Two psychology professors’ research on marijuana addicition has overturned common misconceptions about marijuana use and treatment. The research suggests that psychological addiction is as difficult or more difficult to break than a physical addiction, according to Robert Stephens of Virginia Tech. Stephens and Roger A. Roffman of the University of Washington also learned that brief treatment programs can be as successful as long programs, and that any professional intervention results in more improvement than no intervention.
Before the late 1980s, it was assumed that if adult users wanted to stop, they could do it themselves. "People have thought of marijuana as a relatively benign drug," Stephens said. But studies provide reasons to be concerned:
There is evidence that marijuana causes structural and functional changes in the lungs. Marijuana has more tars than cigarettes, and, even though marijuana abusers do not smoke less, they inhale more deeply and hold the smoke in longer.
Users report problems with attention, concentration, and short-term memory. Research had suggested that the effects go away when the person stops smoking, but recent studies using more sensitive tests suggest there may be subtle permanent impairments.
In the mid-1980s, Stephens and Roffman received a grant from the National Institute of Drug Abuse to study the effectiveness of treatments. They put 212 adults who wanted to stop using marijuana and who had no alcohol or other drug dependency into two different programs. The subjects were mostly white males, 40 percent with some college education, between the ages of 18 and 65, who were using marijuana two or more times per day.
Groups of 10 to 12 people met with two therapists for 10 sessions over three months. One half participated in relapse-prevention therapy to help them identify situations that lead to use of the drug — such as being around other users, being depressed or stressed, or being bored — and then helped them develop plans, skills, and coping strategies to use in those situations. The second half participated in a discussion/support group with therapists present. They talked about their problem and what they wanted to do about it, but were given no help identifying weak spots and no skills or strategies for coping.
After treatment, the participants were monitored for a year. The results were unexpected. "The two treatment programs did equally well," Stephens said.
As many as 70 percent stopped using marijuana in both programs. A year later, only about 25 percent was still abstinent. However, on average, the entire group had reduced use from 27 or 28 days per month to an average of 15, or by nearly half.
The results were similar to those of programs for alcohol, cigarette, heroin, or cocaine treatments. "That led us to believe that the problem with drug dependency is not in physical dependency," Stephens said. Even people abusing drugs that cause severe physical dependence, such as heroin or alcohol, can be helped through the physical withdrawal.
"It's the psychological functions that the drug serves and the reliance on drugs to get so many needs met — escape, dealing with bad moods, relieving boredom — that are difficult to break," Stephens said. "It's difficult to find anything else that fills all those roles."
To test the results of the first study, the researchers put 291 people who wanted to quit into one of three groups to learn the effectiveness of different types of treatment.
As with the previous relapse-prevention program, one group identified high-risk situations and learned coping skills, performed quitting ceremonies, used images and relaxation techniques, and asked fellow members for support. There were 14 sessions over four months.
The second group's members were seen individually for only two sessions one month apart. Participants were given feedback based on an assessment of their problems, their amount of use, and the times they could not resist using marijuana. Then "motivational interviewing" was used to help them develop motivation to want to stop by looking at the ways marijuana was affecting their lives. They were given instructions about ways to cope with difficult situations.
The third study group was given no treatment for four months to see if individual motivation without treatment would get results.
"Four months of treatment did no better than the two-session motivational intervention," Stephens said. "The treatments seem to work by helping users resolve their ambivalence about quitting and identify ways of kicking the habit. Even then, there's a large group not improving significantly." About 45 percent of the participants were abstinent, compared with 17 percent of the group receiving no treatment. (That group subsequently received treatment.)
The studies did show that those who curtailed or stopped use did not replace marijuana with other drugs or alcohol. They also showed that people wanted to stop using basically for personal reasons. "Self-control was the most strongly endorsed reason for quitting."
Other reasons were lack of self-confidence, memory loss, and fear of a serious illness.
Stephens is now involved with a study with 150 subjects from more diverse socio-economic groups in each of three locations: Seattle, Miami, and the University of Connecticut. "They may need more treatment to find strategies for coping. Maybe the short-term therapy works only for people who have sufficient resources," Stephens said. He also plans to study whether shorter treatments work with individuals who are ambivalent about changing their marijuana use.
— Written by Sally Harris
