The question is what can be done to help people become and remain abstinent. For those who cannot remain abstinent, an initial goal is measurable improvement. The first step for clinicians is to help the patient become motivated to change his relationship to drugs. According to the National Institute on Drug Abuse (NIDA), each year 100,000 people seek treatment with a primary (or at least a self-perceived primary) marijuana abuse problem. Without medications to help with detoxification and relapse prevention, health professionals use various approaches to treating patients.
Until a few years ago, it was difficult to find treatment programs specifically for marijuana users. Treatments for marijuana dependence were much the same as therapies for other drug abuse problems. These include detoxification, behavioral therapies and regular attendance at meetings of support groups, such as Narcotics Anonymous.
Recently, researchers have been testing different ways to attract marijuana users to treatment and help them abstain from drug use. Currently no medications for treating marijuana dependence are available. Treatment programs focus on counseling and group support systems.
A marijuana treatment group is typically an abstinence-based group of 10 to 12 persons trying to end their dependence on marijuana. In one recent study, 14 groups were started; they met once a week for 14 weeks and were led by two co-therapists. People were able to join without proving that they had stopped smoking pot before requesting assistance; thus, people entered the groups at varying levels of dependence. The intervention was designed to help people quit using marijuana by the fourth week. They were not asked to leave the group if they were unable to completely stop using marijuana. Instead, those still using the drug were encouraged by the therapists and group members to continue trying to stop.
Another model for treatment involves one-on-one intervention, followed by an assessment session that provides an overview to the patient, an in-depth discussion about the patient’s use of marijuana and reasons for favoring or opposing quitting and answers to questions the client has about quitting or modifying use. In one study using this model, the second session was a feedback session conducted one week after the initial assessment session, employing motivational interviewing strategies to help the person resolve conflicting feelings about changing. During this session, patients who decided to quit smoking marijuana were advised how to prepare for stopping and how to deal with relapse risks. A 30-day plan was developed as an opportunity to try out the behavior change (reducing or stopping use). A review session was conducted with the patient after 30 days had passed.
These two counseling approaches were found to be equally successful. The researchers concluded that a brief, three-session intervention that focuses on helping patients resolve their mixed feelings about change, identifies short-term goals that can be worked on over a 30-day period, provides advice about initiating change and reviews progress after 30 days may be an effective counseling approach for many chronic marijuana smokers. From these studies, drug treatment professionals are learning what characteristics of users are predictors of success in treatment and which approaches to treatment can be most helpful.
Further progress in treatment to help marijuana users includes a number of programs set up to help adolescents in particular. Some of these programs are in university research centers, where most of the young clients report marijuana as their drug of choice. Others are in independent adolescent treatment facilities. Family physicians are also a good source for information and help in dealing with adolescents’ marijuana problems.
The number of adolescents under age 18 receiving substance abuse treatment on any given day in the United States almost doubled between 1991 to 1996, from 44,000 to 77,000.
Mark S. Gold, M.D. contributed to this article.