title: A stepped care approach for reducing cannabis use in opioid-dependent outpatients.
abstract: This study evaluated rates of cannabis use and the effectiveness of an adaptive stepped care intervention for reducing cannabis use in methadone maintenance patients. Patients testing cannabis positive during a 6-month baseline were advanced to more weekly counseling (up to 9 hours per week) until producing four consecutive weeks of cannabis- and other drug-negative urine samples. Patients were followed up for 1 year. Continued access to uninterrupted methadone delivery was ultimately contingent upon attending scheduled counseling and achieving abstinence from all drug use. The results showed that 18% of the clinic census (n = 57) tested positive for cannabis. The effectiveness of the intervention was assessed for 15 patients testing positive for cannabis exclusively. Ten of these patients (67%) discontinued cannabis use prior to the intervention and remained at reduced care. Four of the five patients who were advanced to higher steps of care ultimately discontinued cannabis use; one left treatment against medical advice. The results suggest that motivated stepped care is an effective intervention for reducing cannabis use.
authors.affiliation: The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA. mkidorf@jhmi.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Kidorf
authors.forename: Karin
authors.initials: K
authors.lastname: Neufeld
authors.forename: Van L
authors.initials: VL
authors.lastname: King
authors.forename: Michael
authors.initials: M
authors.lastname: Clark
authors.forename: Robert K
authors.initials: RK
authors.lastname: Brooner
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D032763:Behavior Control / Q000379:methods*; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000517:prevention & control*; D008691:Methadone / Q000627:therapeutic use; D009042:Motivation; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010353:Patient Education as Topic; D012657:Self-Help Groups; D015813:Substance Abuse Detection
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone