In sessions 3 through 9, the counselor builds on the client’s motivation by encouraging the use of specific strategies and skills for accomplishing treatment goals. The counselor offers tools to enhance the client’s motivation to change. This approach is based on cognitive behavioral therapy (CBT) models for substance abuse treatment, with an emphasis on relapse prevention. The Center for Substance Abuse Treatment’s (CSAT’s) Treatment Improvement Protocol (TIP) 34, Brief Interventions and Brief Therapies for Substance Abuse (CSAT 1999a), as well as the KAP Keys (CSAT 2001a) and the Quick Guide (CSAT 2001b) that accompany TIP 34, provides background material on this approach. The CBT sessions follow the approach of Monti and colleagues (1989).

Why Focus on Skills?

Motivation Leads to Skills Development

Once the individual commits to changing his or her behavior, Brief Marijuana Dependence Counseling (BMDC) focuses on building and strengthening skills for becoming and remaining abstinent. The client’s motivation and commitment may vary during treatment, but the motivational enhancement therapy (MET) strategies remain integral to treatment.

The counselor begins by reexploring the client’s commitment to abstinence and using MET strategies (e.g., rolling with resistance, identifying discrepancies) when the client’s motivation wavers. In these sessions, the counselor and client work on developing specific skills (e.g., refusing offers, coping with cravings). This approach is usually slower and somewhat less structured than other CBT approaches, but many individuals who are marijuana dependent find this helpful.

Focusing on the Skills Taught

After completing the engagement, rapport-building, and goal-setting tasks during the early sessions, the client prepares to learn new skills, begins to eliminate problems associated with marijuana use, and addresses other life concerns. During this phase, the counselor coaches the client to develop supportive social connections and establish links with resources to address family, mental, and employment problems. The counselor adjusts the focus, the content of skill topics, and the general approach to meet the client’s needs and provides structure and guidance.

These sessions typically have a more didactic tone than the earlier sections, which are strictly MET. However, these sessions should not be delivered as lectures; the counselor maintains a balance between guiding and teaching, on the one hand, and the client-centered focus of the treatment, on the other.