7 - Contingency-Management Interventions for Cannabis Dependence

Summary

Individuals who seek treatment for substance abuse problems are notoriously difficult to retain in treatment and motivate to change. Even when clients make initial progress, frequently motivation wanes and relapse occurs. Contingency-management (CM) interventions represent one treatment approach that has great potential to effectively motivate and facilitate change in this challenging clinical population. CM may be particularly useful for treating individuals seeking treatment for cannabis abuse or dependence, as their motivation to change their cannabis use may not be as great as those seeking treatment for other types of drug abuse (Budney et al., 1997, 1998b). Cannabis-dependent clients report psychosocial problems similar to other drug abuse clients, but in general they do not experience the type of acute crises or severity of consequences that often drive alcohol-, cocaine-, or heroin-dependent individuals into treatment. Typically, they exhibit frequent and stable patterns of cannabis use with less financial burden and without as great a disruption to daily routines as individuals with other types of drug dependence. Perhaps, for reasons related to this issue, cannabis abusers appear to exhibit at least as much difficulty as other drug abusers in initiating and maintaining abstinence. Results from the few controlled clinical trials examining treatments for cannabis dependence indicate that even the most effective treatments do not engender abstinence among the majority of those who enroll, and the rates of relapse, like with other substance dependence treatments is relatively high (Budney et al., 2000; Copeland et al., 2001; Moore & Budney, 2003; Stephens et al., 1994, 2000). Thus, there exists significant room for enhancement of outcomes.