Validation of a contemplation ladder in an adult substance use disorder sample.

Developing brief measures of motivation to abstain from substance use that reliably predict treatment retention and outcome is a high priority in the addiction field. This study examined the psychometric properties of a contemplation ladder designed to assess readiness to abstain from alcohol and drug use respectively, on the basis of the contemplation ladder for smoking cessation developed by Biener and Abrams (1991). Participants were 394 substance-using male and female welfare recipients referred for treatment. The combined alcohol and other drug (AOD) ladder showed discriminant validity with demographic and health characteristics, convergent validity with conceptually related treatment motivation variables, concurrent validity with baseline AOD treatment and substance use variables, and predictive validity for participation in treatment services up to 1 month later and abstinence outcomes up to 1 year later. The AOD ladder showed predictive validity for those in drug-free treatment and no treatment at baseline but not for those in methadone maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the reciprocal relation between academic motivation and substance use: effects of family relationships, self-esteem, and general deviance

The present study examined the reciprocal relation between academic motivation and cigarette, alcohol, and marijuana use across four annual assessments during adolescence. Data were obtained from 435 adolescents, 13 to 17 years of age at the first assessment, and their mothers. The results of generalized estimating equations (GEE) analysis suggested inverse reciprocal relations across time between academic motivation and both cigarette and marijuana use. Reciprocal relations between academic motivation and alcohol use were not found, possibly due to the normative use of this substance. The examination of mediational mechanisms, including general deviance, self-esteem and family relationships, suggested that the relation between marijuana use and, for younger adolescents, cigarette use and academic motivation is not direct but is indirect, mediated through the general deviance of the adolescent. Deviance, self-esteem, and, for the youngest adolescents, family relationships mediated the relation between academic motivation and subsequent marijuana use.     

Adolescent change language within a brief motivational intervention and substance use outcomes.

Homeless adolescents who used alcohol or illicit substances but were not seeking treatment (n = 54) were recorded during brief motivational interventions. Adolescent language during sessions was coded on the basis of motivational interviewing concepts (global ratings of engagement and affect, counts of commitment to change, statements about reasons for change, and statements about desire or ability to change), and ratings were tested as predictors of rates of substance use over time. Results indicate that statements about desire or ability against change, although infrequent (M = 0.61 per 5 min), were strongly and negatively predictive of changes in substance use rates (days of abstinence over the prior month) at both 1- and 3-month postbaseline assessment (ps     

Examining the effects of academic beliefs and behaviors on changes in substance use among urban adolescents.

This study examines substance use between 10th and l2th grades in a predominantly African American sample of 785 adolescents from an urban environment. Psychological distress, academic factors, and perceptions of parents and peers are used to explain l0th-grade substance use and changes in use using hierarchical linear modeling. Results indicate that low achievement and motivation, high truancy, and perceptions of peer substance use are associated with higher 10th-grade substance use. Growth curve analyses reveal that adolescents who perceive negative school attitudes among peers are more likely to increase their cigarette and marijuana use. Among high-achieving students, low motivation is a risk factor for increased cigarette use. Implications focused on enhancing motivation, reducing truancy, and understanding adolescents' perceptions of their peers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of 225 adolescents (aged 12–18 yrs) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 mo posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-mo follow-up. Peer substance use at intake and 6-mo posttreatment both predicted substance use frequency outcomes at 12-mo follow-up. Alcohol and marijuana use frequencies at 6-mo follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-mo follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-esteem and perceived control in adolescent substance use: Comparative tests in concurrent and prospective analyses.

The relationship of positive and negative dimensions of self-esteem and perceived control to substance (tobacco, alcohol, and marijuana) use was tested with a sample of 1,775 adolescents, surveyed in 8th grade and followed up 1 year later. Esteem and control were highly correlated. Concurrent multiple regression analyses with simultaneous entry indicated internal control inversely related, and self-derogation positively related, to substance use; the unique contribution for control variables was 6.4 times the unique contribution for esteem variables. In prospective analyses, only internal control was significant. Self-attitudes were less relevant in general for substance use among Black adolescents compared with Hispanic and White adolescents; self-derogation was less relevant for adolescents in single-families compared with two-parent families. Previous findings on self-esteem and substance use may be partially reflecting the effect of perceived control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug use among pregnant adolescents.

Despite concern over the co-occurrence of substance use, unplanned pregnancy, and other problem behaviors in adolescence, little information is available on substance use before, during, and after adolescent pregnancy. The authors report data from the first 100 Ss enrolled in an ongoing longitudinal study on drug use before and during pregnancy in adolescence. Unmarried pregnant adolescents, ages 17 and under, were recruited for the study from urban alternative school programs and community social and health service agencies. Findings indicate that although lifetime prevalence of drug use was relatively high and pregnant respondents appear embedded in drug prevalent environments, substance use declined voluntarily and substantially during pregnancy. Prepregnancy drug use predicted substance use during pregnancy, but neither best friends' nor boyfriends' use of alcohol or marijuana predicted subjects' use of these substances during pregnancy after taking prepregnancy use into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive function as an emerging treatment target for marijuana addiction.

Cannabis is the most widely used illicit substance in the world, and demand for effective treatment is increasing. However, abstinence rates following behavioral therapies have been modest, and there are no effective pharmacotherapies for the treatment of cannabis addiction. We propose a novel research agenda and a potential treatment strategy, based on observations that both acute and chronic exposure to cannabis are associated with dose-related cognitive impairments, most consistently in attention, working memory, verbal learning, and memory functions. These impairments are not completely reversible upon cessation of marijuana use, and moreover may interfere with the treatment of marijuana addiction. Therefore, targeting cognitive impairment associated with chronic marijuana use may be a promising novel strategy for the treatment of marijuana addiction. Preclinical studies suggest that medications enhancing the cholinergic transmission may attenuate cannabis-induced cognitive impairments, but these cognitive enhancing medications have not been examined in controlled human studies. Preliminary evidence from individuals addicted to other drugs suggests that computerized cognitive rehabilitation may also have utility to improve cognitive function in marijuana users. Future clinical studies optimally designed to measure cognitive function as well as drug use behavior would be needed to test the efficacy of these treatments for marijuana addiction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent growth trajectories of substance use among pregnant and parenting adolescents.

We examine changes among adolescent girls in substance use during pregnancy and the postpartum period. Three separate latent growth curve analyses assessed the impact of psychosocial, behavioral, and sociodemographic factors on resumption of or change in use of cigarettes, alcohol, and marijuana. The Vulnerable Populations Model for Research and Clinical Practice (Flaskerud & Winslow, 1998) provided the theoretical foundation for this study. This is a secondary analysis of data from a sample of 305 ethnic minority females (245 Latina, 60 African American), aged 13–18 years, who were pregnant at baseline and were participating in an HIV prevention study conducted in inner-city alternative schools in Los Angeles County. Data collected at 4 time points captured changes in substance use from pregnancy through the postpartum period. Baseline predictors included ethnicity/race, partner substance use, childhood abuse history, religiosity, acculturation, depressive symptoms, length of gestation at baseline, and previous substance use. Common predictors of greater resumption and/or greater level of use included greater history of use before pregnancy, partner substance use, childhood abuse, and a longer time since childbirth. African Americans were more likely to be smoking at baseline when they were still pregnant and to use marijuana postpartum; Latinas were more likely to use alcohol over the course of pregnancy and postpartum. Other variables exerted an influence on specific substances. For instance, religiosity impacted cigarette and alcohol use. Findings may assist prenatal care providers to identify and counsel pregnant adolescents at risk for perinatal substance use and to prevent resumption or initiation of substance use after childbirth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy and marijuana cessation: A construct validity analysis.

Hypotheses regarding the relationships between self-efficacy for avoiding marijuana use and theoretically related measures were examined in a sample of 161 men and 51 women who sought treatment aimed at marijuana cessation. Theoretically proposed sources of efficacy judgments showed stronger univariate and multivariate relationships with efficacy for avoiding marijuana use after treatment than before treatment. The cognitive-behavioral relapse prevention treatment resulted in marginally greater self-efficacy, compared with a nonbehavioral treatment, but the link between coping skill training and efficacy was ambiguous. Efficacy contributed incrementally to the prediction of posttreatment marijuana use beyond efficacy source variables, but it did not completely mediate the effects of those sources of efficacy judgments. Predictive validity was stronger for frequency of posttreatment marijuana use than for abstinence status. The need for better assessment of the efficacy construct and potential revisions in efficacy theory as applied to substance use are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders.

The authors compared the effectiveness of the Seeking Safety group, cognitive–behavioral treatment for substance use disorder and posttraumatic stress disorder (PTSD), to an active comparison health education group (Women’s Health Education [WHE]) within the National Institute on Drug Abuse’s Clinical Trials Network. The authors randomized 353 women to receive 12 sessions of Seeking Safety (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment 1 week and 3, 6, and 12 months posttreatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS), the PTSD Symptom Scale–Self Report (PSS-SR), and a substance use inventory (self-reported abstinence and percentage of days of use over 7 days). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively) but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline. Study results do not favor Seeking Safety over WHE as an adjunct to substance use disorder treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Driving after use of alcohol and marijuana in college students.

Driving after use of marijuana is almost as common as driving after use of alcohol in youth (P. M. O'Malley & L. D. Johnston, 2003). The authors compared college students' attitudes, normative beliefs and perceived negative consequences of driving after use of either alcohol or marijuana and tested these cognitive factors as risk factors for substance-related driving. Results indicated that youth perceived driving after marijuana use as more acceptable to peers and the negative consequences as less likely than driving after alcohol use, even after controlling for substance use. Results of zero-inflated Poisson regression analyses indicated that lower perceived dangerousness and greater perceived peer acceptance were associated with increased engagement in, and frequency of, driving after use of either substance. Lower perceived likelihood of negative consequences was associated with increased frequency for those who engage in substance-related driving. These results provide a basis for comparing how youth perceive driving after use of alcohol and marijuana, as well as similarities in the risk factors for driving after use of these substances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of telephone-based continuing care for alcohol and cocaine dependence.

A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested that self-help involvement during treatment and self-efficacy and commitment to abstinence 3 months after treatment mediated subsequent abstinence outcomes. These analyses controlled for substance use prior to the assessment of mediators. Conversely, there was no evidence that self-help beliefs or social support mediated the treatment effect. These results are consistent with a model in which treatment effects are first accounted for by changes in behavior, followed by changes in self-efficacy and in commitment to abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Abstinence Self-Efficacy and Abstinence 1 Year After Substance Use Disorder Treatment.

To better understand the relationship between abstinence self-efficacy and treatment outcomes in substance use disorder patients, experts in the field need more information about the levels of abstinence self-efficacy most predictive of treatment outcomes. Participants (N = 2,967) from 15 residential substance use disorder treatment programs were assessed at treatment entry, discharge, and 1-year follow-up. A signal detection analysis compared the ability of different measures of self-efficacy to predict 1-year abstinence and identified the optimal cutoffs for significant predictors. The maximal level of abstinence self-efficacy (i.e., 100% confident) measured at discharge was the strongest predictor of 1-year abstinence. Treatment providers should focus on obtaining high levels of abstinence self-efficacy during treatment with the goal of achieving 100% confidence in abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is it beneficial to have an alcoholics anonymous sponsor?

Alcoholics Anonymous (AA) attendance is predictive of increased abstinence for many problem drinkers and treatment referral to AA is common. Strong encouragement to acquire an AA sponsor is likewise typical, and findings about the benefits associated with social support for abstinence in AA support this practice, at least indirectly. Despite this widespread practice, however, prospective tests of the unique contribution of having an AA sponsor are lacking. This prospective study investigated the contribution of acquiring an AA sponsor using a methodologically rigorous design that isolated the specific effects of AA sponsorship. Participants were recruited from AA and outpatient treatment. Intake and follow-up assessments included questionnaires, semi-structured interviews, and urine toxicology screens. Eligibility criteria limited prior treatment and AA histories to clarify the relationship of interest while, for generalizability purposes, broad substance abuse criteria were used. Of the 253 participants, 182 (72%) provided complete data on measures central to the aims of this study. Overall reductions in alcohol, marijuana, and cocaine use were found over 12-months and lagged analyses indicated that AA attendance significantly predicted increased abstinence. During early AA affiliation but not later logistic regressions showed that having an AA sponsor predicted increased alcohol-abstinence and abstinence from marijuana and cocaine after first controlling for a host of AA-related, treatment, and motivational measures that are associated with AA exposure or are generally prognostic of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pectin methyl esterase from orange fruit: characterization and localization by in-situ hybridization and immunohistochemistry

AIMS: Information concerning the association between marijuana use and opioid dependence and its treatment is needed to determine effective clinical guidelines for addressing marijuana use among opioid abusers. SETTING AND PARTICIPANTS: Marijuana use was assessed in 107 people enrolled in treatment for opioid dependence. DESIGN AND MEASUREMENT: Univariate comparisons of marijuana users and non-users and multivariate regression analyses were performed to examine associations between marijuana use and socio-demographic, psychosocial, medical and substance-use variables. The relationship between marijuana use and treatment outcome was also explored in a subset of this sample who received treatment that included buprenorphine detoxification and behavior therapy (N = 79). FINDINGS: Sixty-six per cent of participants were current marijuana users and almost all (94%) continued to use during treatment. Users were less likely to be married than non-users, and more likely to report financial difficulties, be involved in drug dealing and engage in sharing of needles (p < 0.05). A unique effect of marijuana use on drug dealing and sharing needles was retained after statistically controlling for the influence of heroin and alcohol use and other socio-demographic variables. No significant adverse relations were observed between marijuana use and treatment outcome. CONCLUSION: Pending a more comprehensive understanding of the function and consequences of marijuana use on psychosocial functioning, it appears that progress in treatment for opioid dependence can be made without mandating that patients abstain from marijuana use.     

Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence.

Sixty individuals seeking outpatient treatment for marijuana dependence were randomly assigned to 1 of 3 treatments: motivational enhancement (M), M plus behavioral coping skills therapy (MBT), or MBT plus voucher-based incentives (MBTV). In the voucher-based incentive program, participants earned vouchers exchangeable for retail items contingent on them submitting cannabinoid-negative urine specimens. MBTV engendered significantly greater durations of documented marijuana abstinence during treatment compared with MBT and M, and a greater percentage of participants in the MBTV group compared with the MBT or M groups were abstinent at the end of treatment. No significant differences in marijuana abstinence were observed between the MBT and M groups. The positive effects of the voucher program in this study support the utility of incentive-based interventions for the treatment of substance dependence disorders including marijuana dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary results for an adaptive family treatment for drug abuse in Hispanic youth.

A small randomized trial investigated a new family-based intervention for Hispanic adolescents who met DSM–IV criteria for substance abuse disorder. The Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) is a tailored/adaptive intervention that includes a flexible treatment manual and multiple treatment components. The study used an “add on” design to isolate the effects on substance abuse, behavior problems, and parenting practices attributable to the newly developed components. Twenty-eight Hispanic adolescents and their families were randomized either to the experimental treatment or to traditional family therapy (TFT) and were assessed at baseline and 8-month follow-up. Despite the small sample, results revealed statistically significant time × treatment effects on both self-reported drug use (marijuana + cocaine), F(1, 22) = 10.59, p     

Contingency management is especially efficacious in engendering long durations of abstinence in patients with sexual abuse histories.

Exposure to sexual victimization is prevalent among persons with substance use disorders (SUDs). Contingency management (CM) treatments utilize concrete and relatively immediate positive reinforcers to retain patients in treatment and reduce substance use, and CM may have particular benefits for patients with histories of sexual victimization. Using data from three randomized trials of CM (N = 393), this study evaluated main and interactive effects of sexual abuse history and treatment condition (standard care versus CM) with respect to during treatment outcomes (retention, proportion of negative urine samples submitted, and longest duration of abstinence) and abstinence at a nine-month follow-up. Compared to patients without sexual abuse histories (N = 316), those with sexual abuse histories (N = 77) submitted a significantly higher proportion of negative samples in treatment. In CM, but not in standard care, patients with sexual abuse histories achieved significantly longer durations of abstinence during treatment than those without sexual abuse histories. Although sexual abuse history was not associated with abstinence at nine-month follow-up evaluations, longest duration of abstinence during treatment was significantly associated with this long-term outcome. Results suggest that SUD patients with sexual abuse histories may accrue particular benefits during CM treatment that are associated with long-term abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Drug testing, drug treatment, and marijuana use: A fairness perspective.

The authors conducted a random statewide telephone survey of 1,484 individuals to study the relationship between marijuana use (in terms of participants' history of marijuana use) and reactions to drug testing and to study 2 hypothetical drug-treatment policies. Job safety sensitivity was related to perceived fairness of drug testing for the participant's job, and more recent marijuana use was associated with more negative reactions. Safety sensitivity was related to perceived fairness of drug treatment. Organizations with voluntary treatment were more attractive than ones with monitored treatment. Marijuana use interacted with drug treatment policy type in predicting reactions to drug treatment. Results suggest that organizations should consider job and employee characteristics when developing a drug treatment policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)