Effectiveness of a marijuana expectancy manipulation: Piloting the balanced-placebo design for marijuana.

Although alcohol and nicotine administration studies have demonstrated that manipulating subjects’ expectancies regarding drug content affects drug response, research with marijuana has not adequately studied drug expectancy effects. The present pilot study was the first to evaluate the credibility and effect of expectancy manipulation on subjective measures and smoking patterns using a marijuana administration balanced-placebo design (BPD). In a 2 × 2 instructional set (told delta-9-tetrahydrocannabinol [THC] vs. told no THC) by drug (smoked marijuana with 2.8% THC vs. placebo) between-subjects design, the authors examined the effect of marijuana expectancy manipulation and the pharmacologic effect on affective and physiologic measures, cigarette ratings, and smoking behavior with 20 marijuana smokers (mean age = 20 years; 25% female). Large main effects of expectancy were found on ratings of cigarette potency, strength, taste, smell, and satisfaction, and observed smoking behavior. Pharmacologic effects were particularly evident for self-reported physical reactions to marijuana and cigarette potency and satisfaction ratings. This study demonstrated the feasibility of the BPD research with marijuana and yielded promising results for future studies examining the independent and combined effects of marijuana pharmacology and expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief treatment for young substance abusers: A pilot study in an addiction treatment setting.

The present study evaluated a motivationally based, 4-session outpatient intervention for young substance abusers presenting for addiction treatment. Follow-up interviews were conducted 6 months after assessment on (a) clients who sought additional help (n = 22) and (b) clients who did not seek additional help (n = 28). Results indicated that (a) participating in an assessment and brief intervention was associated with reduced use and consequences and increased confidence in high-risk situations up to 6 months after entry into the program, and (b) clients who participated in additional treatment showed less of a decrease in substance-related consequences. These findings suggest that brief interventions can serve as either a stand-alone intervention for individuals who need short-term assistance or a first-step intervention for those with more specialized or long-term needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change.

Serious neuropsychological impairments are seen in a minority of addiction treatment clients, and, theoretically, these impairments should undermine behavioral changes targeted by treatment; however, little evidence supports a direct influence of impairment on treatment response. To address this paradox, the authors used structural equation modeling and Project MATCH data (N=1,726) to examine direct, mediated, and moderated paths between cognitive impairment, therapeutic processes, and treatment outcome. Mediated relations were found, wherein impairment led to less treatment compliance, lower self-efficacy, and greater Alcoholics Anonymous Involvement, which, in turn, more proximally predicted drinking. Impairment further moderated the effect of self-efficacy, making it a poor predictor of drinking outcomes in impaired clients, thereby suggesting that impaired and unimpaired clients traverse different pathways to addiction recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: A further test of the teen marijuana check-up.

Cannabis use adversely affects adolescents and interventions that are attractive to adolescents are needed. This trial compared the effects of a brief motivational intervention for cannabis use with a brief educational feedback control and a no-assessment control. Participants were randomized into one of three treatment conditions: Motivational Enhancement Therapy (MET), Educational Feedback Control (EFC), or Delayed Feedback Control (DFC). Those who were assigned to MET and EFC were administered a computerized baseline assessment immediately following randomization and completed assessments at the 3- and 12-month follow-up periods. Participants in the DFC condition were not assessed until the 3-month follow-up. Following the completion of treatment sessions, all participants were offered up to four optional individual treatment sessions aimed at cessation of cannabis use. The research was conducted in high schools in Seattle, Washington. The participant s included 310 self-referred adolescents who smoked cannabis regularly. The main outcome measures included days of cannabis use, associated negative consequences, and engagement in additional treatment. At the 3-month follow-up, participants in both the MET and EFC conditions reported significantly fewer days of cannabis use and negative consequences compared to those in the DFC. The frequency of cannabis use was less in MET relative to EFC at 3 months, but it did not translate to differences in negative consequences. Reductions in use and problems were sustained at 12 months, but there were no differences between MET and EFC interventions. Engagement in additional treatment was minimal and did not differ by condition. Brief interventions can attract adolescent cannabis users and have positive impacts on them, but the mechanisms of the effects are yet to be identified. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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)     

Coping and self-efficacy in marijuana treatment: Results from the Marijuana Treatment Project.

This study examined whether a coping-skills-based treatment for marijuana dependence operated by encouraging the use of coping skills or via other mechanisms. Participants were 450 men and women treated in the multisite Marijuana Treatment Project who were randomly assigned to motivational enhancement therapy plus cognitive-behavioral (MET-CB) treatment, motivational enhancement therapy (MET), or a delayed treatment control group. Marijuana use and coping skills were measured at baseline and at follow-ups through 15 months. Results showed that marijuana outcomes were predicted by treatment type and by coping skills use, but that the coping-skills-oriented MET-CB treatment did not result in greater use of coping skills than did the MET treatment. The results suggest that mechanisms of coping skills treatment may need to be reconceptualized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cannabis use among military veterans after residential treatment for posttraumatic stress disorder.

The present investigation prospectively evaluated whether treatment changes in PTSD symptom severity, among military Veterans in residential PTSD treatment, were related to cannabis use 4 months after discharge from residential rehabilitation. The sample was comprised of 432 male military Veteran patients (Mage = 51.06 years, SD = 4.17), who had a primary diagnosis of PTSD and were admitted to a VA residential rehabilitation program for PTSD. Results demonstrated that lower levels of change in PCL-M scores between treatment intake and discharge were significantly predictive of greater frequency of cannabis use at 4-month follow-up (p     

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)     

Cognitive estimation impairment in Alzheimer disease and mild cognitive impairment.

Intact executive functioning is believed to be required for performance on tasks requiring cognitive estimations. This study used a revised version of a cognitive estimations test (CET) to investigate whether patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) were impaired on the CET compared with normal elderly controls (NECs). Neuropsychological tests were administered to determine the relationship between CET performance and other cognitive domains. AD patients displayed impaired CET performance when compared with NECs but MCI patients did not. Negative correlations between tests of working memory (WM) and semantic memory and the CET were found in NECs and AD patients, indicating that these cognitive domains were important for CET performance. Regression analysis suggests that AD patients were unable to maintain semantic information in WM to perform the task. The authors conclude that AD patients display deficits in working memory, semantic memory, and executive function, which are required for adequate CET performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the Special Section on Health and Cognitive Function.

Numerous factors related to health and diseases have been studied in relation to cognitive function. It has been shown that across the life span, systemic medical diseases can negatively impact cognitive function. Factors that influence the development of medical diseases, such as poor health habits, biological risk factors, hormones, genetic factors, exposure to environmental toxins, and certain treatments for disease, can also have an adverse effect on cognitive function. Conversely, factors such as high levels of education, good health habits, and some treatments for disease can be protective. Included in this special section are 6 empirical articles that examine the relation of health or disease to cognitive function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment for depression in smoking cessation.

Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive–behavioral smoking cessation treatment (ST; n?=?93) or standard, cognitive–behavioral smoking cessation treatment (ST) plus cognitive–behavioral treatment for depression (CBT-D; n?=?86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking (≥25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios?=?2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescents' thoughts about abstinence curb the return of marijuana use during and after treatment.

Despite evidence showing that readiness to change substance use predicts reductions in substance use among treated adolescents, there is little research on changes in thoughts about abstinence and marijuana use during and after treatment. The current study tested whether time-varying changes in adolescents’ motivation to abstain and perceived difficulty to abstain from marijuana use hinder the return of regular marijuana use during and after treatment. Monthly data on thoughts about abstinence, marijuana use, and treatment utilization were collected over 6 months from 142 adolescents recruited from intensive outpatient substance use treatment. Results indicated that higher motivation to abstain (but not perceived difficulty) predicted fewer days of marijuana use, over and above the individual’s average trajectory of marijuana use, the initial severity of marijuana involvement, and the effects of treatment utilization. Moreover, past-month marijuana use influenced both motivation to abstain and perceived difficulty to abstain. Findings highlight the importance of abstinence-related cognitions as a target of intervention during and after treatment and underscore the importance of considering recovery from substance use disorders as a dynamic process of change over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical trial of abstinence-based vouchers and cognitive-behavioral therapy for cannabis dependence.

Ninety cannabis-dependent adults seeking treatment were randomly assigned to receive cognitive-behavioral therapy, abstinence-based voucher incentives, or their combination. Treatment duration was 14 weeks, and outcomes were assessed for 12 months posttreatment. Findings suggest that (a) abstinence-based vouchers were effective for engendering extended periods of continuous marijuana abstinence during treatment, (b) cognitive-behavioral therapy did not add to this during-treatment effect, and (c) cognitive-behavioral therapy enhanced the posttreatment maintenance of the initial positive effect of vouchers on abstinence. This study extends the literature on cannabis dependence, indicating that a program of abstinence-based vouchers is a potent treatment option. Discussion focuses on the strengths of each intervention, the clinical significance of the findings, and the need to continue efforts toward development of effective interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognitive impairment associated with alcohol use disorders: Implications for treatment.

Between 50% and 80% of individuals with alcohol use disorders experience mild to severe neurocognitive impairment. There is a strong clinical rationale that neurocognitive impairment is an important source of individual difference affecting many aspects of addiction treatment, but empirical tests of the direct influence of impairment on treatment outcome have yielded weak and inconsistent results. The authors address the schism between applied-theoretical perspectives and research evidence by suggesting alternative conceptual models of the relationship between neurocognitive impairment and addiction treatment outcome. Methods to promote neurocognitive recovery and ways in which addiction treatments may be modified to improve psychosocial adaptation are suggested. Specific suggestions for future research that may help clarify the complex relations between neurocognitive impairment and addiction treatment are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cholinesterase inhibitors: Current pharmacological treatments for Alzheimer's disease.

Examines the use of cholinesterase inhibitors (ChEIs) for the pharmacological treatment of Alzheimer's disease (AD). Topics discussed include: (1) the pathophysiology of AD and the cholingergic hypothesis, (2) the development of the cholinesterase inhibitors, and (3) current issues and future directions for research and use of ChEIs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive processing therapy for posttraumatic stress disorder in a residential treatment setting.

Cognitive processing therapy (CPT) is an exposure-based protocol designed to reduce posttraumatic stress disorder (PTSD) symptoms and challenge faulty beliefs and interpretations that prevent trauma survivors from coming to terms with their traumatic experiences. This article provides a brief summary of this treatment and the related literature and describes how the CPT protocol was modified to implement this treatment in this study's setting. Also provided is a discussion of various institutional and intrapatient barriers that existed before the introduction of CPT and how these difficulties were ultimately resolved. Patients' responses to treatment, as indicated by both qualitative and quantitative data, are also reviewed. A total of 18 patients participated and completed treatment with CPT (50% Caucasian, 22.2% African American, 16.7% biracial, 5.6% Native American, and 5.6% Hispanic). Overall, the women participating in the protocol benefited greatly, and 15 of the 18 women had a statistically significant reduction in scores measuring PTSD symptoms. The article concludes with recommendations to other programs and providers interested in providing CPT to similar treatment populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of the cognitive test for the blind as an assessment of intellectual functioning.

Objective: To investigate the concurrent validity of the Cognitive Test for the Blind (CTB) as an intellectual assessment for the visually impaired or blind (VI/B) population. The ecological validity of the CTB was also examined. Design: Correlational analyses. Participants: Two hundred ninety-two persons with visual impairment or blindness. Main Outcome Measure: The CTB Verbal section, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Verbal section, and the Survey of Functional Adaptive Behavior. Results: A correlation of .72 was obtained between the CTB and the WAIS-R. The correlations of the CTB Total and WAIS-R Verbal sections with overall adaptive functioning were .50 and .47, respectively. Conclusions: The CTB offers valid assessment of intellectual functioning for persons with visual impairment or blindness, as well as other useful information that may aid in the treatment planning process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overlap of clusters of psychiatric symptoms among clients of a comprehensive addiction treatment service.

This article describes the prevalence and overlap of psychiatric symptoms among 2,784 clients of the outpatient programs at a comprehensive addictions treatment facility. The psychiatric symptoms were assessed by a computer-based questionnaire, and the analysis focused on the overlap of symptom clusters (multimorbidity) and their relation to selected intake variables known to be predictors of treatment outcome. Of all clients, 27.4% scored positive for 1, 18.9% for 2, and 22.3% for 3 or more clusters, the most frequent being depression, anxiety, and history of conduct disorder. Multimorbidity was significantly correlated with female gender, unemployment, less social support, cannabis problems, fewer legal problems, and increased treatment engagement. Clients with more substance use disorders presented more psychiatric symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrative Cognitive Therapy for Depression: A Preliminary Investigation.

This study is a preliminary investigation of an integrative treatment aimed at improving the efficacy of cognitive therapy (CT) for depression. The development of the treatment protocol was based on process findings, which suggested that strategies used in CT to resolve alliance ruptures may actually exacerbate problems in the therapeutic relationship. The protocol integrates, within the traditional CT treatment manual, procedures to repair alliance ruptures that are derived from or consistent with humanistic and interpersonal therapies. Although conducted by inexperienced therapists, the integrative treatment led to greater improvement than a waiting-list condition. The results also compare favorably to previous findings for CT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual dopamine/serotonin releasers: Potential treatment agents for stimulant addiction.

"Agonist therapy" for cocaine and methamphetamine addiction involves administration of stimulant-like medications (e.g., monoamine releasers) to reduce withdrawal symptoms and prevent relapse. A significant problem with this strategy is that many candidate medications possess abuse liability because of activation of mesolimbic dopamine (DA) neurons in the brain. One way to reduce DA-mediated abuse liability of candidate drugs is to add in serotonin (5-HT) releasing properties, since substantial evidence shows that 5-HT neurons provide an inhibitory influence over mesolimbic DA neurons. This article addresses several key issues related to the development of dual DA/5-HT releasers for the treatment of substance use disorders. First, the authors briefly summarize the evidence supporting a dual deficit in DA and 5-HT function during withdrawal from chronic cocaine or alcohol abuse. Second, the authors discuss data demonstrating that 5HT release can dampen DA-mediated stimulant effects, and the "antistimulant" role of 5-HT2C receptors is considered. Next, the mechanisms underlying potential adverse effects of 5-HT releasers are described. Finally, the authors discuss recently published data with PAL-287, a novel nonamphetamine DA/5-HT releasing agent that suppresses cocaine self-administration but lacks positive reinforcing properties. It is concluded that DA/5-HT releasers could be useful therapeutic adjuncts for the treatment of cocaine and alcohol addictions, as well as for obesity, attention-deficit disorder, and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)