Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

28. Matching and Differential Therapies 655treatment with a primary complaint of marijuana abuse or dependence. Currently,no effective pharmacotherapies for marijuana dependence exist, andonly a few controlled trials of psychosocial approaches have been completed;thus, there is as yet little data on the types of individuals who respond particularlywell or poorly to these approaches. Stephens, Roffman, and Curtin (2000)compared a delayed treatment control, a two-session motivational approach,and the more intensive (14 session) relapse prevention approach, and foundbetter marijuana outcomes for the two active treatments compared with thedelayed treatment control group, but no significant differences between thebrief and the more intensive treatment. More recently, a replication and extensionof that study, involving a multisite trial of 450 marijuana-dependentpatients, compared three approaches: (1) a delayed treatment control,(2) a two-session motivational approach, and (3) a nine-session combinedmotivational–coping skills approach. Results suggested that both active treatmentswere associated with significantly greater reductions in marijuana usethan the delayed treatment control through a 9-month follow-up (MTPResearch Group, 2004). Moreover, the nine-session intervention was significantlymore effective than the two-session intervention, and this effect was alsosustained through the 9-month follow-up. Adding contingency managementhas also been shown to improve outcomes in these populations (Budney, Higgins,Radonovich, & Novy, 2000). Moreover, some early evidence suggests thatindividuals who submit drug-negative urines at treatment inception may havebetter response to treatment (Moore & Budney, 2002), a finding that is consistentwith that of the general drug abuse treatment literature (Ehrman, Robbins,& Cornish, 2001).CONCLUSIONSRecent years have been marked by enormous progress in the identification of awide range of empirically validated pharmacological and behavioral therapiesfor SUDs. Important new treatment options, such as naltrexone and acamprosatefor alcohol use disorders, and buprenorphine for opioid dependence, wereunavailable 20 years ago, as were behavioral therapies, including contingencymanagement, behavioral marital counseling, motivational interviewing, andCBT—all of which have demonstrated efficacy across a range of SUDs andpopulations. Equally promising are the findings that combining pharmacotherapieswith behavioral therapies can extend, strengthen, and make treatmenteffects more durable. Nevertheless, the rapid, recent progress in the identificationof efficacious therapies has not been matched by identification of moderatingvariables or consistent patient predictors of response to specific treatmentapproaches that can guide researchers’ and clinicians’ efforts to match individu-