Cannabis dependence is controversial. What are the health and behavioral risks of becoming cannabis-dependent? What counseling approaches have been tested with adults and adolescents, and how effective are they? What are the arguments for legalization, regulation, or prohibition? Looking back and toward the future, what do we know and what do we need to learn? This state-of-the-science review sets out to answer all such questions, beginning with an historical examination and moving into diagnosis, classification, epidemiology, public health, policy, issues relating to regulation and prohibition, and evidence-based interventions.
Author(s): G. Alan Marlatt (Foreword), Roger Roffman, Robert S. Stephens (Editors)
Edition: 1
Year: 2006
Language: English
Pages: 404
Half-title......Page 2
Series-title......Page 3
Title......Page 4
Copyright......Page 5
Dedication......Page 6
Contents......Page 8
Contributors......Page 16
Acknowledgments......Page 19
Part I: The Nature of Cannabis Dependence......Page 21
The Adverse Health and Psychological Consequences of Cannabis Dependence......Page 23
Part II: Interventions with Cannabis-Dependent Adults......Page 24
The Policy Implications of Cannabis Dependence......Page 25
Part V: Conclusion......Page 26
Foreword......Page 27
Part I The Nature of Cannabis Dependence......Page 32
1 Themes in the History of Cannabis Dependence......Page 34
Diversity of Cannabis Preparations......Page 35
The Influence of Tales, Legend, Myth, and Lore......Page 36
Commissions of Inquiry Concerning Cannabis Dependence......Page 38
The 1893–1894 Indian Hemp Drugs Commission......Page 39
The 1929 Preliminary Report on Indian Hemp and Peyote issued by US Surgeon General Hugh S. Cummings......Page 40
The 1944 LaGuardia Committee Report (“The Marihuana Problem in the City of New York”)......Page 41
The 1972 Report of the National Commission on Marihuana and Drug Abuse......Page 44
Understanding Cannabis Dependence and Withdrawal by Studying Cannabinoid Neurochemistry......Page 45
Specifying Cannabis Dependence through Classi.cation and Diagnosis......Page 46
Determining the Prevalence of Cannabis Dependence through Epidemiological Research......Page 47
Addressing the Need for Cannabis Dependence Interventions......Page 48
References......Page 49
Nature of the Syndrome......Page 52
Classification......Page 53
Diagnosis......Page 55
ICD-10......Page 56
Evidence for Cannabis Dependence, Including Tolerance and Withdrawal......Page 58
Etiology, Course and Natural History......Page 61
Measurement of Cannabis Dependence......Page 62
References......Page 64
Basic Neuropharmacology of Cannabis Effects and the Existence of an Endocannabinoid System......Page 68
Overview......Page 69
Clinical Significance of Cannabis Withdrawal Symptoms......Page 70
Characterization of SR 141716A Precipitated Withdrawal in Cannabinoid-Dependent Animals......Page 72
Intrinsic Effects of SR 141716A......Page 74
Cannabinoid Self-Administration......Page 75
CB Cannabinoid Receptor Mechanisms of Action......Page 76
Neuroadaptive Changes Underlying Cannabinoid Dependence......Page 77
Interrelationships with Other Neurochemical Systems......Page 78
Cannabinoid Systems Modulate Opioid Dependence......Page 79
Opioid Systems Modulate Cannabinoid Dependence......Page 80
References......Page 81
Introduction......Page 89
Epidemiology’s Contribution to Nosological Studies of Cannabis Dependence......Page 90
How Many Are Becoming Affected, with Focus on the USA?......Page 95
Where Are We More or Less Likely to Find Cases of Cannabis Dependence?......Page 100
Variation In Relation to Geography and Geopolitical Location......Page 101
Variation In Relation to Time......Page 104
Variation In Relation to Characteristics of Individuals: Sociodemographics......Page 107
Personality Traits......Page 108
Frequent Geographic Relocation......Page 109
Diffusion Processes......Page 110
Why Do Some People Become Cannabis Dependent When Others Do Not?......Page 111
A History of Other Forms of Drug Dependence......Page 112
Primary Socialization Theory......Page 114
Religion, Religiosity, Spirituality......Page 115
Family History and Genetics......Page 116
Mechanisms: Pathogenesis, Natural History, and Consequences of Cannabis Dependence......Page 118
Early Stages......Page 119
Natural History In Relation to Clinical Features......Page 120
Consequences......Page 121
Prevention, Intervention, Amelioration, and Control......Page 124
Future Directions......Page 125
References......Page 126
Assessing Health Effects of Chronic Cannabis Use......Page 137
The Respiratory Risks of Cannabis Smoking......Page 138
Chronic Cannabis Use and Respiratory Cancers......Page 139
Chronic Cannabis Use and Brain Function......Page 141
Chronic Cannabis Use and Cognitive Impairment......Page 142
Accidental Injury and Chronic Cannabis Use......Page 145
Cardiovascular Effects......Page 146
The Educational Consequences of Adolescent Cannabis Dependence......Page 147
The Gateway Hypothesis......Page 148
Psychosis and Schizophrenia......Page 150
Conclusions......Page 152
References......Page 153
Part II Interventions with Cannabis-Dependent Adults......Page 160
6 Cognitive-Behavioral and Motivational Enhancement Treatments for Cannabis Dependence......Page 162
MET Principles and Techniques......Page 164
CBT Principles and Techniques......Page 167
Combining MET and CBT Approaches......Page 169
Group versus Individual Treatment......Page 170
Issues in the Treatment of Cannabis Dependence......Page 171
Review of Treatment-Outcome Studies......Page 173
Mechanisms of Change......Page 177
Summary and Future Directions......Page 179
References......Page 181
7 Contingency-Management Interventions for Cannabis Dependence......Page 185
Conceptual Framework......Page 186
Efficacy of CM......Page 187
Principles of Application......Page 188
Effective Implementation......Page 190
Participants......Page 192
Treatments......Page 193
Results......Page 195
Using CM to Engage Probation-Referred Marijuana Abusers in Treatment......Page 197
Cannabis Abuse among Cocaine Abusers......Page 198
Cannabis Abuse in the Methadone Clinic......Page 199
Cannabis Use in Individuals with Severe Psychiatric Illness......Page 200
Concluding Comments......Page 201
References......Page 203
8 The Marijuana Check-Up......Page 208
Marketing the MCU......Page 211
The Assessment and Personal Feedback Report......Page 214
Motivational Interviewing......Page 217
Clinical and Ethical Issues......Page 218
Did the MCU reach individuals who were using marijuana in a potentially problematic pattern and who were ambivalent about making changes?......Page 221
Did these ambivalent marijuana using individuals actually follow through and receive the intervention?......Page 222
Did the MCU reach a population of users that differed from those who voluntarily approach treatment aimed at quitting?......Page 223
Did the MET condition increase readiness to change and reduce marijuana use?......Page 226
Conclusions and Future Directions......Page 230
References......Page 231
Prevalence......Page 235
Background and Development of the Approach......Page 236
Major Principles and Techniques of GSC......Page 237
Cannabis-Specific Natural Recovery Studies......Page 239
Efficacy of Brief Treatments for Cannabis Users......Page 241
A Controlled Treatment Trial Using GSC with Cannabis Users......Page 242
Assessment......Page 243
Treatment Description for Individual and Group Treatment Formats......Page 244
Within Treatment Data, Retention Rates, and Follow-up......Page 245
GSC Treatment Outcomes......Page 246
Conclusions and Recommendations......Page 248
References......Page 249
10 Supportive–Expressive Psychotherapy for Cannabis Dependence......Page 256
Empirical Bases......Page 257
SE Psychotherapy Techniques......Page 258
Supportive Techniques......Page 259
Identifying CCRTs......Page 260
Dealing with Cognitive Deficits from Long-Term Use......Page 261
Typical Sequencing of Treatment Components......Page 262
Therapist Training......Page 263
Studies of SE Psychotherapy with Cannabis Users......Page 264
Illustrative Case Study......Page 268
Conclusion and Future Directions......Page 270
References......Page 271
Part III Interventions with Cannabis-Dependent Adolescents and Young Adults......Page 276
Introduction......Page 278
Goals and Treatment Mechanisms......Page 280
Treatment Structure and Content......Page 281
Treatment Structure and Content......Page 282
Treatment Goals and Mechanisms......Page 283
Treatment Rationale......Page 284
Goals and Treatment Mechanisms......Page 285
Background and Rationale......Page 286
Goals and Treatment Mechanisms......Page 287
Treatment Structure and Content......Page 288
Study Design......Page 289
Analytic Procedure......Page 290
Characteristics of Adolescents Presenting for Outpatient Cannabis Treatment......Page 291
Comparison with Family or other Collateral Reports......Page 292
Therapist Training and Supervision......Page 293
Overall outcomes......Page 294
Who Will Benefit from Treatment?......Page 295
Cost-Effectiveness Analysis......Page 296
Therapist’s Response to Manualized Treatment......Page 297
Conclusions and Recommendations......Page 298
References......Page 300
Epidemiology of Adolescent Cannabis Use......Page 306
Negative Consequences of Adolescent Cannabis Use......Page 307
Intervention Research with Adolescents......Page 308
Developmental Issues in Designing Interventions for Adolescents......Page 310
The Check-up: Tailoring an Intervention for Adolescent Cannabis Users......Page 311
US and Australian Studies in Progress......Page 313
Recruitment Approaches......Page 314
Characteristics of Enrolled Teens......Page 315
Outcomes......Page 317
Working with Persons Concerned About an Adolescent......Page 318
Marketing Strategies......Page 319
Coercion......Page 320
Summary and Discussion......Page 321
References......Page 323
Why Target Young Adult Marijuana Users?......Page 328
Why Evaluate a Motivational Enhancement Approach?......Page 329
MET......Page 331
MET and CM......Page 332
Therapists and Training......Page 333
Review of Study......Page 335
Conclusions and Future Directions......Page 336
Summary......Page 339
References......Page 340
Part IV Policy......Page 344
Introduction......Page 346
Does Cannabis Dependence Require a Policy Response?......Page 347
Public Health System Responses to Cannabis Dependence......Page 349
Public Health Policies for Cannabis......Page 350
Public Education about Cannabis Dependence......Page 351
Screening and Brief Intervention for Hazardous Cannabis Use......Page 352
Specialist Treatment for Cannabis Dependence......Page 353
Dealing with Comorbid Substance Disorders......Page 354
Dealing with Comorbid Mental Disorders......Page 355
Responding to Adolescent Cannabis Dependence......Page 356
Dependence and Therapeutic Cannabinoid Use......Page 357
Possible Effects of Changes in the Legal Status of Cannabis Use......Page 358
De Facto Legalization of Cannabis Use......Page 359
De Jure Legalization of Cannabis......Page 360
Conclusions......Page 361
References......Page 362
Part V Conclusion......Page 372
What is the Nature of Cannabis Dependence?......Page 374
What are the Consequences of Cannabis Dependence?......Page 379
Is the Treatment of Cannabis Dependence Effective?......Page 381
What Should the Policy on Cannabis Dependence Be?......Page 385
References......Page 386
Index......Page 388
