Assessing Cannabis Craving in a Treatment Setting

In a treatment or clinic setting, patients are typically assessed with numerous forms, questionnaires, and interviews. To reduce burden on patients, we suggest using the 12-item MCQ rather than the full version.

3.2.1. Training on Completion of MCQ

As discussed above (Subheading 3.1.3.), patients should be given instructions before completing the MCQ (see Note 2).

3.2.2. Measurement of Craving

The use of the MCQ in a treatment setting may be more flexible than in a research setting. A patient's level of craving may be assessed at initial intake or at baseline before entering treatment. Craving can then be measured periodically during and at the end of treatment to determine treatment outcome. Presumably, craving levels will decrease as a person reduces cannabis use or achieves abstinence.

4. Notes

1. At a minimum, a history of cannabis use should include the following: age of first use, age when use became regular (e.g., weekly, monthly), lifetime estimate of number of times using cannabis, frequency of use in past 6 mo, frequency of use in past 30 d, amount (e.g., number of joints) typically used at one time, and type of cannabis preparation typically used.

2. Each item of the MCQ is rated on a 7-point Likert scale from strongly disagree to strongly agree. The following instructions should appear at the top of the MCQ form or on the computer monitor if using a computerized version and should be read aloud to the participant the first time it is completed: "Indicate how strongly you agree or disagree with each of the following statements by placing a check mark in one of the spaces between strongly disagree and strongly agree. The closer you place your check mark to one end or the other indicates the strength of your agreement or disagreement. If you don't agree or disagree with a statement, place your check mark in the middle space. Please complete every item. We are interested in how you are thinking or feeling right now as you are filling out the questionnaire."

3. All items are scored on a scale ranging from 1 (strongly disagree) to 7 (strongly agree). For the 12-item MCQ, the scores of the three items in each factor should be summed for a total factor scale score (range 3-21). Factor 1 (compulsivity) consists of items 2, 7, and 10; factor 2 (emotionality) consists of items 4, 6, and 9; factor 3 (expectancy) consists of items 5, 11, and 12; and factor 4 (purposefulness) consists of items 1,3, and 8 (see Table 1).

4. No-Craving Script: You're at the beach lying on a blanket. The warm sun penetrates your skin and relaxes you thoroughly. A fresh breeze blows over your body as you run your hands through the clean white sand and let the grains fall through your fingers. You're feeling refreshed and at ease, and pleasant thoughts run through your mind. You can hear the sounds of waves splashing rhythmically against the shore. Nearby some children are playing a game. A bright red beach ball lands near your blanket. You look up and see two of the children running toward you to get their ball. You stand up, pick up the ball and toss it to them. They laugh and giggle and run back to their game. You go to the blanket and lie down. You're enjoying this day completely.

Low-Urge Script: You're on the phone talking to friend you haven't seen in a year. This is a long distance call and the phone connection is not very good; there's a lot of static on the line and you can hear other voices faintly in the background. Your friend just told you that he's making plans to visit you in a couple of weeks. You're happy and excited. The two of you always had great times in the past, and you know that it's going to be a fantastic visit. The static gets worse and it's hard to hear your friend. You suggest that you hang up and call right back so the two of you can make definite plans. As you hang up the phone you remember the bag of marijuana that you bought earlier and think about smoking a joint. A smile comes to your face as you think how much fun the two of you will have together.

High-Urge Script: You're at a friend's house sitting in a big comfortable chair. You're with people you've known for a long time and you're enjoying yourself very much. You're feeling relaxed and totally at ease. Many of your friends are smoking marijuana. As you sit there listening to the conversation and music, you begin to think about how enjoyable a joint would be. The smoke begins to fill the room and you think about how satisfying it would be to hold a joint between your fingers. The more you think about smoking marijuana, the stronger your desire becomes. Maybe tonight when you're with your friends and having a good time, it would be okay to get stoned. How could you really enjoy yourself fully unless you were smoking pot? Your desire to smoke becomes really intense and you know that there's no good reason not to smoke any of the joints being passed around.

References

1. Substance Abuse and Mental Health Services Administration. (2003) Overview of Findings from the 2002 National Survey on Drug Use and Health (DHHS Publication No. SMA 03-3836), Rockville, MD.

2. American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.), American Psychiatric Association, Washington, DC.

3. Budney, A. J., Novy, P. L., and Hughes, J. R. (1999) Marijuana withdrawal among adults seeking treatment for marijuana dependence. Addiction 94, 1311-1321.

4. Budney, A. J., Hughes, J. R., Moore, B. A., and Novy, P. L. (2001) Marijuana abstinence effects in marijuana smokers maintained in their home environment. Arch. Gen. Psychiatry 58, 917-924.

5. Heishman, S. J., Singleton, E. G., and Liguori, A. (2001) Marijuana Craving Questionnaire: development and initial validation of a self-report instrument. Addiction 96, 1023-1034.

6. Singleton, E. G., Trotman, A. J.-M., Zavahir, M., Taylor, R. C., and Heishman, S. J. (2002) Determination of the reliability and validity of the Marijuana Craving Questionnaire using imagery scripts. Exp. Clin. Psychopharmacol. 10, 47-53.

7. Carter, B. L. and Tiffany, S. T. (1999) Meta-analysis of cue-reactivity in addiction research. Addiction 94, 327-340.

8. Heishman, S. J., Saha, S., and Singleton, E. G. Imagery-induced tobacco craving: duration and lack of assessment reactivity bias. Psychol. Addict. Behav., 18,284-288.

9. Singleton, E. G., Anderson, L. M., and Heishman, S. J. (2003) Reliability and validity of the Tobacco Craving Questionnaire and validation of a craving-

induction procedure using multiple measures of craving and mood. Addiction 98, 1537-1546.

10. Ehrman, R. N., Robbins, S. J., Childress, A. R., Goehl, L., Hole, A. V., and O'Brien, C. P. (1998) Laboratory exposure to cocaine cues does not increase cocaine use by outpatient subjects. J. Subst. Abuse Treat. 15, 431-435.

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