Individualized Assessment and Treatment for Marijuana Dependence: Treatment Mecha

描述(申请人提供)：大麻是美国最常用的非法药物，但对大麻依赖的治疗并不完全有效。到目前为止，最有效的治疗方法是采用动机增强(MET)、认知-行为应对技能治疗(CB)和应急管理(CM)来戒酒。这项建议是我们最近完成的一项研究的竞争性更新，该研究旨在增强应对和自我效能，以改善大麻的长期结果。在目前的提案中，我们正在探索这样一种想法，即对应对技能进行更多量身定制的教学，可能会比迄今看到的更好地改善大麻依赖的结果。针对大麻依赖患者的个性化评估和治疗计划(IATP)将采用经验抽样(ES)来确定每个患者在吸毒情况下的优势和劣势，以便相应地进行治疗。一项试点研究的结果表明，酒精依赖患者的IATP在治疗后比一揽子CB计划(PCBT)获得了更好的饮酒结果，IATP患者报告比PCBT参与者更多地使用应对技能，治疗后应对技能的报告与治疗后饮酒有关。参与者将是275名符合大麻依赖标准的男性和女性，他们被随机分配到4种治疗条件中的一种情况下进行9个疗程的治疗：标准化MET+CB(SMET-CB)、SMET+CM(SMET-CB-CM)、IATP或IATP+CM(IATP-CM)。在所有治疗中，患者将在治疗前两周、治疗期间每周、治疗结束后另一周以及在第8个月和第14个月通过手机进行ES。在IATP条件下，从治疗前和治疗期间ES期间收集的信息将为对患者的药物使用和使用冲动进行功能分析提供数据。治疗师将使用这些信息来解决适应和不适应的特定认知、情感和行为，并将为患者量身定做特定的应对技能计划。治疗过程中的经验抽样将允许调整治疗目标和程序，使治疗适应。在SMET-CB条件下，经验采样数据将不用于治疗，但仍将提供饮酒和应对技能的体内测量。根据假设，无论是在治疗后还是在长期随访中，IATP条件下获得的应对技能都比SMET-CB条件下的要好得多，而且应对技能的变化将预示IATP条件下更好的结果。进一步预测，将CM加入IATP和SMET-CB将提高短期和长期结果。这一结果将对改进治疗以适应患者的力量和缺陷，以及为预防复发而进行的应对技能培训的有效性产生影响。收集的数据将揭示患者在治疗过程中实时使用应对技能的方式。最后，重复使用ES周期将使我们能够确定治疗如何影响思想、感觉和行为，以及这些反过来如何影响长期和短期结果。

DESCRIPTION (provided by applicant): Marijuana is the most commonly used illicit drug in the US, but treatment for marijuana dependence is not fully effective. The most effective treatments to date have employed motivational enhancement (MET) plus cognitive-behavioral coping skills treatment (CB) and contingency management (CM) for abstinence. This proposal is a competitive renewal of our recently completed study to enhance coping and self-efficacy to improve marijuana outcomes in the long term. In the current proposal we are exploring the idea that more tailored teaching of coping skills may result in improved outcomes for marijuana-dependence than those seen thus far. The Individualized Assessment and Treatment Program (IATP) for marijuana dependent patients will employ experience sampling (ES) to determine the strengths and weaknesses of each patient in drug-use situations so that treatment can be tailored accordingly. Results from a pilot study indicated that IATP for alcohol dependent patients yielded better drinking outcomes at post treatment than a packaged CB program (PCBT), that IATP patients reported greater use of coping skills than PCBT participants, and that post treatment reports of coping skills were related to post treatment drinking. Participants will be 275 men and women meeting criteria for marijuana dependence and randomly assigned to 9 sessions of treatment in one of 4 treatment conditions: Standardized MET plus CB (SMET-CB); SMET+ CM (SMET-CB-CM); IATP; or IATP + CM (IATP-CM). Patients in all treatments will engage in ES via cell-phone for two weeks prior to treatment, for a weekly period during treatment, for another week after treatment has ended, and for two weekly periods at months 8 and 14. In the IATP conditions, the information gathered from the pretreatment and during-treatment ES periods will provide data for a functional analysis of patients' drug use and urges to use. Therapists will use the information to address specific cognitions, affects, and behaviors that are adaptive and maladaptive, and will tailor a specific coping skills program with the patient. During-treatment experience sampling will allow adjustment of the treatment goals and procedures, making the treatment adaptive. In the SMET-CB conditions the experience sampling data will not be used in therapy, but will still provide in-vivo measures of drinking and coping skills. It is hypothesized that IATP conditions will yield significantly better coping skill acquisition than SMET-CB conditions, both at post treatment and at extended follow-ups, and that change in coping skills will predict better outcomes for the IATP conditions. It is further predicted that the addition of CM to both IATP and SMET-CB will enhance short-term and long-term outcomes. The results will have implications for improved tailoring of treatment to patients' strength and deficits, and for the validity of the training of coping skills for relapse prevention The data collected will shed light on the ways in which patients in treatment use coping skills in real-time contexts. Finally, the use of repeated ES periods will allow us to determine how treatment impacts thoughts, feelings and behaviors, and how these in turn affect outcome in the long and short term.