Behavioral treatment for marijuana dependence: Randomized trial of contingency management and self-efficacy enhancement

Objective: The purpose of the present study was to develop a treatment for marijuana dependence specifically designed to enhance self-efficacy. Method: The participants were 215 marijuana-dependent men and women randomized to one of three 9-week outpatient treatments: a condition intended to enhance self-efficacy through successful completion of treatment-related tasks (motivational enhancement plus cognitive-behavioral treatment plus contingency management reinforcing completion of treatment homework; MET + CBT + CMHomework); a condition that controlled for all elements except for reinforcement of homework (MET + CBT + contingency management reinforcing drug abstinence: MET + CBT + CMAbstinence): or a case management control condition (CaseM). Participants in the two MET + CBT conditions were also asked to complete interactive voice recordings three times per week during treatment to confirm homework completion. Results: All patients showed modest improvements over time through 14 months, with few between-treatment effects on outcomes. Latent Class Growth Models, however, indicated that a subsample of patients did extremely well over time. This subsample was more likely to have been treated in the CMAbstinence condition. In turn, this treatment effect appears to have been accounted for by days of continuous abstinence accrued during treatment, and by pre-post increases in self-efficacy. Conclusions: The most effective treatments may be those that elicit abstinence while increasing self-efficacy. (c) 2012 Elsevier Ltd. All rights reserved.