The Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration, funded three clinical sites and a Coordinating Center (CC) to design and implement the Marijuana Treatment Project (MTP) in the late 1990s. A major focus of CSAT is rigorous testing of approaches to treat marijuana dependence in both adults and adolescents. MTP studied the efficacy of treatments for adults who are dependent on marijuana. At the time of funding, MTP was one of the largest Knowledge Development and Applications initiatives funded by CSAT. Another was the Cannabis Youth Treatment (CYT) Study, which resulted in the CYT Series, a five-volume resource that provides unique perspectives on treating adolescents for marijuana use (Godley et al. 2001; Hamilton et al. 2001; Liddle 2002; Sampl and Kadden 2001; Webb et al. 2002).
This manual for Brief Marijuana Dependence Counseling (BMDC) is based on the research protocol used by counselors in MTP. The manual provides guidelines for counselors, social workers, and psychologists in both public and private settings who treat adults dependent on marijuana. The 10 weekly one-on-one sessions in the BMDC manual offer examples of how a counselor can help a client understand certain topics, keep his or her determination to change, learn new skills, and access needed community supports (exhibit I-1). Stephens and colleagues (2002) describe the MTP rationale, design, and participant characteristics.
Me? Hooked on Pot?
Many individuals for whom this intervention was designed often have difficulty accepting that they are dependent on marijuana. The topic is controversial, even for those who walk through a counselor's door to talk about their marijuana use. People who become clients in BMDC may have
· Put off actions and decisions to the point of being a burden on family and friends
· Given up personal aspirations
· Had nagging health concerns, such as worries about lung damage
· Made excuses for unfinished tasks or broken promises
· Experienced disapproval from family and friends
· Been involved in the criminal justice system.
A Caucasian father of two teenagers, Doug was in his early 40s when his wife forced him to talk
to a counselor about marijuana. He was not happy to be in the counselor's office. "What's the big deal?" he asked. "It's just pot." Doug's wife had given him an ultimatum: either he quit getting high or she would move out. She delivered this ultimatum when their 15-year-old son was suspended from school for smoking marijuana.
When they were younger, Doug and his wife smoked pot together. As their children grew older, however, his wife gave it up. For a long time, she tolerated Doug's continued use, with their agreeing that he'd be discreet. Both felt that the children should not know about his using. Doug tried to be careful, but a few times his son had walked in on him using marijuana.
"Why can't you settle for my promising to try harder to hide it from the kids?" he argued. "It's not
as if it's really a problem. After all, our family benefits from my income."
Given what he said in the first several minutes he spent with the counselor, he saw the real issue as his wife's refusal to be reasonable. But Doug also mentioned that he wondered, "What will people think if word gets out that I smoke marijuana?"
Shirley struggled with thoughts about marijuana and its effects. An African-American mother of
three girls, Shirley was troubled by what she perceived as a conflict between her personal and
Getting high helped her relax and sleep. Shirley had first smoked pot with a favorite uncle, and
other members of her close-knit family had experienced getting high. No one was critical of her
smoking. However, Shirley wanted to be an elementary school teacher. While student teaching,
she was struck by the incongruity of having chosen a profession that called for being a good role model for children yet regularly getting stoned. She had thought a lot about quitting. When she tried to stop, she felt agitated and had difficulty sleeping. Shirley worried that she might not
succeed in changing. She started seeing a counselor to sort out her confusion.
Like Doug, Shirley was grappling with a complicated issue. Doug and Shirley perceived aspects of their marijuana experiences as positive, yet they were troubled by possible consequences.
A 36-year-old married Hispanic man, Miguel has known for years that getting high is no longer a
casual part of his life. When he tried to stop, he got angry at the slightest provocation, could not
relax, and inevitably returned quickly to frequent use.
Not too long ago, Miguel made an appointment at a drug treatment agency but never showed up. The agency employee who answered the phone asked him, "Is marijuana the only drug you use?" He thinks that he needs help but doubts that anyone would understand how he feels. He does not want to be treated like an addict.