Cannabis Youth Treatment Study

Cannabis is a substance containing the chemical compound delta-9-tetrahydrocannabinol (i.e., THC), which exists in multiple forms commonly known as hashish, marijuana, and blunts. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), cannabis intoxication is typically associated with symptoms such as euphoria, sedation, lethargy, impaired judgment, distorted sensory perceptions, and impaired motor performance. Cannabis is the most widely used illicit psychoactive substance in the United States, and prevalence rates are high, particularly among adolescents. In 2006, the National Survey on Drug Use and Health estimated that 6.7% of 12- to 17-year-olds used cannabis within the past month.

Due to the growing literature demonstrating significant social, medical, and psychological consequences of cannabis use disorders among adolescents, the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration, within the U.S. Department of Health and Human Services, created the Cannabis Youth Treatment Study (CYTS) to identify the cost, effectiveness, and cost-benefit of short-term outpatient treatment programs for adolescents with cannabis use disorders. Grants were awarded to four sites to conduct the study; these sites included the University of Connecticut Health Center; Operation Parental Awareness and Responsibility, Inc.; Chestnut Health Systems; and Children's Hospital of Philadelphia. A 35-member steering committee composed of researchers and clinicians from each grant site, other research collaborators, CSAT staff, and an independent advisory board chose five short-term interventions that showed promise from previous research for implementation in the CYTS. Some of the treatments were subjected to previous randomized controlled trials but were implemented with adults.

The five interventions were evaluated in two trials, which included motivational enhancement treatment and cognitive behavior therapy, 5 sessions (MET/ CBT5); motivational enhancement treatment and cognitive behavior therapy, 12 sessions (MET/ CBT12); family support network (FSN); the adolescent community reinforcement approach (ACRA); and multidimensional family therapy (MDFT). The first two treatment approaches, MET/CBT5 and MET/CBT12, included a combination of two sessions of MET with either three or seven CBT sessions, respectively. MET was used to decrease ambivalence and increase motivation to change cannabis use, whereas CBT provided the adolescent with skills for refusing cannabis, increasing social support and pleasant activities, and coping with high-risk situations. The FSN intervention was a treatment package combining the MET/CBT12 with six parent education group meetings, four therapeutic home visits, referral to support groups, and case management. The ACRA utilized operant conditioning, skills training, and social systems approaches in a 12-to 14-week intervention, including 10 individual sessions with the adolescent, four sessions involving caregivers, and limited case management. MDFT was a comprehensive intervention based on systems theory and included 12 to 15 sessions with the individual, parents, and entire family, as well as case management over 12 to 14 weeks. Participants of the CYTS included 600 adolescents and their families. To be included in the study, adolescents had to be between the ages of 12 and 18, meet one or more DSM-IV-TR criteria for cannabis abuse or dependence based on self-report, used cannabis in the past 90 days, and be [Page 155]appropriate for outpatient treatment. Exclusion criteria included heavy use of alcohol or other drugs within the past 90 days and presence of factors based on participant report that prohibited or limited participation in treatment (e.g., limited cognitive abilities, significant conduct problems). Participants were primarily male (83%), Caucasian (61%) or African American (30%), and from single-parent families (50%). Many of the adolescents were previously involved in the juvenile justice system (62%) and engaged in risk behaviors (e.g., multiple sexual partners). Participants were randomly assigned to one of three treatment conditions within each treatment site due to limited case flow and resources. In Trial 1 (at University of Connecticut Health Center and Operation PAR), treatment conditions were MET/CBT5, MET/CBT12, or FSN; in Trial 2 (at Chestnut Health Systems and Children's Hospital of Philadelphia), treatment conditions were MET/CBT5, ACRA, or MDFT. Therapists were experienced clinicians from diverse educational backgrounds (20% doctoral level, 50% master's level, 30% bachelor's level) and participated in weekly supervision with clinical coordinators.

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