Executive Summary

Cannibus Youth Treatment - Cooperative Agreement 

Significance and Background	Consequences and Correlates of Use
Existing Treatment Options	The CYT Cooperative Agreement
Treatments Being Compared	Research Design
Timeline	Steering Committee
Map of Sites	Download this document as an Adobe file (647K)

Significance and Background. In 1996, marijuana use reached a 12-year high among adolescents ages 12-18 (ISR, 1997). Among 8th graders, 23% reported lifetime use and 11% reported use in the past month. Among high school seniors, 45% reported lifetime use and 22% reported use in the past month. Among 12-17 year olds, marijuana is now the primary substance of abuse among adolescents entering treatment and mentioned in emergency room admissions and autopsies (OAS, 1995, 1997).

Consequences and Correlates of Use. Frequent marijuana use is associated with a motivational syndrome of apathy, decreased attention span, poor judgment, diminished capacity to carry out long-term plans, social withdrawal, and a preoccupation with acquiring marijuana (Cohen, 1980, 1981; Schwartz, 1987). It is also associated with co-occurring problems including alcohol use, depression, anxiety, attention deficit/hyperactivity, conduct disorder, illegal activity, sexual activity, unwanted pregnancies as well as problems at school and home (Donovan & Jessor, 1985; Farrell et al., 1992; Hawkins et al., 1992; Jessor & Jessor, 1977; Kaminer, 1995; Musty & Kaback, 1995; Rob et al., 1990).

Existing Treatment Options. Over 79% of the admissions for primary marijuana problems are treated in outpatient ambulatory settings, split between about 69% in regular outpatient (1-9 hours a week) and 10% in intensive outpatient (9-15 hours per week). While information is still emerging about adolescent treatment effectiveness, there is considerable tension between efforts to develop short, cost-effective treatments and findings that 50% or more adolescents relapse to marijuana or alcohol use within the first three months after discharge ( Brown & Vik, 1994; Brown, Vik, & Creamer, 1989; Catalano, Hawkins, Wells, Miller, & Brewer, 1991; Kennedy & Miami, 1993). There are however, several promising options for improving treatment effectiveness which focus on motivational enhancement, relapse prevention, problem solving, coping strategies, case management, family support, family therapy, and work with the adolescent’s concerned others to change their environments (Azrin, et al., 1994; Brown, et al, 1994; Graham et al., 1996; Kadden et al., 1989; Liddle et al., 1995)

CYT Cooperative Agreement. The purposes of SAMHSA’s Center for Substance Abuse Treatment’s (CSAT) "Cannabis Youth Treatment" cooperative agreement are, (a) to test the relative effectiveness and cost-effectiveness of a variety of interventions which are targeted at reducing/eliminating marijuana use and its associated problems in adolescents, and (b) to provide validated models of these interventions for the treatment field. The study is being conducted in collaboration with staff from Chestnut Health Systems (CHS-MC) in Bloomington and Madison County, IL, Alcohol Research Center (ARC) in Farmington, CT, Operation PAR in St. Petersburg, FL, and the Child Guidance Center (CGC) in Philadelphia, PA. A list of the Steering Committee and a map of the CYT sites is also linked to this document.

Treatments Being Compared. Adolescent participants will be assigned to one of five treatment conditions:

1. MET/CBT5 - This is a five-session treatment composed of two individual sessions of Motivational Enhancement Therapy (MET) and three weekly group sessions of Cognitive-Behavioral Therapy (CBT). The MET sessions focus on factors that motivate participants who abuse substances to change, while in the CBT sessions, participants learn skills to cope with problems and meet needs in ways that do not involve turning to marijuana or alcohol. To be conducted in all four sites, this treatment is designed to be inexpensive and in line with what many parents and insurers are seeking as a basic intervention.

2. MET/CBT12 - This treatment is composed of two sessions of MET and ten weekly group sessions of CBT. This treatment is designed to provide more of the same kind of treatment as MET/CBT5 to test for dosage effects and is more in line with what many providers try to provide.

3. FSN - The Family Support Network (FSN) treatment includes the MET/CBT12 group therapy plus additional engagement-type case management, family support groups, and aftercare. To be conducted at PAR, this treatment is designed to wrap several additional low-cost services around the MCBT12 group therapy. This treatment is designed to try and address family issues and services in line with CSAT TIPS recommendations.

4. ACRA - The Adolescent Community Reinforcement Approach (ACRA) is composed of ten individual sessions with the adolescent and four sessions with caregivers. The focus is on rearranging environmental contingencies so that abstinence from marijuana is more rewarding than using behavior. ACRA will teach participants how to build on their reinforcers, how to use existing community resources that will support positive change, and how to develop a positive support system within the family.

5. MDFT - Multidimensional Family Therapy (MDFT) is a twelve-week, is composed of 12 to 15 individual family-focused sessions plus additional phone and case management contacts. Sessions are with the participant and his/her family on an individual basis with more focus on roles, other problem areas and their interaction. This treatment tries to use a more integrated approach to family issues and focuses on helping adolescents build more effective and age-appropriate interpersonal and conflict resolution skills while helping parents establish a more effective and supportive parenting style. Treatment also focuses on building appropriate social supports with peers, schools and other involved services providers.

These five treatments can also be grouped in several different ways. First, they vary by mode - with the first three being combinations of individual and group approaches and the last two being purely individual treatment approaches. Second, the MET/CBT and ACRA interventions are based on behavioral treatment approaches while the FSN and MDFT interventions are based on family treatment approaches. Third, they are expected to vary in terms of increasing resource intensity and cost.

Research Design. In each of the four sites (ARC, PAR, CHS-MC, CGC), approximately 150 Adolescents will be systematically assigned to one of the three conditions. At ARC and PAR they will be assigned to the brief MET/CBT5 or one of the two other individual/group combinations of MET/CBT12 or FSN. At the CHS and CGC adolescents will by systematically assigned to the brief MET/CBT5 treatment or one of the two individual approaches of ACRA or MDFT. All conditions are a) replicated in two or more sites, and b) manual driven with expert work groups supporting them. All participants will be assessed at intake, 3, 6 and 9 months. To validate the adolescents’ self reports, urine tests and collateral assessments will also be done at intake 3 and 6 months. To minimize attrition, interviews which cannot be done in person and the nine month interviews will be done by phone. MET/CBT5 is expected to take six weeks; MET/CBT12, MDFT and ACRA are expected to take 12 weeks; and FSN is expected to take 12 weeks but has a limited aftercare component that lasts another 12 weeks. Thus, the three-month interview is approximately the primary point of discharge and the six- and nine-month interviews occur approximately three and six months post discharge respectively. The data to be collected include the Global Appraisal of Individual Needs (GAIN; Dennis, 1998), EZ urine screens for cannabis and cocaine (Medtox, 1997), Diagnostic Interview Schedule for Children (DISC; Shaffer, Fisher, Lucas, and NIMH DISC Editorial Board, 1998) modules for anxiety, depression, conduct disorder, alcohol, marijuana and tobacco use disorders, a supplemental assessment form with several additional short scales related to motivation, coping, peers, personality and temperament and a collateral assessment form with questions paralleling the GAIN and addressing parenting. The full research design is described further elsewhere (Dennis, Diamond, Donaldson, Godley, Kaminer, Tims and CYT Steering Committee, 1998).

Timeline. The three-year study began in October 1997. Starting in the spring of 1998, adolescent’s who abuse marijuana will be assigned to one of five treatment conditions of increasing intensity and cost: The recruitment and treatment phase of the study will last 12 to 15 months. Clients will be followed up on a flow basis through the spring of 2000 and analyses will be conducted during the project on baseline needs, costs, outcomes, and cost-effectiveness. The final report is due in September, 2000.

References

Azrin, N.H., Donohue, B., Besalel, V.A., Kogan, E.S., & Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child and Adolescent Substance Abuse, 3, 1-16.

Brown, S.A., Myers, M.G., Mott, M.A., & Vik, P.W. (1994). Correlates of success following treatment for adolescent substance abuse. Applied & Preventive Psychology, 3, 61-73.

Brown, S. A., & Vik, P. W. (1994). Adolesent functioning four years after substance abuse treatment. Presented at the Annual Convention of the American Psychological Association, Los Angeles.

Brown, S. A., Vik, P. W., & Creamer, V. A. (1989). Characteristics of relapse following adolescent substance abuse treatment. Addictive Behaviors, 14, 291-300.Brown, S. A., & Vik, P. W. (1994). Adolescent functioning four years after substance abuse treatment. Presented at the Annual Convention of the American Psychological Association, Los Angeles.

Brown, S. A., Vik, P. W., & Creamer, V. A. (1989). Characteristics of relapse following adolescent substance abuse treatment. Addictive Behaviors, 14, 291-300.

Catalano, R. F., Hawkins, J. D., Wells, E. A., & Miller, J. (1991). Evaluation of the effectiveness of adolescent drug abuse treatment, assessment of risks for relapse, and promising approaches for relapse prevention. The International Journal of Addictions, 25,1085-1140.

Cohen, S. (1980). Cannabis: Impact on motivation, Part I. Drug Abuse and Alcoholism Newsletter, 9(10), Vista Hill Foundation.

Cohen, S. (1981). Cannabis: Impact on motivation, Part I. Drug Abuse and Alcoholism Newsletter, 10, Vista Hill Foundation.

Dennis, M.L. (1998). Global Appraisal of Individual Needs (GAIN) manual. Administration, Scoring and Interpretation, Bloomington, IL: Lighthouse Publications.

Dennis, M.L., Diamond, G., Donaldson, J., Godley, S., Kaminer, Y., Tims, F., and CYT Steering Committee (1998). Research Design and General Protocol for CSAT’s Cannabis Youth Treatment (CYT) Cooperative Agreement. Bloomington, IL: Chestnut Health Systems.

Donovan, J. E., & Jessor, R. (1985). Structure of problem behavior in adolescence and young adulthood. Journal of Consulting and Clinical Psychology, 53, 890-904.

Farrell, M. Danish, S. J., & Howard, C. W. (1992). Relationship between drug use and other problem behaviors in urban adolescents. Journal of Consulting and Clinical Psychology, 60, 705-712.

Graham, K., Annis, H.M., Brett, P.J., & Venesoen, P. (1996). A controlled field trial of group versus individual cognitive-behavioral training for relapse prevention. Addiction, 91, 1127-1139.

Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112(1), 64-105.Institute for Social Research (1997). Monitoring the Future Study. Ann Arbor, MI: University of Michigan.

Jessor, R., & Jessor, S. L. (1977). The social-psychological framework. In R. Jessor & S. L. Jessor (Eds.), Problem behavior & psychosocial development: A longitudinal study of youth (pp. 17-42). New York, NY: Academic Press.

Kadden, R.M., Cooney, N.L., Getter, H., & Litt, M.D. (1989). Matching alcoholics to coping skills or interactional therapies: Posttreatment results. Journal of Consulting and Clinical Psychology, 57, 698-704.

Kaminer, Y. (1995). Pharmacotherapy for adolescents with psychoactive substance use disorders. In E.Rahdert & D. Czechowicz (Eds.), Adolescent drug abuse: Clinical assessment and therapeutic interventions (pp. 291-324). NIDA Research Monograph 156. Rockville, MD: National Institute on Drug Abuse.

Kaminer, Y. (1995). Pharmacotherapy for adolescents with psychoactive substance use disorders. In E.Rahdert & D. Czechowicz (Eds.), Adolescent drug abuse: Clinical assessment and therapeutic interventions (pp. 291-324). NIDA Research Monograph 156. Rockville, MD: National Institute on Drug Abuse.

Kennedy, B. P. & Minami, M. (1993). The Beech Hill Hospital/Outward bound adolescent chemical dependency treatment program. Journal of Substance Abuse Treatment, 10, 395-406.

Liddle, H.A., Dakof, G.A., Parker, K., Barrett, K., Diamond, G.S., Garcia, R., & Palmer, R. (1995). Multidimensional family therapy of adolescent substance abuse. Manuscript submitted for publication.

Medtox Diagnostic, Inc (1997). EZ Screen Urine Testing for THC/Cocaine: Product specifications. Burlington, NC 27214 (1238 Anthony Road): Author.

Musty, R.E., & Kaback, L. (1995). Relationships between motivation and depression in chronic marijuana users. Life Sciences, 56(23/24), 2151-2158.

Office of Applies Studies (OAS; 1995). Drug abuse warning network. Annual medical examiner data 1995, (Series D-1, prepared by CSR Inc). Rockville, MD: Substance Abuse and Mental Health Services Adminstration.

Office of Applies Studies (OAS; 1997). National admissions to substance abuse treatment services. The treatment episode data set (TEDS) 1992-1995, (Advanced Report No. 12, prepared by B. Ray, R. Thoreson, L Henderson, & M. Toce). Rockville, MD: Substance Abuse and Mental Health Services Adminstration.

Rob, M., Reynolds, I., & Finlayson, P.F. (1990). Adolescent marijuana use: Risk factors and implications. Australian and New Zealand Journal of Psychiatry, 24, 47-56.

Schwartz, R.H. (1987). Marijuana: An overview. Pediatric Clinics of North America, 34, 305-317.

Shaffer, D., Fisher, P., & Lucas, C., and NIMH DISC Editorial Board, (1998). Diagnostic Interview Schedule for Children (DISC). New York: Columbia University.

Cannabis Youth Treatment Steering Committee

The Cannabis Youth Treatment cooperative agreement is managed by a steering committee that meets semi-annually and is made up of representatives from each of the grantees and the Center for Substance Abuse Treatment. The principal investigator of the coordinating center, each of the four site grantees, and the CSAT project officer each have one vote in making decisions. These voting members plus the CSAT evaluation specialist make up an Executive Committee that meets almost weekly. Below is detailed contact information for each of the members of the Executive Committee Members, followed by a roster of the full Steering Committee.

Jean Donaldson, M.A., Project Officer Center for Substance Abuse Treatment Rockwall II, Suite 740 5600 Fishers Lane Rockville, MD 20852 Phone: 301-443-6259 Fax: 301-480-3045 E-Mail: JDonalds@SAMHSA.gov	Michael Dennis, Ph.D. Principal Investigator Chestnut Health Systems, Inc. Lighthouse Institute 720 W. Chestnut St. Bloomington, IL 61701 Phone: 309-827-6026 Fax: 309-829-4661 E-Mail: Mdennis@chestnut.org Grant No: TI11320
Thomas Babor, Ph.D., Principal Investigator University of Connecticut Health Center Connecticut Youth Team/MC1320 263 Farmington Ave. Farmington, CT 06030-1410 Phone: 860-679-4666 Fax: 860-679-8090 E-Mail: Babor@nso.uchc.edu Grant No: TI11324	Susan Godley, Rh.D., Principal Investigator Chestnut Health Systems, Inc. Lighthouse Institute 720 W. Chestnut St. Bloomington, IL 61701 Phone: 309-827-6026 Fax: 309-829-4661 E-Mail: Sgodley@chestnut.org Grant No: TI11321
Guy Diamond, Ph.D., Principal Investigator Children's Hospital of Philadelphia Department of Child & Adolescent Psychiatry Kirkbride Center Project TASA, Room 233 111 North 49th St. 2nd Floor Philadelphia, PA 19104 Phone: 215-590-7550 Fax: 215-590-4710 E-Mail: GDiamond@psych.upenn.edu Grant No.: TI11323	Frank Tims, Ph.D., Principal Investigator Operation PAR, Inc. Shirley-Colletti Academy 6720 54th Ave. North St. Petersburg, FL 33709 Phone: 727-547-4508 (PAR) Fax: 727-549-6171 (PAR) Phone: 813-979-3556 (University) Fax: 813-570-5083 (University) E-Mail: FTims@aol.com Grant No:TI11317
Non-Voting Member James Herrell, Ph.D., Evaluation. Specialist Center for Substance Abuse Treatment Rockwall II, Suite 840 5600 Fishers Lane Rockville, MD 20852 Phone: 301-443-2376 Fax: 301-480-3144 E-Mail: JHerrell@SAMHSA.gov

Michael L. Dennis, Ph.D.	(Chair & CHS CC PI), Chestnut Health Systems, Inc.
Guy Diamond, Ph.D. Jean Donaldson, M.A. Susan H. Godley, Rh.D. Thomas Babor, Ph..D. Frank Tims, Ph.D.	(CGC PI), Child Guidance Center (CSAT GPO), Center for Substance Abuse Treatment (CHS MC PI), Chestnut Health Systems, Inc. (ARC PI), Alcohol Research Center (PAR PI), Operation Par, Inc.
Thomas N. Chirikos, Ph.D. James Fraser, M.S. Michael T. French, Ph.D. Frentzie M. Glover, M.Ed. Mark D. Godley, Ph.D. Nancy Hamilton James Herrell, Ph.D. Ronald Kadden, Ph.D. Richard Lennox, Ph.D. Howard Liddle, Ph.D. Kerry Anne McGeary, Ph.D. Susan Sampl, Ph.D. Christy Scott, Ph.D. Janet C. Titus, Ph.D. Joan I. Unsicker, M.S. Charles Webb, Ph.D. William White, M.A.	University of South Florida Chestnut Health Systems, Inc University of Miami Child Guidance Center Chestnut Health Systems, Inc. Operation Par, Inc. Center for Substance Abuse Treatment Alcohol Research Center Chestnut Health Systems, Inc. University of Miami University of Miami Alcohol Research Center Chestnut Health Systems, Inc Chestnut Health Systems, Inc Chestnut Health Systems, Inc Alcohol Research Center Chestnut Health Systems, Inc