Individualized assessment and treatment program (IATP) for cannabis use disorder: Randomized controlled trial with and without contingency management

Abstract

This study tested a new approach to the treatment of cannabis use disorder (CUD). CUD is difficult to treat, and achieving abstinence is particularly difficult. The individualized assessment and treatment program (IATP) was intended to address this problem by providing a highly individualized approach to the training of coping skills most relevant for each individual. To do this, an experience sampling procedure was used prior to treatment to record patients' marijuana use behavior and associated thoughts, feelings, coping behaviors, and situations. This information was used by therapists to plan treatment that would address the specific strengths and weaknesses of each patient in drug-use situations. The present study tested IATP against a conventional combined motivational enhancement cognitive-behavioral treatment (MET-CBT), with or without the addition of contingency management (CM) for abstinence. The patients were 198 men and women randomly assigned to 1 of 4 nine-session treatment conditions: MET-CBT, MET-CBT-CM, IATP, or IATP-CM. Patients were assessed out to 14 months. Planned contrasts indicated that the IATP conditions yielded greater levels of abstinence than did the MET-CBT conditions. The addition of CM did not bolster the performance of IATP but did do so for MET-CBT. As expected, IATP lead to greater use of coping skills than did the MET-CBT conditions. However, coping skills use was not a significant predictor of outcome when other variables were in the same analyses. Self-efficacy was a robust predictor and mediator of outcome. We suggest that the IATP may act by enhancing self-efficacy. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT02030665.

Figures

Figure 1.

Flow of patients in the IATP project for treatment of cannabis dependence.

Figure 2.

Example of Functional Analysis Chart for IATP. Chart summarizes information regarding when drug use or drug urges occurred, plus antecedent thoughts, moods, and situations.

Figure 3.

Main outcome measures over time by treatment condition. MET+CBT+CM = motivational enhancement plus cognitive-behavioral treatment plus contingency management. IATP-CM=Individualized Assessment and Treatment Program plus contingency management.

Figure 4.

Process measures. Coping Strategies Scale scores and Marijuana Self-Efficacy scale scores over time by Treatment Condition. MET+CBT+CM = motivational enhancement plus cognitive-behavioral treatment plus contingency management. IATP-CM=Individualized Assessment and Treatment Program plus contingency management.