DESCRIPTION (provided by applicant): This is a second revision of a renewal application (2 RO1 DA014050-06; Marijuana Dependence Treatment PRN) last reviewed in March of 2007 and submitted in response to NIDA's Behavioral and Integrative Treatment Development Program (PA-07-111). The goal of this trial is to evaluate the efficacy of a continuing care protocol for outpatient counseling of marijuana dependent adults. Two hundred twenty treatment-seeking marijuana dependent adults will receive a 9-session individual counseling intervention comprised of motivational enhancement therapy, cognitive-behavioral therapy, and contingency management. This core treatment represents the empirically tested standard of care for adult marijuana dependence based on six previously conducted trials. All participants will also be offered the opportunity, over a 9-month period, to repeatedly reinitiate continuing care counseling in brief episodes of up to three sessions. All participants will be reassessed at the 3, 9, and 15-month anniversaries of enrollment. Following their 9- session core treatment, the 110 experimental condition participants will additionally have a motivational enhancement treatment "check-up" session with their counselor at the 4, 7, and 10-month anniversaries of enrollment intended to reinforce the maintenance of treatment gains, identify relapse, and/or prompt continuing care session utilization as needed. The experimental condition's rationale is based on: A) findings from our current trial that suggest greater rates of abstinence among individuals who utilized more post-acute care counseling sessions, B) the continuing care literature suggesting that an acute-care treatment model is an inadequate fit for a chronic disorder such as marijuana dependence and C) recent research demonstrating the efficacy of continuing care check-up sessions in prompting treatment reengagement by participants who failed to benefit from counseling. The study's specific aims are: (1) develop an enhanced model of continuing care; (2) evaluate its efficacy for improving utilization of continued care counseling sessions, 3) assess its impact on marijuana use outcomes, and 4) explore a mechanism of action for how ongoing monitoring promotes utilization of continuing care counseling. A continuing care model that promotes earlier identification of the need for a return to treatment and effectively supporting the individual in re-engaging will likely accelerate the achievement of stable recovery through several beneficial outcomes: periods of relapse will be shortened; addiction-related illness and disease, and attendant health care system costs will be attenuated; and expectations concerning the realistic possibility of overcoming substance dependence will be reinforced. PUBLIC HEALTH RELEVANCE: Of the 3.1 million U.S. daily marijuana users, 1.2 million have a marijuana disorder. Two national epidemiological surveys conducted 10 years apart indicate that the prevalence of DSM-IV marijuana abuse and dependence diagnoses has significantly increased despite rates of past year use having remained stable. Treatment admissions for primary marijuana abuse have more than doubled between 1993 (7%) and 2003 (16%). Marijuana use disorders have increased and continue to affect a significant portion of the population, thus necessitating continuing efforts to develop more efficacious behavioral interventions.

Project Narrative. Of the 3.1 million U.S. daily marijuana users, 1.2 million have a marijuana disorder. Two national epidemiological surveys conducted 10 years apart indicate that the prevalence of DSM-IV marijuana abuse and dependence diagnoses has significantly increased despite rates of past year use having remained stable. Treatment admissions for primary marijuana abuse have more than doubled between 1993 (7%) and 2003 (16%). Marijuana use disorders have increased and continue to affect a significant portion of the population, thus necessitating continuing efforts to develop more efficacious behavioral interventions.