Organization of This Manual

Section II. Overview of the Brief Marijuana Dependence Counseling Model and Manual

Section II describes the theoretical basis for BMDC treatment. It explains the therapeutic tasks of the BMDC approach, describes the target population, and provides an overview and the suggested sequencing of BMDC sessions.

Section III. Common Treatment Issues

Section III presents potential pitfalls in BMDC and guidelines for handling issues that may arise.

Some problems identified are not specific to marijuana treatment and may apply generally to substance use disorders or clinical counseling.

Section IV. Getting Started: Assessment Session

Section IV details the strategies for initiating BMDC treatment with a client dependent on marijuana. The assessment session outlines strategies for building rapport, assessment procedures, and MET techniques for engaging the client and identifying goals and change strategies. Clinical information for assessing and evaluating the client’s status, level of marijuana use, problems related to use, and reasons for wanting to change is gathered by the counselor during the initial evaluation and is used to develop an individualized treatment plan. The session includes assessment and scoring tools for completing a client’s Personal Feedback Report (PFR), a critical tool in the implementation of BMDC.

Section V. Enhancing Motivation: Sessions 1 and 2

Sessions 1 and 2 of BMDC follow MET principles. During session 1, the counselor uses the completed PFR to make the client aware of the effects of marijuana use on critical life areas and to increase motivation. Using motivational interviewing strategies, the counselor elicits and reinforces the client’s motivation for change. If the client is ready to change, the discussion shifts from motivational enhancement to cognitive behavioral strategies, goal setting, and the skills to accomplish goals. The guidelines for session 2 instruct the counselor on how to reinforce the client’s efforts to initiate change, review goals and plan alternative strategies for behavior change, and encourage support from the friend or relative who has been invited to the session by the client.

Section VI. Changing Marijuana Use Through Skill Building: Sessions 3 Through 9

Section VI outlines material for the remaining seven sessions of BMDC, including the use of cognitive behavioral strategies for building client motivation and maintaining treatment gains. This section describes the six core skill topics and four elective skill topics used with clients in BMDC (exhibit I-2).

The counselor and client jointly select one of the four elective topics that they decide is most

appropriate. The guidelines for sessions 3 through 9 are twofold:

• The sessions follow detailed protocols for using cognitive behavioral skills to build on client strengths and to overcome specific skill deficits associated with substance dependence.

• The sessions identify other problems that can interfere with recovery from marijuana dependence and suggest clinical case management interventions.

Section VII. Supplemental Readings

A. Who Needs Treatment? The Nature, Prevalence, and Consequences of Marijuana Dependence

This section provides a comprehensive review of the literature on the epidemiology of marijuana dependence, the significance of the problem, and the rational for developing effective and replicable treatments.

B. How Effective Is Treatment for Marijuana Dependence? The Marijuana Treatment Project and Related Studies

This section presents the design, rationale, and findings from major clinical trials that have focused exclusively on marijuana dependence treatment, including MET.

C. Implementing Brief Marijuana Dependence Counseling

This section is intended for program developers, administrators, and supervisors who are responsible for establishing and maintaining an infrastructure to support clinical implementation of BMDC. These guidelines can be used in identifying an appropriate site for BMDC, selecting and supervising counselors, easing the transition to marijuana-specific treatment, and monitoring effectiveness.