or a 4-month delayed treatment control (DTC) condition. Results indicated that marijuana use, dependence symptoms, and negative consequences were reduced significantly in relation to pretreatment levels at l-, 4-, 7-, 13-, and 16-month follow-ups. Participants in the RPSG and IAI treatments showed significantly and substantially greater improvement than DTC participants at the 4-month follow-up. There were no significant differences between RPSG and IAI outcomes at any follow-up. The relative efficacy of brief versus extended interventions for chronic marijuana-using adults is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behavior associated with HIV transmission (substance use and risky sexual behavior) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behavior. Our findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behavior occur more in tandem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Young-adult malt liquor drinkers: Prediction of alcohol problems and marijuana use.

Malt liquor (ML) is a cheap, high alcohol content beverage that is marketed to appeal to young adults. Findings from the few published studies of ML use suggest that it may be associated with excessive drinking, alcohol problems, and the use of illicit drugs. The authors conducted separate hierarchical multiple regressions to examine the role of ML use and psychosocial variables (e.g., personality, ML motives) in alcohol-related problems and marijuana use. Demographic characteristics served as controls. The sample consisted of 639 (456 men, 183 women) young adults (M = 22.9 years, SD = 4.2) who regularly (≥40 oz/week) consumed ML. ML use significantly and positively predicted alcohol problems, ML-specific problems, and marijuana use, above and beyond their associations with typical alcohol use. Marijuana was the illicit drug of choice, and 46% reported concurrent use of marijuana and ML. Those who concurrently used ML and marijuana began drinking at a younger age and reported more substance use (particularly marijuana) and more alcohol-related problems than did nonconcurrent users. These results suggest that ML use may represent a risk for alcohol problems and marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the discriminative validity of a family history of problem drinking index with a national sample of young adults

OBJECTIVE: This study used data from the National Longitudinal Survey of Youth (NLSY) to test hypotheses relevant to the discriminative validity of a trichotomous family history of problem drinking index. Early onset substance use, adolescent antisocial behaviors and lifetime alcohol and illicit drug use were used as criterion variables. METHOD: Prospective, longitudinal survey data from over 9,000 young adult subjects (ages 23-30 yrs) in the NLSY archive were used to evaluate several hypotheses regarding familial risk of alcoholism. RESULTS: General support for discriminant validity was indicated, as the high density familial risk group differed from the moderate (paternal or maternal problem drinking only) and low-risk groups with regard to a somewhat earlier onset of marijuana use, higher levels of antisocial behaviors in adolescence (especially substance-related offenses and property offenses) and higher levels of lifetime marijuana and cocaine use. The high- and moderate-risk groups differed from the low-risk group with regard to alcohol use and alcohol-disordered problems (e.g., negative consequences, dependency symptoms). CONCLUSIONS: Risk associated with high familial problem-drinking density includes an earlier onset of illicit substance use, higher rates of lifetime marijuana and cocaine use and more frequent adolescent antisocial behavior. The general pattern of the findings was robust for men and women and suggests that high-risk status may reflect both a high genetic loading and a high environmental risk loading.     

Improving quality of life in men with prostate cancer: A randomized controlled trial of group education interventions.

Men who were recently treated for prostate cancer (N=250) were randomly assigned to a control group, a group education intervention (GE), or a group education-plus-discussion intervention (GED). Both GE and GED increased prostate cancer knowledge. In the year postintervention, men in the GED condition were less bothered by sexual problems than men in the control condition, and they were more likely to remain steadily employed (93.0%) than men in the GE (75.6%) or control (72.5%) conditions. Among noncollege graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition. Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderators of the benefits of psychoeducational interventions for men with prostate cancer.

The authors examined whether 3 individual difference variables--self-esteem, self-efficacy, and depressive symptoms--interacted with psychoeducational group interventions for men with prostate cancer (n = 250) to predict general and prostate-specific quality of life. Men with nonmetastatic prostate cancer were randomly assigned to an education intervention, an education plus group discussion intervention, or usual care and followed for 12 months. Eight groups of 10 to 12 men were convened in each condition. Men who began the study with lower self-esteem, lower prostate-specific self-efficacy, and higher depressive symptoms benefited the most from the interventions. Of these 3 moderator variables, the most consistent results emerged for self-esteem. That is, the benefits of the intervention were strongest for men with low self-esteem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Treatments for Cannabis Dependence: Findings From a Randomized Multisite Trial.

This study evaluated the efficacy of 2 brief interventions for cannabis-dependent adults. A multisite randomized controlled trial compared cannabis use outcomes across 3 study conditions: (a) 2 sessions of motivational enhancement therapy (MET); (b) 9 sessions of multicomponent therapy that included MET, cognitive-behavioral therapy, and case management; and (c) a delayed treatment control (DTC) condition. Participants were 450 adult marijuana smokers with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis of cannabis dependence. Assessments were conducted at baseline, and at 4, 9, and 15 months postrandomization. The 9-session treatment reduced marijuana smoking and associated consequences significantly more than the 2-session treatment, which also reduced marijuana use relative to the DTC condition. Most differences between treatments were maintained over the follow-up period. Discussion focuses on the relative efficacy of these brief treatments and the clinical significance of the observed changes in marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of drug use in a conceptual model of intimate partner violence in men and women arrested for domestic violence.

In a previous study, alcohol problems in perpetrators and their partners contributed directly and indirectly to intimate partner violence (IPV), even after including other correlates of violence in the model (G. L. Stuart et al., 2006). The present study extends these findings by examining the role of illicit drug use. We recruited 271 men and 135 women arrested for IPV and used structural equation modeling to examine the data. Results showed that drug use, as reported by the perpetrators, was a stronger predictor of IPV than were alcohol problems in perpetrators and their partners. Arrested males' marijuana use and stimulant use (i.e., cocaine and amphetamines) were associated with perpetration of IPV, and their report of their female partners' stimulant use was associated with her violence perpetration. In arrested women, specific substances used did not predict violence perpetration beyond other model variables; however, female perpetrators' report of male partners' stimulant use predicted male psychological and physical aggression, after controlling for other variables. These results provide further evidence that drug problems by both partners may be important in the evolution of aggression. Implications for batterer intervention programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A brief, web-based personalized feedback selective intervention for college student marijuana use: A randomized clinical trial.

Despite clear need, brief web-based interventions for marijuana-using college students have not been evaluated in the literature. The current study was designed to evaluate a brief, web-based personalized feedback intervention for at-risk marijuana users transitioning to college. All entering first-year students were invited to complete a brief questionnaire. Participants meeting criteria completed a baseline assessment (N = 341) and were randomly assigned to web-based personalized feedback or assessment-only control conditions. Participants completed 3-month (95.0%) and 6-month (94.4%) follow-up assessments. Results indicated that although there was no overall intervention effect, moderator analyses found promising effects for those with a family history of drug problems and, to a smaller extent, students who were higher in contemplation of changing marijuana use at baseline. Implications of these findings for selective intervention of college marijuana use and web-based interventions in general are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluations and expectancies of alcohol and marijuana problems among college students.

Two studies examined the associations between evaluations (good-bad) and expected likelihood (likely-unlikely) of alcohol- and marijuana-related problems and hazardous consumption and problems among college students. Participants provided data on alcohol use, alcohol-related problems, and expectancies and evaluations of alcohol problems; marijuana use indices, marijuana-related problems, marijuana effect expectancies, and likelihood and evaluations of marijuana problems. Evaluations of alcohol problems were positively related to the number of binge drinking occasions and alcohol-related problems. The interaction between evaluations and expectancies was significant in predicting the number of binge drinking occasions. Expectancies demonstrated a curvilinear relationship with binge drinking and alcohol-related problems. Marijuana users evaluated marijuana-related problems as less negative and less likely to occur than did nonusers. Expectancies, but not evaluations, of negative consequences were significantly associated with marijuana use intensity. Expectancies of problems demonstrated a curvilinear relationship with marijuana-use intensity and marijuana problems. Men evaluated alcohol and marijuana problems less negatively than did women. In summary, the expected likelihood of alcohol-marijuana problems and the evaluation of such problems represent a vulnerability factor associated with increased liability for hazardous alcohol and marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax

BACKGROUND: The objective of the study was to analyze the efficiency of video-assisted thoracic surgery (VATS) for the treatment of primary (PSP) or secondary (SSP) spontaneous pneumothorax in an initial series of 99 patients. METHODS: From April 1992 to December 1995, 74 men and 25 women with a median age of 31 years (range, 17 to 85 years) were treated by VATS for persistent (n = 40) or recurrent (n = 59) PSP (n = 65) or SSP (n = 34). Postoperative parameters such as use of analgesics, length of hospital stay, and duration of drainage were compared with those of a control group of 100 patients treated by lateral thoracotomy between January 1988 and December 1991. RESULTS: Conversion to lateral thoracotomy was necessary in 6 (9.2%) patients with PSP and in 10 (29.4%) patients with SSP, in most cases because of adhesions. Postoperative complications occurred in 1 (1.7%) patient with PSP and in 6 (25%) patients with SSP. There were no operative deaths. After a median follow-up period of 29 months, 4 (4.8%) recurrences were noted. All recurrences occurred in patients with PSP and during the first year of our experience. Compared with lateral thoracotomy, treatment by VATS resulted in a significantly shorter hospital stay and drainage duration in patients with PSP but not in patients with SSP. The use of analgesics was reduced in all patients treated by VATS independent of the type of pneumothorax. CONCLUSIONS: Surgical treatment by VATS is a viable alternative to lateral thoracotomy in patients with PSP. The usefulness of VATS in patients with SSP remains to be defined.     

Effect of a monitored care unit on resource utilization in a pediatric ICU

The prevalence and predisposing conditions for primary and secondary Raynaud's phenomenon (RP) were examined in The Framingham Study based on 16 years of follow-up of a cohort of 4182 men and women. The association with atypical chest pain and migraine headache was also investigated. Over the 16 years of follow-up there were 130 men and 171 women who developed primary RP. The prevalence in women (9.6%) was somewhat higher than in men (8.1%) and 81.4% of the RP was primary. Secondary RP was equally prevalent in men (18.6%) and women (19.7%). The most common causes of secondary RP were beta-blocker use (34.2%), carpal tunnel syndrome (10.5%) and rheumatoid arthritis (7.2%). Primary RP cases differed from noncases by having lower systolic blood pressure (p < or = 0.001) and diastolic blood pressure (p < 0.0001), and more coronary disease (p = 0.009), smoking (p < or = 0.01) and higher blood sugars (p < or = 0.009). Atypical chest pain was present more often than noted previously in The Framingham Study general population survey, and was equally prevalent in primary and secondary RP and in the two sexes. Associated migraine was more prevalent in women (14.4%) than men (5.0%). Vibrating tool use with associated RP occurred in 14.6%.     

Comparing the Developmental Trajectories of Marijuana Use of African American and Caucasian Adolescents: Patterns, Antecedents, and Consequences.

Adolescent marijuana use has tripled recently, and the once-noted race gap between African American and Caucasian adolescents in marijuana use appears to have disappeared. Yet, relatively little research has examined marijuana use among African American adolescents. In this study, we examined developmental trajectories of marijuana use among Caucasian and African American adolescents to identify whether and when differences in marijuana use appear and whether the precursors and outcomes associated with these developmental trajectories differ by race. Findings indicate that both the developmental patterns and outcomes associated with marijuana use are different for African American and Caucasian adolescents. Early-onset Caucasian and mid-onset African American adolescents experienced the greatest number of negative outcomes later in life associated with their marijuana use, suggesting that groups to target for intervention may vary by race. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and vulnerability for marijuana use problems: The role of affect dysregulation.

This study examined the moderating effects of impulsivity and affect lability on relations between marijuana use frequency and use consequences. From a sample of 592 undergraduates, 300 marijuana users completed a survey that assessed marijuana problems and the hypothesized risk and vulnerability factors. Affective variables were significantly associated with increased marijuana problems above and beyond the effects of gender and lifetime use frequency. A hypothesized vulnerability mechanism, whereby impulsivity strengthened the relationship between use frequency and marijuana problems, was observed. The findings support the hypothesis that affect dysregulation enhances risk for marijuana problems among young adults who use marijuana. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for inner-city African American men.

Interventions to reduce HIV risk behavior have shown promise but have demonstrated inconsistent effects with heterosexual men. This article reports a cognitive-behavioral HIV risk reduction intervention designed for heterosexually active African American men. Men (N?=?117) recruited from a public clinic were randomly assigned to either (a) a 6-hr video-based small group motivational-skills intervention, or (b) a 6-hr video-based contact-matched HIV education comparison group. Results showed men in the motivational-skills intervention reported lower rates of unprotected vaginal intercourse and higher rates of condom use at the 3-month follow-up. However, because of increased condom use in the comparison condition, differences between groups dissipated 6 months following the intervention. These findings are among the first to demonstrate effects from a motivational-skills intervention for reducing HIV risk in men who have sex with women using a model designed to facilitate transferring prevention technology to community settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An affective-motivational model of marijuana and alcohol problems among college students.

The study examined models of marijuana (n = 309) and alcohol (n = 731) problems. Impulsivity was directly associated with both marijuana- and alcohol-related problems. Negative mood regulation expectancies were indirectly associated with marijuana problems through coping motives. Sensation seeking was indirectly associated with alcohol problems through enhancement motives. Affect lability and negative affect were indirectly associated with alcohol problems though coping motives. In both models, coping motives were directly associated with use-related problems. A multigroup analysis indicated that the association between negative affect and coping motives as well as use and problems was stronger among participants using both alcohol and marijuana relative to alcohol only. Enhancement motives were a stronger predictor of alcohol use among participants using alcohol only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Associations of substance use problems with intimate partner violence for at-risk men in long-term relationships.

Associations of substance use problems in men--defined as a man's meeting at least 1 criterion of dependence on each of a number of substances by his mid-20s--with their perpetration of intimate partner violence (IPV) were examined in an at-risk community sample of 150 men in long-term relationships from their late adolescence to their late 20s. Men who had a problem with substances other than sedatives (especially cannabis and hallucinogens) committed more IPV than did men without such problems. Most of the men who had a problem with marijuana also had an alcohol problem, which explains why alcohol was found to have only an indirect association with IPV. The failure of previous alcohol-use studies to control for co-occurrence of alcohol and marijuana problems may explain the discrepancy with conclusions from past research that alcohol problems contribute directly to the perpetration of IPV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)