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Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users: 5 Sessions

Background on the
CYT Cooperative Agreement

MET/CBT5 was developed as a brief intervention to be tested at four treatment sites within the Cannabis Youth Treatment study. Section III of this manual describes the rationale for choosing the elements of the MET/CBT5 therapy. The following description illustrates the context in which MET/CBT5 was developed.

Goals and Objectives

The purpose of the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) Cannabis Youth Treatment Cooperative Agreement was to test the relative effectiveness and cost-effectiveness of a variety of interventions targeted at reducing/eliminating marijuana use and associated problems in adolescents and to provide validated models of these interventions to the treatment field. The target population was adolescents with cannabis use disorders of abuse or dependence, as defined by the American Psychiatric Association (1994), who were assessed as appropriate for treatment in outpatient settings.

Overview of Study

The study was conducted in collaboration with staff from Chestnut Health Systems (CHS–MC) in Bloomington and Madison County, Illinois, the University of Connecticut Health Center (UCHC) in Farmington, Connecticut, Operation Parental Awareness and Responsibility (PAR) in St. Petersburg, Florida, and the Children’s Hospital of Philadelphia (CHOP), Pennsylvania. It involved five manual-based, expert-supported treatment conditions:

• MET/CBT5—This is the five-session treatment described in this manual. It comprises two individual sessions of motivational enhancement therapy (MET) and three group sessions of cognitive behavioral therapy (CBT). The MET sessions focus on factors that motivate clients to change. In the CBT sessions, clients learn skills to cope with problems and meet their needs in ways that do not involve turning to marijuana or alcohol.
  
  
• MET/CBT5+CBT7—This treatment is composed of the complete MET/CBT5 treatment combined with seven supplemental cognitive behavioral sessions covering additional coping skills topics.
  
  
• FSN—The Family Support Network (FSN) treatment consists of the MET5+CBT7 treatment combined with additional support for families (home visits, parent education meetings, parent support group), aftercare, and case management.
  
  
• ACRA—The Adolescent Community Reinforcement Approach (ACRA) is composed of 12 individual sessions with an adolescent and the adolescent’s parent, caregiver, or concerned other. The focus is on learning alternative skills to cope with problems and meet needs with an emphasis on the adolescent’s environment. Concerted effort is made to change the environmental contingen-cies— both positive and negative—related to substance use.
  
  
• MDFT—Multidimensional Family Therapy (MDFT) is a family-focused treatment that includes 12 weekly sessions to work individually with adolescents and their families. MDFT focuses on family roles, other problem areas, and their interactions.

These treatments can also be grouped in three different ways. First, they vary by mode, with the first three being combinations of individual and group approaches and the last two being purely individual treatment approach-es. Second, the MET/CBT and ACRA interventions were based on behavioral treatment approaches, while the FSN and MDFT interventions were based on family treatment approaches. Third, the treatment conditions were expected to vary in terms of resource intensity and cost, with the MET/CBT5 intervention expected to be the least costly therapy to implement.

At each site, approximately 150 adolescents were systematically assigned to one of three conditions. At ARC and PAR, they were assigned to the brief MET/CBT5 or to one of the two other individual/group combinations, MET/CBT5+CBT7 or FSN. At CHS–MC and CHOP, adoles-cents were assigned to the brief MET/CBT5 treatment or one of the two individual approaches, ACRA or MDFT. Thus, all five conditions were repli-cated in two or more sites, with the MET/CBT5 condition implemented at all four sites. All clients were assessed at intake and at 3, 6, and 9 months. To validate clients’ responses, urine tests and collateral assessments are also done at intake and at 3 and 6 months.

The general research design document prepared by Dennis and colleagues describes the overall research plan in greater detail (Dennis, Titus, Diamond, Donaldson, Godley, Tims, Webb, Kaminer, Babor, French, Godley, Hamilton, Liddle & Scott, under review). The project’s Web site (www.chestnut.org/CYT) can be accessed for further information about the CYT project.

Client and Provider Information

Target Population
MET/CBT5 is designed for the treatment of adolescents between the ages of 12 and 18 with problems related to marijuana use, as indicated by one of the following:

• Meeting criteria for cannabis abuse or dependence
• Experiencing problems (including emotional, physical, legal, social, or academic problems) associated with marijuana use
• Using marijuana at least weekly for 3 months.

Although this treatment includes suggestions for addressing both drug and alcohol use, it is not designed for treating adolescents with poly-substance dependence or those who are heavily using other substances as well as marijuana. In the CYT study, adolescents were excluded from the study who drank alcohol on 45 or more of the previous 90 days or who used another drug on 13 or more of the previous 90 days.

MET/CBT5 should not be used to treat adolescents

• Requiring a level of care that is higher than outpatient treatment
• With a social anxiety disorder severe enough to prevent participa-tion in group therapy sessions
• With a severe conduct disorder
• With an acute psychological disorder severe enough to prevent full participation in treatment.

In the CYT study, this treatment was effectively implemented with adolescents with mixed demographic characteristics such as race, age, socioeconomic group, and gender, as well as from different geographic regions. When treating clients, therapists need to be culturally aware of and sensitive to the client group so they can provide relevant examples and use language that is understood by the clients in the therapy session. Likely referral sources of potential MET/CBT5 clients are parents, the justice system, school personnel, and medical or mental health care providers. Self-referral is infrequent.

Level of Care

MET/CBT5 is appropriate for use as either an outpatient treatment (ASAM level 1) or early intervention (ASAM level 0.5).

MET/CBT5 can be used by organizations that provide outpatient care, including mental health clinics, youth social service agencies, and mental health private practice settings. Other organizations such as community centers, schools, or general medical settings may appropriately implement MET/CBT5 if they have properly trained staff. Medical settings may be partic-ularly well suited for implementation of MET/CBT5 as an early intervention.

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