Marijuana Dependence

Exhibit IV2 Dsmiv Substance Abuse Criteria

Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home 2. Recurrent substance use in situations in which it is physically hazardous 3. Recurrent substance-related legal problems 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused by the effects of the substance Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Copyright 1994. American Psychiatric...

Assessment Session Protocol

The counselor welcomes the client and provides an overview of the session. In this session, the counselor assesses the client's marijuana use while laying the foundation for a positive client-counselor relationship. Build Rapport and Give an Overview of the Assessment Process To build rapport and engage the client during the assessment session, the counselor informs the client about the sequence of events for this session and what to expect in the overall treatment approach. Introducing session...

Brief Counseling for Marijuana Dependence

DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857 Numerous people contributed to this document, which is part of the Marijuana Treatment Project (MTP) Cooperative Agreement. The document was written by Karen L. Steinberg, Ph.D., Roger A. Roffman, D.S.W., Kathleen M. Carroll, Ph.D., Bonnie McRee, M.PH., Thomas F Babor, Ph.D., M.PH., Michael Miller, Ph.D., Ronald...

Reasons for Quitting Questionnaire

People who want to stop smoking marijuana may have several reasons for quitting. I am interested in finding out your reasons for wanting to quit. There are no right or wrong reasons. Any reason is a good one. Below is a list of reasons that a person may have. Please read each statement and circle the number that best describes how much this reason applies to you at this time. I want to quit smoking marijuana at this time 1. To show myself that I can quit if I want to 2. Because I will like...

Reasons for Quitting Questionnaire continued

Please check the box that applies to you. I have not yet quit smoking marijuana (answer only 28). I have stopped smoking marijuana already (answer only 29). 28. If you have not yet quit smoking marijuana, circle the number that indicates how ready you are RIGHT NOW to stop smoking marijuana. 29. If you have stopped smoking marijuana already, circle the number that indicates how ready you are RIGHT NOW to remain abstinent. to remain abstinent to remain abstinent Reasons for Quitting...

Instructions for Creating the Personal Feedback Report continued

Your Problems Related to Marijuana For these items, use Marijuana Problem Scale (form AS5). You indicated that your marijuana use causes a number of problems for you, including On the Personal Feedback Report, check off the items indicated as a minor or serious problem. You identified ____ problems caused by your marijuana use. This places you in the ____th percentile relative to other adults seeking marijuana treatment. This means that you experience more problems than ____ percent of...

Review the PFR

The PFR review takes approximately 30 minutes. The counselor explains that by reviewing the PFR (form AS8), the client will understand reasons for and against changing and what and when problems might arise. The counselor leads the client through a systematic review of the PFR, giving the client an opportunity to explore each point. The counselor avoids simply verifying the information obtained during the assessment session. The counselor periodically seeks the client's thoughts and feelings...

Use the Problem Checklist To Identify and Prioritize Psychosocial Problems Other Than Substance

Problems unrelated to marijuana use that may be a hindrance to the client's abstinence efforts include Lack of housing or financial support Chronic or acute medical conditions Family or parental pressures Need for transportation and child care. By reviewing the client's intake or initial session assessments, including the measures of motivation and marijuana-related problems identified on the Personal Feedback Report PFR form AS8 , the counselor develops a sense of the type and severity of the...

Urge Surfing

Many people try to cope with their urges by gritting their teeth and toughing it out. Some urges, especially when you first return to your old using environment, are too strong to ignore. When this happens, it can be useful to stay with your urge to use until it passes. This technique is called urge surfing. Urges are like ocean waves. They are small when they start, grow in size, and then break up and dissipate. You can imagine yourself as a surfer who will ride the wave, staying on top of it...

Practice Skills for Coping With Automatic Thoughts

The counselor and client practice self-talk C Let's practice self-talking in response to concerns about quitting. We'll choose a general concern about quitting to work on. Then you'll do two things 1. State the concern in your own words, using an I statement. 2. After stating the concern, follow it with a challenging statement. Again, use the pronoun I when making a challenging statement, and say it forcefully. The counselor illustrates how to self-talk by focusing on a particular automatic...

Link Negative Moods and Marijuana

The counselor explores the relationship between marijuana smoking and the experience of negative moods and the role of automatic thoughts Shirley (S) I miss smoking pot when I'm overwhelmed by bad feelings. I felt better after getting high. C Smoking helped you cope with your negative mood. S Yeah, but I would get depressed again when I came down from the high. C What works for you in the short term causes other problems later. C Today we've reviewed ways to cope with negative thoughts. You...

Current Findings About Marijuana

Marijuana is the most commonly used illicit substance in the United States (Clark et al. 2002 Substance Abuse and Mental Health Services Administration 2003). According to the 2003 National Survey on Drug Use and Health, 14.6 million people ages 12 and older had smoked marijuana in the preceding month (Substance Abuse and Mental Health Services Administration 2004). It is estimated that approximately 4.3 million people used marijuana at levels consistent with abuse or dependence in the past...

How Do You Give Up Marijuana

If you are serious about quitting, the best way is to stop cold turkey. You might be surprised that it's easier than you think. Soon after quitting, you'll find that your thinking becomes clearer. To quit using marijuana, you have to confront your desire to get stoned. You will be going into battle against a part of yourself that you no longer wish to exist. Giving up marijuana, especially if you've been using for some time, is a bit like losing an old friend. Quitting may feel like a funeral,...

Overview of ihe Marijuana Treatment Project1

CSAT funded MTP to design and conduct a study of the efficacy of treatments for marijuana dependence, to extend this line of research, and to broaden the applicability of the approach to a more diverse group than that used in earlier trials (Stephens et al. 1994b, 2000). The treatment sites were the University of Connecticut School of Medicine, Department of Psychiatry, Farmington, Connecticut The Village South, Miami, Florida and the University of Washington, School of Social Work, Seattle,...

Assessing Marijuana

BMDC uses the criteria identified in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), to diagnose marijuana dependence (exhibit IV-I) and marijuana abuse (exhibit IV-2). These criteria help the counselor determine a client's level of substance involvement and the associated consequences, as well as appropriate level of treatment. These criteria also can be used in later sessions to measure treatment effectiveness. The...

Structured Clinical Interview for DSMIV

(Non-Alcohol Substance Use Disorders Module Modified for Marijuana Use, Past Month) How old were you when you first started smoking marijuana regularly (i.e., 3 or more times a How old were you when your marijuana use began to cause you problems _ Now I am going to ask you several questions about your marijuana use for the past month, that is Current marijuana dependence is characterized by a maladaptive pattern of marijuana use leading to clinically significant impairment or distress, as...

Marijuana Treatment Project

MTP was funded by the Center for Substance Abuse Treatment in 1997 and conducted in three States (Connecticut, Florida, and Washington) over a 3-year period. MTP compared two active treatments with a delayed treatment control condition (Stephens et al. 2002). One active treatment consisted of nine individual counseling sessions delivered over a 12-week period. The initial sessions focused on MET. These were followed by CBT skills training along with additional case management if needed. With...

Assess High Risk Situations

The counselor explains that marijuana use behavior is learned over time. The client's understanding of his or her use patterns can help the client change those patterns. Understanding high-risk situations can help the client avoid or cope with those situations C If using marijuana changes the way a person acts, thinks, and feels, it's helpful to begin by identifying use patterns and habits. Once your patterns are identified, you may find it easier to change your behavior. You can find ways to...

Review consequences of action and inaction

C What do you see happening if you don't see a doctor C It sounds as if you're concerned about calling your probation officer right now what do you think will happen if you don't Throughout the sessions, the counselor praises all the client's efforts to carry out the Support Plan, even small steps. The counselor conveys confidence that the client has the resources and skills to carry out the plan and obtain services, during treatment and after treatment C I'm impressed that you arranged a place...

Develop Skills for Coping With Automatic Thoughts

The counselor helps the client identify automatic thoughts and reviews some of the techniques used in previous sessions C Everyone trying to stop marijuana use has thoughts about using. It's not the thought that creates the problem but how people cope with it. If you learn to recognize these thoughts and counter them with contrary thoughts, they need not lead to a lapse. The three general principles for coping effectively with thoughts about using are 1. It's easier to choose to remain...

Reinforce That Thoughts About Marijuana Use Are Normal

The counselor discusses the relationships among thoughts, feelings, and using marijuana Counselor (C) For people who have smoked marijuana for a long time, thoughts about using are normal almost anyone who stops using thinks about starting up again. Thinking about using is not a problem provided you don't act on those thoughts. You may feel guilty about thoughts, and you may try to get them out of your mind. This skill topic will help you learn new ways to manage your thoughts before you slip....

Structured Clinical Interview for DSMIV continued

(Non-Alcohol Substance Use Disorders Module Modified for Marijuana Use, Past Month) Now I am going to ask you a few more questions about your marijuana use for the past month, Current marijuana abuse is characterized by a maladaptive pattern of marijuana use leading to clinically significant impairment or distress, as manifested by one or more of the following occurring during the assessment period. 8. In the past month, have you missed work or school because you were high or hung over Have you...

Boring Story

Jan was in her mid-30s when she began to think she needed to quit smoking pot. Sometimes she enjoyed it, but after 15 years of regular use Jan was unhappy with herself for smoking so much marijuana. She began every day with a hit and smoked every hour or two throughout the day. Several times in the past few years she had tried to cut back to smoking just in the evenings and on weekends. A few times she kept to her limits, but inevitably she'd inch her way back up. When she thought about it, she...

Some Alternatives to Marijuana

You can do many things to stop using marijuana. Some may work better than others. Some help you resist the urge to smoke or avoid tempting situations or satisfy your needs in more constructive ways than smoking marijuana. Expect to try several and add any that may be helpful. Think about what worked when you gave up marijuana before or when you made other changes in your life. Be kind to yourself as you begin this change process you're doing something to take care of yourself, and you deserve...

Marijuana Use Self Awareness Record

As a way to increase awareness about your patterns of use, we'll use this form to identify the kinds of situations, thoughts, feelings, and consequences that are associated with your marijuana use. It may be difficult initially, but once you get accustomed to paying more attention, you will become skilled at discovering the ways in which you typically use marijuana. Trigger (What types of events tend to make you want to use For example, an argument, disappointment, loss, or frustration spending...

Using Motivational Interviewing Strategies

Sessions 1 and 2 rely heavily on the motivational interviewing strategies described in Miller and Rollnick (2002). Motivational interviewing is a technique used in motivational enhancement therapy (MET). The counselor assesses the client's motivation by using motivational interviewing strategies, which include asking open-ended questions, listening reflectively, affirming the client, summarizing the client's views of change, eliciting self-motivational statements, recognizing and addressing...

Deep Muscle Relaxation Practice Exercise

Arrange to spend some quiet time in a room where you will not be interrupted. Try to practice this relaxation technique at least three times during the next week. Proceed through the eight groups of muscles in the list below, first tensing each for 5 seconds and then relaxing each for 15 to 20 seconds. Settle back as comfortably as you can, take a deep breath, and exhale very slowly. You may feel most comfortable if you close your eyes. Notice the sensations in your body you will soon be able...

You listed the following personal reasons for quitting marijuana and said that they applied to you moderately quite a

_To show myself that I can quit if I want to _Because I will like myself better if I quit _Because I won't have to leave social functions or other people's houses to smoke _So I can feel in control of my life _Because my family and friends will stop nagging me if I quit _To get praise from people I'm close to _Because smoking marijuana does not fit in with my self-image _Because smoking marijuana is becoming less socially acceptable _Because someone has told me to quit or else _Because I will...

Timeline Follow Back Marijuana Use Summary Sheet

(To be completed after the calendar data have been collected.) I would like to ask you a few more questions about your marijuana and alcohol use. 1. During the past month, from_to_, on average, how much marijuana per week do you think you used in ounces Probe by asking the participant how many ounces of marijuana he or she buys (or receives) per week. If the client seems uncertain about level of use, the counselor helps him or her approximate by using the following types of probes Would you say...

Brief Marijuana Dependence Counseling

These three examples illustrate several important questions commonly asked by people about their marijuana use Is it possible to be dependent on marijuana Do I want to stop using because of what I've experienced Can I succeed in stopping, given the challenges I've faced in the past The counseling approach presented in this manual addresses these issues among others. It comprises three key intervention components motivational enhancement, cognitive behavioral skills training, and case...

Identifying the Individuals Stage of Change

The stages-of-change model (Prochaska and DiClemente 1982) describes a sequence of stages through which individuals progress as they think about and change their behaviors. It gives the counselor insight into the client's thinking so that the counselor can select strategies specific to the client's stage. This model was adapted for the Marijuana Treatment Project and assumes Progress in overcoming marijuana dependence (e.g., getting ready for the first day of abstinence, getting through the...

About Marijuana and How It Affects the Body

Cannabis is the general name given to a variety of preparations derived from the plant Cannabis sativa. The main psychoactive ingredient in cannabis is delta-9-tetrahydrocannabinol or THC. Some 400 other chemicals also are in the cannabis plant. When a person smokes marijuana, THC enters the bloodstream through the walls of the lungs and is taken to the brain. THC is stored in fatty tissues and can be detected in urine for days, weeks, or sometimes months. The effects of marijuana depend on the...

Coping With a Slip

A slip is marijuana use that occurs after a period of abstinence. A slip doesn't mean a person will return to regular marijuana use. That would be a relapse. Slips occur when motivation is lagging or when a high-risk situation occurs unexpectedly. Slips do not mean that all the success and progress to date have been lost. How your partner or friend responds to a slip can mean the difference between returning to abstinence or going into a relapse. Here are some...

Provide Information on the Effects of Seemingly Irrelevant Decisions

The counselor helps the client understand that apparently irrelevant decisions can have major repercussions (see Marlatt and Gordon 1985) Counselor (C) Many ordinary choices seem to have nothing to do with using. Although they may not involve choosing directly whether to use, they move you closer to making that choice. Through a series of minor decisions, you come to a point where using becomes likely. These seemingly unimportant decisions that put you on a path to resuming marijuana use are...

Managing Thoughts About Marijuana5

Here are several ways of managing thoughts about marijuana Challenge your thought Do you really need to use Think of the benefits of not using (see Creating Your List below). Remember the unpleasant drug experiences and aftereffects (read list on card see below ). Find distractions Think of something unrelated to marijuana use. Think positively Remind yourself of your successes so far. Leave or change the situation. Call your supporter or a friend and try to talk it out. Use images of riding...