Cannabis Dependence: Its Nature, Consequences and Treatment

, by Edited by Roger Roffman , Robert S. Stephens , Foreword by G. Alan Marlatt

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ISBN: 9780521814478 | 0521814472
Cover: Hardcover
Copyright: 3/20/2006

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Cannabis dependence is controversial. Does it occur or is it a myth put forth by those who oppose legalization? What are the signs of cannabis dependence? How many people are affected? 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 those 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.

List of Contributors

Acknowledgments

xviii

Executive Summary

Foreword

xxvi

Part I: The Nature of Cannabis Dependence

1 Themes in the History of Cannabis Dependence

ROGER A. ROFFMAN, SAM SCHWARTZ AND ROBERT S. STEPHENS

Diversity of Cannabis Preparations

(1)

The Influence of Tales, Legend, Myth, and Lore

(2)

Memoirs and Writings of Key Literary Figures and Artists

(1)

Commissions of Inquiry Concerning Cannabis Dependence

(7)

The 1925 Panama Canal Zone Report

(1)

The 1929 Preliminary Report on Indian Hemp and Peyote issued by US Surgeon General Hugh S. Cummings

(1)

The 1944 LaGuardia Committee Report ("The Marihuana Problem in the City of New York")

(3)

The 1972 Report of the National Commission on Marihuana and Drug Abuse

(1)

Understanding Cannabis Dependence and Withdrawal by Studying Cannabinoid Neurochemistry

(1)

Specifying Cannabis Dependence through Classification and Diagnosis

(1)

Determining the Prevalence of Cannabis Dependence through Epidemiological Research

(1)

Addressing the Need for Cannabis Dependence Interventions

(1)

A Closing Note

(1)

References

(3)

2 The Diagnosis of Cannabis Dependence

THOMAS F. BABOR

Introduction

(1)

Nature of the Syndrome

(1)

Classification

(2)

Diagnosis

(3)

ICD-10

(2)

DSM-IV

(1)

Evidence for Cannabis Dependence, Including Tolerance and Withdrawal

(3)

Etiology, Course and Natural History

(1)

Measurement of Cannabis Dependence

(2)

Conclusion

(1)

References

(4)

3 Understanding the Pharmacology and Physiology of Cannabis Dependence

ARON H. LICHTMAN AND BILLY R. MARTIN

Basic Neuropharmacology of Cannabis Effects and the Existence of an Endocannabinoid System

(1)

Characterization of Cannabis Dependence

(7)

Overview

(1)

Clinical Significance of Cannabis Withdrawal Symptoms

(2)

Abrupt Cannabinoid Withdrawal in Laboratory Animals

(1)

Precipitated Cannabinoid Withdrawal in Cannabinoid-Dependent Animals

(3)

Cannabinoid Self-Administration

(1)

Neurochemical Mechanisms Underlying Cannabis Dependence

(3)

CB1 Cannabinoid Receptor Mechanisms of Action

(1)

Neuroadaptive Changes Underlying Cannabinoid Dependence

(1)

Interrelationships with Other Neurochemical Systems

(1)

Reciprocal Roles of the Cannabinoid and Opioid Systems in Dependence

(2)

Cannabinoid Systems Modulate Opioid Dependence

(1)

Opioid Systems Modulate Cannabinoid Dependence

(1)

Implications of Animal Studies for Understanding Human Dependence

(1)

References

(8)

4 The Epidemiology of Cannabis Dependence

JAMES C. ANTHONY

Introduction

(1)

Epidemiology's Contribution to Nosological Studies of Cannabis Dependence

(5)

How Many Are Becoming Affected, with Focus on the USA?

(5)

Where Are We More or Less Likely to Find Cases of Cannabis Dependence?

(11)

Variation In Relation to Geography and Geopolitical Location

(3)

Variation In Relation to Time

(3)

Variation In Relation to Characteristics of Individuals: Sociodemographics

(1)

Variation In Relation to Other Characteristics of Individuals

(2)

Variation In Relation to Socially Shared Characteristics of Individuals or Environments

(1)

Why Do Some People Become Cannabis Dependent When Others Do Not?

(7)

A History of Other Forms of Drug Dependence

(2)

ASP Disorder

(1)

Primary Socialization Theory

(1)

Religion, Religiosity, Spirituality

(1)

Parents and Parenting

(1)

Family History and Genetics

(2)

Directions for New Research

(1)

Mechanisms: Pathogenesis, Natural History, and Consequences of Cannabis Dependence

(6)

Early Stages

(1)

Natural History In Relation to Clinical Features

(1)

Consequences

(3)

Fetal Exposure

(1)

Prevention, Intervention, Amelioration, and Control

(1)

Future Directions

(1)

References

(11)

5 The Adverse Health and Psychological Consequences of Cannabis Dependence

WAYNE HALL AND NADIA SOLOWIJ

Assessing Health Effects of Chronic Cannabis Use

106

(1)

The Respiratory Risks of Cannabis Smoking

107

(3)

Chronic Cannabis Use and Respiratory Cancers

108

(2)

Chronic Cannabis Use and Brain Function

110

(1)

Chronic Cannabis Use and Cognitive Impairment

111

(3)

Accidental Injury and Chronic Cannabis Use

114

(1)

Cardiovascular Effects

115

(1)

Special Populations of Cannabis-Dependent Persons

116

(5)

The Educational Consequences of Adolescent Cannabis Dependence

116

(1)

The Gateway Hypothesis

117

(2)

Psychosis and Schizophrenia

119

(2)

Conclusions

121

(1)

References

122

(11)

Part II: Interventions with Cannabis-Dependent Adults

6 Cognitive-Behavioral and Motivational Enhancement Treatments for Cannabis Dependence

ROBERT S. STEPHENS, ROGER A. ROFFMAN, JAN COPELAND AND WENDY SWIFT

MET Principles and Techniques

133

(3)

CBT Principles and Techniques

136

(2)

Combining MET and CBT Approaches

138

(1)

Group versus Individual Treatment

139

(1)

Issues in the Treatment of Cannabis Dependence

140

(2)

Review of Treatment-Outcome Studies

142

(4)

Mechanisms of Change

146

(2)

Summary and Future Directions

148

(2)

References

150

(5)

7 Contingency-Management Interventions for Cannabis Dependence

ALAN J. BUDNEY, BRENT A. MOORE, STACEY C. SIGMON AND STEPHEN T. HIGGINS

Conceptual Framework

155

(1)

Basic Principles

156

(1)

Efficacy of CM

156

(1)

Principles of Application

157

(2)

Effective Implementation

159

(2)

Initial Treatment Study for a CM Voucher Program for Cannabis Dependence

161

(5)

Study Design

161

(1)

Participants

161

(1)

Treatments

162

(2)

Results

164

(2)

Using CM to Engage Probation-Referred Marijuana Abusers in Treatment

166

(1)

Cannabis as a Secondary Drug of Abuse

167

(2)

Cannabis Abuse among Cocaine Abusers

167

(1)

Cannabis Abuse in the Methadone Clinic

168

(1)

Cannabis Use in Individuals with Severe Psychiatric Illness

169

(1)

CM in the Treatment of Adolescent Marijuana Abusers

170

(1)

Concluding Comments

170

(2)

References

172

(8)

8 The Marijuana Check-Up

ROBERT S. STEPHENS AND ROGER A. ROFFMAN

Implementing a MCU

180

(6)

Marketing the MCU

180

(3)

The Assessment and Personal Feedback Report

183

(3)

Motivational Interviewing

186

(1)

Clinical and Ethical Issues

187

(3)

A Controlled Trial of the MCU

190

(9)

Conclusions and Future Directions

199

(1)

References

200

(4)

9 Guided Self-Change: A Brief Motivational Intervention for Cannabis Abuse

LINDA C. SOBELL, MARK B. SOBELL, ERIC F. WAGNER, SANGEETA AGRAWAL AND TIMOTHY P. ELLINGSTAD

Prevalence

204

(1)

GSC Treatment

205

(6)

Background and Development of the Approach

205

(1)

Major Principles and Techniques of GSC

206

(2)

Applying GSC Treatment to Cannabis Users

208

(3)

A Controlled Treatment Trial Using GSC with Cannabis Users

211

(6)

Participants

212

(1)

Assessment

212

(1)

Treatment Description for Individual and Group Treatment Formats

213

(1)

Within Treatment Data, Retention Rates, and Follow-up

214

(1)

Cannabis Abuser Characteristics at Pre-treatment

215

(1)

GSC Treatment Outcomes

215

(2)

Conclusions and Recommendations

217

(1)

References

218

(8)

10 Supportive–Expressive Psychotherapy for Cannabis Dependence

BRIN F.S. GRENYER AND NADIA SOLOWIJ

Empirical Bases

226

(1)

SE Psychotherapy Techniques

227

(6)

Supportive Techniques

228

(1)

Expressive Techniques

229

(1)

Identifying CCRTs

229

(1)

Dealing with Cognitive Deficits from Long-Term Use

230

(1)

Typical Sequencing of Treatment Components

231

(1)

Therapist Training

232

(1)

Studies of SE Psychotherapy with Cannabis Users

233

(4)

Illustrative Case Study

237

(2)

Conclusion and Future Directions

239

(1)

References

240

(7)

Part III: Interventions with Cannabis-Dependent Adolescents and Young Adults

11 The Cannabis Youth Treatment Study: The Treatment Models and Preliminary Findings

GUY DIAMOND, JODI LECKRONE, MICHAEL L. DENNIS AND SUSAN H. GODLEY

Introduction

247

(2)

Description of the Interventions

249

(9)

MET/CBT5 (Sampl & Kadden, 2001)

249

(2)

MET/CBT12 (Webb et al., 2002b)

251

(1)

FSN plus MET/CBT12 (Hamilton et al., 2001)

252

(1)

ACRA (Godley et al., 2001a)

253

(2)

MDFT (Liddle, 2002)

255

(3)

Overview of CYT Study

258

(7)

Study Design

258

(1)

Analytic Procedure

259

(1)

Participants

260

(2)

Clinical Procedures

262

(1)

Results

263

(2)

Cost-Effectiveness Analysis

265

(1)

Therapist's Response to Manualized Treatment

266

(1)

Conclusions and Recommendations

267

(2)

References

269

(6)

12 The Teen Cannabis Check-up: Exploring Strategies for Reaching Young Cannabis Users

JAMES P. BERGHUIS, WENDY SWIFT, ROGER A. ROFFMAN, ROBERT S. STEPHENS AND JAN COPELAND

Epidemiology of Adolescent Cannabis Use

275

(1)

Negative Consequences of Adolescent Cannabis Use

276

(3)

Intervention Research with Adolescents

277

(2)

Developmental Issues in Designing Interventions for Adolescents

279

(1)

The Check-up: Tailoring an Intervention for Adolescent Cannabis Users

280

(2)

US and Australian Studies in Progress

282

(5)

Recruitment Approaches

283

(1)

Characteristics of Enrolled Teens

284

(2)

Outcomes

286

(1)

Perceptions of the Intervention

287

(1)

Issues in Implementing a Check-up Intervention

287

(3)

Working with Persons Concerned About an Adolescent

287

(1)

Marketing Strategies

288

(1)

Confidentiality and Consent

289

(1)

Coercion

289

(1)

Counselor Training and Quality Assurance

290

(1)

Summary and Discussion

290

(2)

References

292

(5)

13 Engaging Young Probation-Referred Marijuana-Abusing Individuals in Treatment

KATHLEEN M. CARROLL, RAJITA SINHA AND CAROLINE EASTON

Why Target Young Adult Marijuana Users?

297

(1)

Why Target Marijuana Users Referred by the Legal System?

298

(1)

Why Evaluate a Motivational Enhancement Approach?

298

(2)

Why Evaluate a Contingency Management Approach?

300

(1)

Description of the Interventions

300

(4)

MET

300

(1)

MET and CM

301

(1)

Therapists and Training

302

(2)

Review of Study

304

(4)

Results

305

(1)

Conclusions and Future Directions

305

(3)

Summary

308

(1)

References

309

(6)

Part IV: Policy

14 The Policy Implications of Cannabis Dependence

WAYNE HALL AND WENDY SWIFT

Introduction

315

(1)

Key Features of the Epidemiology of Cannabis Use and Dependence

316

(1)

Does Cannabis Dependence Require a Policy Response?

316

(2)

Public Health System Responses to Cannabis Dependence

318

(1)

Public Health Policies for Cannabis

319

(1)

Public Education about Cannabis Dependence

320

(1)

Screening and Brief Intervention for Hazardous Cannabis Use

321

(1)

Specialist Treatment for Cannabis Dependence

322

(4)

Withdrawal Management

323

(1)

Dealing with Comorbid Substance Disorders

323

(1)

Dealing with Comorbid Mental Disorders

324

(1)

Responding to Adolescent Cannabis Dependence

325

(1)

Cannabis Dependence and the Cannabis Policy Debate

326

(1)

Dependence and Therapeutic Cannabinoid Use

326

(1)

Possible Effects of Changes in the Legal Status of Cannabis Use

327

(3)

Decriminalization of Cannabis Use

328

(1)

De Facto Legalization of Cannabis Use

328

(1)

De Jure Legalization of Cannabis

329

(1)

Conclusions

330

(1)

References

331

(12)

Part V: Conclusion

15 The Nature, Consequences and Treatment of Cannabis Dependence: Implications for Future Research and Policy

ROBERT S. STEPHENS AND ROGER A. ROFFMAN

What is the Nature of Cannabis Dependence?

343

(5)

What are the Consequences of Cannabis Dependence?

348

(2)

Is the Treatment of Cannabis Dependence Effective?

350

(4)

What Should the Policy on Cannabis Dependence be?

354

(1)

Conclusion

355

(1)

References

355

(2)

Index

357

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Cannabis Dependence: Its Nature, Consequences and Treatment

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