Adolescent Views about Abstinence and Re…

Adolescent Views about Abstinence and Relapse with Marijuana Use
The August 2009 issue of Clinician’s Research Digest reports on an interesting study that appeared in the Journal of Consulting and Clinical Psychology (2009, 77, 554-565) by researchers King, Chung & Maisto. Up to 2/3 of adolescents return to regular marijuana use 3-6 months after treatment. Booster sessions after treatment could potentially assist in relapse prevention, but the timing and content of the booster sessions have not been well researched. This study included 142 adolescents recruited from 6 addiction treatment facilities. During outpatient treatment that lasted for 6-8 weeks, adolescents marijuana use gradually declined but an increase began to occur at months 5 and 6. They found that motivation to abstain from marijuana declined over time and became predictive of the trajectory of marijuana use. The findings from this study highlight how recovery from substance abuse is a “dynamic process of change over time”. Additionally, “targeting abstinence-related cognitions and increasing self-efficacy related to abstinence compliance during and after treatment can significantly impact current use of marijuana and future relapse in marijuana use among adolescents” Booster sessions beginning at 3 months after treatment may be useful.
I found this article interesting for a number of reasons:
• It reinforces the dynamic nature of both the etiology and recovery from marijuana use
• It reinforces the need to address abstinence related cognitions, which we find to be a central component of 12-step programs
• It recommends booster sessions beginning 3 months after treatment. This was the most surprising conclusion as it does not define what constitutes booster session but more importantly, does not recommend a more frequent schedule. My experience is that adolescents especially need to be practicing, rehearsing and reinforcing their recovery efforts frequently. Waiting for 3 months risks waiting too long.
• Finally, the study reported that a 33% of the adolescents were diagnosed with ADHD and conduct disorder. 80% were diagnosed with marijuana abuse and 50% also meeting criteria for alcohol abuse. These concurrent diagnoses make interpreting the finding more challenging. Certainly teens with ADHD and conduct disorder will necessarily have a harder time with treatment compliance than non-affected youth. Those with concurrent alcohol use are further involved in illegal and influential drug use. The statistics also allow that some students could have all four diagnoses (which we see with regularity at our therapeutic boarding school). These young people require longer term treatment and very carefully planned aftercare.

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