Treating Marijuana Use

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• Marijuana is now the number one reason kids enter treatment—more than alcohol, cocaine, heroin, meth, ecstasy, and other drugs combined.i

• Data from the National Institute on Drug Abuse found that in 1993 marijuana comprised approximately 8% of ALL treatment admissions, but by 2009 that number had increased to 18%.ii

• Many researchers have pointed to higher potency as a possible reason for skyrocketing treatment admissions rates globally for cannabis.iii THC concentration in the Netherlands, has increased from 9% to 15% in the past 10 years. The increase in THC content is attributed to indoor cultivation and improved breeding.iv

• Treatment, sometimes with enforceable sanctions: Decades of research have shown that treatment reduces crime and saves money. But newer interventions, like drug courts or interventions that combine positive drug tests with very short sanctions (like 1-3 days in jail) can significantly reduce drug use and help people live a better life. Using the judicial system wisely by enforcing abstinence with short stints in jail is an incentive drug users sometimes need—indeed it has shown to work better than traditional, voluntary treatment alone.

• For those who have not progressed to full cannabis addiction, screening, brief interventions and referral to treatment (SBIRT) mechanisms may be appropriate. SBIRT services include an initial drug screens by general primary care physicians or counselors to identify at-risk persons, brief advice—such as a one-time intervention for short consultation and literature, brief interventions – such as one to twelve sessions of substance use intervention, and, finally, (if necessary), referral to treatment for dependent users to receive specialized services, case management, and follow-up support in the community. v

• A major method to treat cannabis addiction is through cognitive-behavioral therapy (CBT). Cognitive-behavioral therapy comprises a combination of approaches meant to increase self-control. A central element of this treatment is anticipating likely problems and helping patients develop effective coping strategies. In several studies, most people receiving a cognitive-behavioral approach maintained the gains they made in treatment throughout the following year vi vii

• Motivational approaches, such as motivational interviewing, are best used to produce rapid, internally motivated change. Interpersonal, family, and couples therapy are used to treat drug use in the system in which was developed and maintained. Including family is particularly useful for helping patients stay in treatment (this is particularly true for adolescents), and addressing the reasons for which drug use began. viii

i Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Center for Administration, Treatment Episode Data Set (TEDS). Based on administrative data reported by States to TEDS through October 15, 2012. http://wwwdasis.samhsa.gov/webt/quicklink/US10.htm

ii Substance Abuse and Mental Health Services Administration. (2009). Office of Applied Studies. Treatment Episode Data Set (TEDS): 2009 Discharges from Substance Abuse Treatment Services, DASIS.

iii See for example Compton, W., Grant, B., Colliver, J., Glantz; M., Stinson, F. (2004). Prevalence of Cannabis Use Disorders in the United States: 1991-1992 and 2001-2002 Journal of the American Medical Association.. 291:2114-2121. And Sabet, K. (2006). The (often unheard) case against cannabis leniency. In Pot Politics (Ed. M. Earleywine).Oxford University Press, pp. 325-355.

iv Tetrault, J.M., et al. Effects of cannabis smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med 167, 221-228 (2007).

v Substance Abuse and Mental Health Services Administration – Based Approaches to Drug Abuse Treatment (2011). Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare. Available at: http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf

vi See National Institute on Drug Abuse, Evidence- Based Approaches to Drug Abuse Treatment. Accessed November 2011 at http://www.nida.nih.gov/podat/Evidence2.html

vii Carroll, K.M., et al. The use of contingency management and motivational/skills- building therapy to treat young adults with cannabis dependence. Journal of Consulting and Clinical Psychology 74(5):955-966, 2006

viii Carroll, KM (2005). Recent advances in the psychotherapy of addictive disorders. Current Psychiatry Reports, 7 :329- 336.

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