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1.  Changing Motives for Use: Outcomes from a Cognitive-Behavioral Intervention for Marijuana-Dependent Adults 
Drug and alcohol dependence  2014;139:41-46.
Motives for use have been identified as important predictors of substance use and related problems; however, little is known about how motives for use change following an intervention and how this change may impact future substance use behaviors. The present study sought to describe change in motives following an intervention for marijuana-dependent adults. Furthermore, investigators examined change in motives as a predictor of treatment outcome.
The study randomized 74 adults to one of two conditions: both of which received 9-session base treatment of cognitive behavioral therapy and motivational enhancement therapy and had access to additional sessions of cognitive behavioral treatment on an as needed basis. The experimental condition received two additional “check-ups” during the course of follow-up.
Significant decreases in reported frequency of motives used were observed following treatment. Changes in Expansion and Coping were associated with differential treatment outcomes. Decreases in Expansion were associated with poorer treatment outcome, while decreases in Coping were associated with better treatment outcome.
The relationship between expansion motives and outcomes was paradoxical. Although there were some inconsistencies in the findings, the results regarding the coping motive were consistent with hypotheses and may have important implications for treatment.
PMCID: PMC4435569  PMID: 24685559
Motives; Cognitive Behavioral Therapy; Motivational Enhancement Therapy; Marijuana; Cannabis; Treatment Outcomes
2.  Situational Determinants of Use and Treatment Outcomes in Marijuana Dependent Adults 
Addictive behaviors  2013;39(3):546-552.
Research and theory strongly support the importance of situational determinants of substance use as targets for intervention, but few studies have systematically examined situational use characteristics in marijuana dependent adults. The present study describes situational use of marijuana in a population of 87 marijuana dependent adults and reports relationships with outcomes of treatment. Use in negative affective situations was independently associated with psychological distress, maladaptive coping strategies, lower self-efficacy, and poorer outcomes post-treatment. The findings were consistent with research on using drugs to cope with negative affect providing evidence of convergence between two different methods of assessing high risk situations for substance use. The results support continued emphasis on coping with negative affect as a target in treatments for marijuana dependence.
PMCID: PMC3917157  PMID: 24321697
marijuana; addiction treatment; situational determinants
3.  A Self-Determination Model of Childhood Exposure, Perceived Prevalence, Justification, and Perpetration of Intimate Partner Violence 
The present research was designed to evaluate self-determination theory as a framework for integrating factors associated with intimate partner violence (IPV) perpetration. The proposed model suggests that childhood exposure to parental violence may influence global motivational orientations which, in turn result in greater cognitive biases (overestimating the prevalence of IPV and justification of IPV) which, in turn, contribute to an individual’s decision to use abusive behavior. Participants included 124 men who had engaged in abusive behavior toward an intimate partner. Results provided reasonable support for the proposed model and stronger support for a revised model suggesting that controlled orientation, rather than autonomy orientation, appears to play a stronger role in the association between childhood exposure to parental violence and cognitive biases associated with abusive behavior.
PMCID: PMC3604988  PMID: 23526064
domestic violence; autonomy orientation; controlled orientation; social norms
5.  Social Norms and Self-efficacy Among Heavy Using Adolescent Marijuana Smokers 
Psychology of Addictive Behaviors  2011;25(4):727-732.
Adolescence is a time in which individuals are particularly likely to engage in health-risk behaviors, with marijuana being the most prevalent illicit drug used. Perceptions of others’ use (i.e., norms) have previously been found to be related to increased marijuana use. Additionally, low refusal self-efficacy has been associated with increased marijuana consumption. This cross-sectional study examined the effects of normative perceptions and self-efficacy on negative marijuana outcomes for a heavy using adolescent population. A structural equation model was tested and supported such that significant indirect paths were present from descriptive norms to marijuana outcomes through self-efficacy. Implications for prevention and intervention with heavy using adolescent marijuana users are discussed.
PMCID: PMC3342009  PMID: 21842969
marijuana; adolescent substance abuse; social norms; social learning theory
6.  Randomized Controlled Trial of Motivational Enhancement Therapy with Non-treatment Seeking Adolescent Cannabis Users: A Further Test of the Teen Marijuana Check-Up 
Cannabis use adversely affects adolescents and interventions that are attractive to adolescents are needed. This trial compared the effects of a brief motivational intervention for cannabis use with a brief educational feedback control and a no-assessment control.
Participants were randomized into one of three treatment conditions: Motivational Enhancement Therapy (MET), Educational Feedback Control (EFC) or Delayed Feedback Control (DFC). Those assigned to MET and EFC were administered a computerized baseline assessment immediately following randomization and completed assessments at the 3- and 12-month follow-up periods. Participants in the DFC condition were not assessed until the 3-month follow-up. Following the completion of treatment sessions, all participants were offered up to 4 optional individual treatment sessions aimed at cessation of cannabis use.
High schools in Seattle, WA, USA.
310 self-referred adolescents who smoked cannabis regularly.
Main outcome measures included days of cannabis use, associated negative consequences, and engagement in additional treatment.
At the 3-month follow-up, participants in both the MET and EFC conditions reported significantly fewer days of cannabis use and negative consequences compared to DFC. Frequency of cannabis use was less in MET relative to EFC at 3 months, but did not translate to differences in negative consequences. Reduction in use and problems were sustained at 12-months but there were no differences between MET and EFC interventions. Engagement in additional treatment was minimal and not different by condition.
Brief interventions can attract and have positive impacts on adolescent cannabis users, but the mechanisms of the effects are yet to be identified.
PMCID: PMC3177997  PMID: 21688877
7.  Motives for cannabis use in high-risk adolescent users 
The present investigation examined the relationships between motives for cannabis use and negative consequences associated with cannabis use following a brief intervention. The sample consisted of 205 adolescent cannabis users (66.3% male), who were recruited in high schools and randomly assigned to a brief two-session motivational enhancement therapy (MET) or an educational feedback control (EFC). Results supported the hypothesis that using cannabis to cope with negative affect would predict the number of problems and dependence symptoms related to cannabis use, after controlling for age, gender, years and frequency of cannabis use, and internalizing and externalizing behavior problems. Significant interactions between internalizing behavior problems and the coping motive showed that using to cope was associated with a higher number of cannabis dependence symptoms among adolescents reporting lower levels internalizing behavior problems. Findings support the potential utility of conducting further research to explore the coping motive as an important indicator of problematic cannabis use.
PMCID: PMC3211084  PMID: 21688873
cannabis; marijuana; adolescents; cannabis use motives; internalizing behavior problems
8.  Treatment process, alliance and outcome in brief versus extended treatments for marijuana dependence 
Addiction (Abingdon, England)  2010;105(10):1799-1808.
The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome.
Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated.
Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence.
Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence.
PMCID: PMC3422659  PMID: 20840200
Alliance; behavioral treatment; brief treatment; marijuana dependence; Marijuana Treatment Project; treatment process
9.  A Telephone Intervention for Substance-Using Adult Male Perpetrators of Intimate Partner Violence 
To preliminarily evaluate telephone-delivered motivational enhancement therapy (MET) in motivating unadjudicated and nontreatment seeking intimate partner violence (IPV) perpetrators, who also use substances, to self-refer into treatment.
124 adult men were recruited via a multimedia marketing campaign and were randomly assigned to the intervention (MET) or comparison group following a baseline assessment. Participants in the MET condition received a personalized feedback report on their IPV and substance-use behaviors, consequences, and social norms beliefs.
Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, increasing motivation for treatment seeking, and changing perceived norms for IPV and substance abuse (SA).
Applications for brief MET interventions to facilitate voluntary treatment entry among substance-using IPV perpetrators are discussed.
PMCID: PMC3384695  PMID: 22754270
IPV perpetration; substance abuse; brief interventions; randomized controlled trials; motivational enhancement therapy; check-up model; voluntary treatment referral
10.  Development of a Marketing Campaign to Recruit Non-adjudicated and Untreated Abusive Men for a Brief Telephone Intervention 
Journal of family violence  2008;23(5):343-351.
Although voluntary enrollment by abusive men in domestic violence perpetrator treatment programs occurs, most men enter treatment only after they have injured a partner or family member and have been arrested, convicted and sentenced. This leaves a serious gap for those who engage in abusive behavior but who have not been served by the legal or social service systems. To address this gap, the researchers applied social marketing principles to recruit abusive men to a telephone-delivered pre-treatment intervention (the Men’s Domestic Abuse Check-Up—MDACU), designed to motivate non-adjudicated and untreated abusive men who are concurrently using alcohol and drugs to enter treatment voluntarily. This article discusses recruitment efforts in reaching perpetrators of intimate partner violence, an underserved population. Informed by McGuire’s communication and persuasion matrix, the researchers describe three phases of the MDACU’s marketing campaign: (1) planning, (2) early implementation, and (3) revision of marketing strategies based on initial results. The researchers’ “lessons learned” conclude the paper.
PMCID: PMC3375950  PMID: 22707851
Abusive men; Social marketing; Recruitment; Early intervention; Prevention
11.  The Sex Check: The Development of an HIV-Prevention Service to Address the Needs of Latino MSM 
The Sex Check is a brief, telephone-delivered, HIV-prevention intervention tailored for individuals who are at high risk of HIV infection or transmission but who are neither reducing their risk on their own nor seeking support for this purpose. Because the intervention is delivered on a one-to-one basis, permits anonymity, is marketed to “men who have sex with men,” and is brief, it may be particularly responsive to cultural, structural, and attitudinal barriers to serving Latino MSM. Because many Latino MSM continue to engage in high risk sexual behaviors, developing and testing prevention interventions with this population is a public health priority.
PMCID: PMC3352663  PMID: 22605913
HIV prevention; Latino MSM; high-risk sexual behaviors; risk reduction
12.  Lowering Obstacles to HIV Prevention Services: Effects of a Brief, Telephone-Based Intervention Using Motivational Enhancement Therapy 
Annals of Behavioral Medicine  2007;34(2):177-187.
Brief and low-burden HIV risk reduction counseling interventions are needed for populations at greatest risk for HIV infection.
This randomized controlled trial tested a brief theory-based counseling intervention delivered entirely over the telephone for men who engage in unprotected intercourse with men.
Participants received either risk reduction counseling that included information, motivational enhancement and behavior skills building, or brief HIV education counseling. A total of 319 participants completed follow-up assessments over a 10-month period. Descriptive and random effects mixed models are used to evaluate findings.
Results demonstrate that a brief telephone intervention can reach and engage high-risk men in risk reduction counseling. Nearly one third of participants identified as men of color; the median age was 33 years. Participants in both counseling conditions increased their motivation and behavioral skills to practice safer sex and reduced their number of sex partners and frequencies of engaging in unprotected anal sex over the study observation period. However, there were few differences between intervention conditions.
The effects of repeated measurement reactivity and brief interpersonal consciousness raising may account for the lack of differences between counseling conditions and the decrease in risk for all participants over time.
PMCID: PMC3352672  PMID: 17927556
13.  Self-Determination Theory and Motivational Interviewing: Complementary Models to Elicit Voluntary Engagement by Partner-Abusive Men 
Research examining intimate partner violence (IPV) has lacked a comprehensive theoretical framework for understanding and treating behavior. The authors propose two complementary models, a treatment approach (Motivational Interviewing, MI) informed by a theory (Self-Determination Theory; SDT), as a way of integrating existing knowledge and suggesting new directions in intervening early with IPV perpetrators. MI is a client-centered clinical intervention intended to assist in strengthening motivation to change and has been widely implemented in the substance abuse literature. SDT is a theory that focuses on internal versus external motivation and considers elements that impact optimal functioning and psychological well-being. These elements include psychological needs, integration of behavioral regulations, and contextual influences on motivation. Each of these aspects of SDT is described in detail and in the context of IPV etiology and intervention using motivational interviewing.
PMCID: PMC3351133  PMID: 22593609
14.  Evaluating the Impact of Intimate Partner Violence on the Perpetrator: The Perceived Consequences of Domestic Violence Questionnaire 
Journal of Interpersonal Violence  2010;25(9):1684-1698.
Surprisingly, little is known about how IPV perpetrators perceive the consequences of their violent behavior. This article describes the development and evaluation of the Perceived Consequences of Domestic Violence Questionnaire (PCDVQ). The PCDVQ is a 27-item self-report instrument designed to assess the consequences of intimate partner violence (IPV) as perceived by the perpetrator. Data from 124 nontreatment seeking, male, IPV perpetrators recruited from the community provided support for the internal consistency of the PCDVQ. Participants reported an average of 9.97 (SD = 4.57) consequences. Scores on the PCDVQ significantly predicted motivation for change, β = .19, t(113) = 2.03, p < .05, and treatment seeking, χ2(df = 1) = 10.79, p < .01, odds ratio = 1.27 (95% CI: 1.10-1.46). Clinical implications of this instrument are discussed.
PMCID: PMC3341660  PMID: 20139346
consequences; assessment; domestic violence; intervention; motivational interviewing
15.  The Men’s Domestic Abuse Check-Up 
Violence against Women  2008;14(5):589-605.
Batterer intervention programs primarily work with individuals mandated to participate. Commonly, attrition is high and outcomes are modest. Motivational enhancement therapy (MET), most widely studied in the substance abuse field, offers a potentially effective approach to improving self-referral to treatment, program retention, treatment compliance, and posttreatment outcomes among men who batter and who abuse substances. A strategy for using a catalyst variant of MET (a “check-up”) to reach untreated, nonadjudicated perpetrators is described in detail. Unique challenges in evaluating the success of this approach are discussed, including attending to victim safety and determining indicators of increased motivation for change.
PMCID: PMC3341132  PMID: 18408174
abusers; check-up; motivational
16.  Normative Misperceptions of Abuse Among Perpetrators of Intimate Partner Violence 
Violence against Women  2010;16(4):370-386.
This research was designed to evaluate the applicability of social norms approaches to interventions with male perpetrators of intimate partner violence (IPV). Participants included 124 nonadjudicated IPV perpetrating men recruited from the general population who completed assessment of their own IPV behaviors via telephone interviews and estimated the prevalence of behaviors in other men. Results indicated that IPV perpetrators consistently overestimated the percentage of men who engaged in IPV and that their estimates were associated with violence toward their partner over the past 90 days. Findings provide preliminary support for incorporating social norms approaches into clinical applications.
PMCID: PMC3341134  PMID: 20200408
domestic violence; motivational interviewing; social norms
17.  The Teen Marijuana Check-Up: An In-School Protocol for Eliciting Voluntary Self-Assessment of Marijuana Use 
Given the prevalence of regular marijuana use among adolescents and associated risks for adverse consequences to functioning, effective interventions are needed that are tailored for this population. To date, most such counseling approaches have relied on non-voluntary participation by adolescent marijuana smokers and the outcomes have been only modestly successful. The Teen Marijuana Check-Up is a brief motivational enhancement intervention publicized as a non-pressured and confidential opportunity for the teen marijuana smoker to “take stock” of his/her use. The intervention is designed for in-school implementation and intended to elicit the teen's voluntary participation. This paper highlights the manner in which adolescents are recruited, key intervention elements, the nature of the counseling style utilized, and clinical challenges. The outcomes of two trials with this intervention are briefly discussed.
PMCID: PMC2613344  PMID: 19122796
cannabis; marijuana; adolescent; brief intervention; check-up
18.  Motivational Enhancement Therapy for Adolescent Marijuana Users: A Preliminary Randomized Controlled Trial 
This study's aims were (a) to investigate the feasibility of a school-based motivational enhancement therapy (MET) intervention in voluntarily attracting adolescents who smoke marijuana regularly but who are not seeking formal treatment and (b) to evaluate the efficacy of the intervention in reducing marijuana use. Ninety-seven adolescents who had used marijuana at least 9 times in the past month were randomly assigned to either an immediate 2-session MET intervention or to a 3-month delay condition. Two thirds of the sample characterized themselves as in the precontemplation or contemplation stages of change regarding marijuana use. Participants’ marijuana use and associated negative consequences were assessed at baseline and at a 3-month follow-up. Analyses revealed that both groups significantly reduced marijuana use at the 3-month follow-up ( p < .001); however, no between-group differences were observed. Despite the absence of a clear effect of MET, this study demonstrated that adolescents could be attracted to participate in a voluntary marijuana intervention that holds promise for reducing problematic levels of marijuana use.
PMCID: PMC2587139  PMID: 16822119
motivational enhancement therapy; adolescents; cannabis; marijuana; school based
19.  Marijuana Dependence and Its Treatment 
The prevalence of marijuana abuse and dependence disorders has been increasing among adults and adolescents in the United States. This paper reviews the problems associated with marijuana use, including unique characteristics of marijuana dependence, and the results of laboratory research and treatment trials to date. It also discusses limitations of current knowledge and potential areas for advancing research and clinical intervention.
PMCID: PMC2797098  PMID: 18292704
20.  The check-up: in-person, computerized, and telephone adaptations of motivational enhancement treatment to elicit voluntary participation by the contemplator 
Countless barriers come between people who are struggling with substance abuse and those charged with providing substance abuse treatment. The check-up, a form of motivational enhancement therapy, is a harm reduction intervention that offers a manner of supporting individuals by lowering specific barriers to reaching those who are untreated. The check-up was originally developed to reach problem drinkers who were neither seeking treatment nor self-initiating change. The intervention, marketed as an opportunity to take stock of one's experiences, involves an assessment and personalized feedback delivered with a counseling style termed motivational interviewing. Check-ups can be offered in care settings to individuals who, as a result of screening, manifest risk factors for specific disorders such as alcoholism. They can also be free-standing and publicized widely to the general public. This paper will discuss illustrations of in-person, computerized, in-school, and telephone applications of the free-standing type of check-up with reference to alcohol consumers, adult and adolescent marijuana smokers, and gay/bisexual males at risk for sexual transmission of HIV. The paper's major focus is to highlight how unique features of each application have the potential of reducing barriers to reaching specific at-risk populations. Also considered are key policy issues such as how check-up services can be funded, which venues are appropriate for the delivery of check-up interventions, pertinent competency criteria in evaluating staff who deliver this intervention, how marketing can be designed to reach contemplators in untreated at-risk populations, and how a check-up's success ought to be defined.
PMCID: PMC1781441  PMID: 17210075
21.  Lesbian and Bisexual Women in Small Cities—At Risk for HIV? 
Public Health Reports  1996;111(4):347-352.
Women who have sex with women are a relatively hidden group that has been overlooked in most AIDS research and prevention efforts, primarily because the efficiency of HIV transmission between female partners is believed to be low. Although data are scant, it is commonly assumed that members of this population are not at high risk for HIV infection. However, a recent study of lesbian and bisexual women living in the San Francisco Bay area reported a relatively high seroprevalence rate and has raised additional questions about this group's HIV risk. The present study, the first to focus on lesbian and bisexual women living outside major AIDS epicenters, provides additional evidence. It describes risk factors for HIV transmission among lesbian and bisexual women living in small cities in four geographic regions of the United States.
On three consecutive evenings in 1992, members of the research team distributed anonymous structured written surveys to women patrons as they entered gay bars in each of 16 small cities.
Almost 17% of bisexual respondents and 0.5% of lesbians reported having had unprotected vaginal or anal sex with a male during the two months prior to the survey. Almost 10 percent of bisexual women and 8.8% of lesbians in the sample reported a history of injection drug use. Among those women surveyed who said they had been tested, 1.4% reported they were infected with HIV.
Self-identified sexual orientation was highly consistent with recent sexual behavior. HIV risk related to sexual behavior was concentrated among self-identified bisexual women. The prevalence of injection drug use was substantial among both bisexual and lesbians. Developers of HIV risk behavior programs should take the prevalence of these risk behaviors into consideration in the design of effective HIV prevention interventions tailored to the needs of this hidden population.
PMCID: PMC1381880  PMID: 8711103
22.  Levels and Predictors of HIV Risk Behavior Among Women in Low-Income Public Housing Developments 
Public Health Reports  1995;110(6):707-713.
THE PREVALENCE OF increases in human immunodeficiency virus infection and illness rates among urban disadvantaged women underscore the urgent need for acquired immunodeficiency syndrome prevention interventions for high-risk women.
Few studies, however, have examined the factors contributing to risk in this population or predictors of risk taking and risk reduction.
A total of 148 women, most of them of racial minorities, living in low-income public housing developments completed measures designed to assess risk for human immunodeficiency virus infection and to analyze factors related to risk taking, including knowledge about acquired immunodeficiency syndrome, behavior change self-efficacy, intention to use condoms, and social norm perception about safer sex practices. History of sexually transmitted diseases, low rates of condom use, and relationships with men who were injection drug users or who were not sexually exclusive were commonly reported.
Women were divided into high- or low-risk categories based on behavior during the two preceding months. Women at low risk believed more strongly in personal efficacy of behavior change, were more committed to using condoms, and perceived risk reduction steps as more socially normative than high-risk women. Culturally tailored human immunodeficiency virus prevention interventions that address these dimensions are needed.
PMCID: PMC1381813  PMID: 8570824

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