Self-efficacy and motivation to quit marijuana use among young women

Readiness to change among justice-involved young adults in an alternative sentencing program who screened positive for alcohol or drug risk

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Justice-involved young adults are in need of tailored substance use interventions.

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Readiness to change is a key component of substance use behavioral change.

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Many justice-involved young adults were ready to change their substance use.

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Personal reasons to quit using drugs are a potential intervention target.

Introduction

Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults.

Method

Justice-involved young adults (18–24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness.

Results

More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated.

Conclusions

This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.

A psychometric assessment of the Brief Situational Confidence Questionnaire for Marijuana (BSCQ-M) in juvenile justice-involved youth

Cannabis refusal self-efficacy, defined as confidence in the ability to refuse cannabis or to avoid cannabis use, is associated with decreased cannabis use. Juvenile justice-involved youth are at high risk for cannabis use and may have lower refusal self-efficacy. While court-involved, non-incarcerated (CINI) and incarcerated youth are groups that are both at high-risk for cannabis use, the experience of incarceration may impact the measurement of refusal self-efficacy for cannabis. The factor structure, measurement invariance, and concurrent validity of the Brief Situational Confidence Questionnaire for Cannabis (BSCQ-M) was assessed among CINI (n = 148) and incarcerated (n = 199) youth (80.7% male, M_age = 16.3). Confirmatory factor analyses indicated that a correlated 3-factor model including positive/good times, negative internal, and negative external situational factors best fit the data. Multigroup measurement invariance testing revealed that the BSCQ-M demonstrated configural, metric, scalar, and residual invariance across CINI and incarcerated samples, indicating measurement invariance across the two groups. Negative binomial regressions revealed that BSCQ-M scores were significantly negatively associated with concurrent cannabis use. Results suggest that the BSCQ-M is a brief, psychometrically sound measure of refusal self-efficacy for cannabis among juvenile justice-involved youth that can be utilized with both CINI and incarcerated youth.

Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

Alcohol substitution during one month of cannabis abstinence among non-treatment seeking youth

OBJECTIVE

Cannabis and alcohol use are correlated behaviors among youth. It is not known whether discontinuation of cannabis use is associated with changes in alcohol use. This study assessed alcohol use in youth before, during, and after 4 weeks of paid cannabis abstinence.

METHODS

Healthy, non-treatment seeking, cannabis users (n = 160), aged 14-25 years, 84% of whom used alcohol in the last month, were enrolled for a 4-week study with a 2-4 week follow-up. Participants were randomly assigned to 4 weeks of either biochemically-verified cannabis abstinence achieved through a contingency management framework (CB-Abst) or monitoring with no abstinence requirement (CB-Mon). Participants were assessed at baseline and approximately 4, 6, 10, 17, 24, and 31 days after enrollment. A follow-up visit with no cannabis abstinence requirement for CB-Abst was conducted after 2-4 weeks.

RESULTS

Sixty percent of individuals assigned to the CB-Abst condition increased in frequency and quantity of alcohol consumption during the 4-week period of incentivized cannabis abstinence. As a whole, CB-Abst increased by a mean of 0.6 drinking days and 0.2 drinks per day in the initial week of abstinence (p's < 0.006). There was no evidence for further increases in drinking frequency or quantity during the 30-day abstinence period (p's > 0.53). There was no change in drinking frequency or quantity during the 4-week monitoring or follow-up periods among CB-Mon.

CONCLUSIONS

On average, 4 weeks of incentivized (i.e., paid) cannabis abstinence among non-treatment seeking youth was associated with increased frequency and amount of alcohol use in week 1 that was sustained over 4 weeks and resolved with resumption of cannabis use. However, there was notable variability in individual-level response, with 60% increasing in alcohol use and 23% actually decreasing in alcohol use during cannabis abstinence. Findings suggest that increased alcohol use during cannabis abstinence among youth merits further study to determine whether this behavior occurs among treatment seeking youth and its clinical significance.

Cannabis, Decision-Making, and Online Assistance Seeking

BACKGROUND AND OBJECTIVES

Maladaptive decision-making strategies could contribute to cannabis-related problems, as some individuals may neither select safe patterns of cannabis use, nor seek treatment.

METHODS

To explore decision-making styles and their relationship to cannabis-related harm, 153 respondents completed the Cannabis Use Disorders Identification Test-Revised (CUDIT-R), the Melbourne Decision Making Questionnaire (MDMQ), and answered questions about their willingness to seek online: (1) further information or (2) treatment for cannabis-related issues.

RESULTS

Multiple regression considered relationships between problematic cannabis use, decision-making style, and cannabis use within the past month. Subscales of the CUDIT-R revealed that: (1) hazardous use was associated with higher hypervigilance and higher decisional self-esteem; (2) dependence symptoms were associated with lower vigilance and higher procrastination; and (3) harmful use was associated with higher procrastination. People with symptoms of CUD were less likely to seek further help or support online if prone to procrastination or buckpasssing.

DISCUSSION AND CONCLUSIONS

Decisional style influenced cannabis use and symptoms. Those people with cannabis-related problems that did not seek online assistance were defensively avoidant.

SCIENTIFIC SIGNIFICANCE

Procrastination is a feature of problematic cannabis use. Online offers of assistance may be ignored by defensively avoidant CUD clients. (Am J Addict 2019;00:1-7).

Perceptions of Iranian Female Drug Users Toward HIV Testing: A Qualitative Content Analysis

BACKGROUND

Drug-dependent women are the vulnerable population deprived of access to health services and also have particular relevance to public health perspective because they are important bridge population for driving HIV/AIDS epidemic. This qualitative study aimed to explore the perception of drug-dependent women regarding HIV testing.

METHODS

In this qualitative study, we approached 23 women with substance use disorders in 2 of the selected drop-in centers in the south Tehran. Focus group discussion, face-to-face semistructured interviews, and field notes were used to collect the data. Qualitative content analysis was used to extract the explanatory model of women's perceptions about HIV testing.

RESULTS

Four main themes emerged from the data: forgotten health during use, having misconception, and sharing of sexual partner in secrecy and concerns. Seven subthemes were extracted, including not being sex worker, point of ruin, voluntary selection and concerns about fear of abandonment and fear of loss and death, double concern, and future of children.

CONCLUSION

Beliefs and values of drug-dependent women can be positive points leading them to do an HIV test, and misconceptions of these women would be corrected by using safe behavioral skills training.

Psychotherapy Is Chaotic-(Not Only) in a Computational World

Objective: The aim of this article is to outline the role of chaotic dynamics in psychotherapy. Besides some empirical findings of chaos at different time scales, the focus is on theoretical modeling of change processes explaining and simulating chaotic dynamics. It will be illustrated how some common factors of psychotherapeutic change and psychological hypotheses on motivation, emotion regulation, and information processing of the client's functioning can be integrated into a comprehensive nonlinear model of human change processes.

Methods: The model combines 5 variables (intensity of emotions, problem intensity, motivation to change, insight and new perspectives, therapeutic success) and 4 parameters into a set of 5 coupled nonlinear difference equations. The results of these simulations are presented as time series, as phase space embedding of these time series (i.e., attractors), and as bifurcation diagrams.

Results: The model creates chaotic dynamics, phase transition-like phenomena, bi- or multi-stability, and sensibility of the dynamic patterns on parameter drift. These features are predicted by chaos theory and by Synergetics and correspond to empirical findings. The spectrum of these behaviors illustrates the complexity of psychotherapeutic processes.

Conclusion: The model contributes to the development of an integrative conceptualization of psychotherapy. It is consistent with the state of scientific knowledge of common factors, as well as other psychological topics, such as: motivation, emotion regulation, and cognitive processing. The role of chaos theory is underpinned, not only in the world of computer simulations, but also in practice. In practice, chaos demands technologies capable of real-time monitoring and reporting on the nonlinear features of the ongoing process (e.g., its stability or instability). Based on this monitoring, a client-centered, continuous, and cooperative process of feedback and control becomes possible. By contrast, restricted predictability and spontaneous changes challenge the usefulness of prescriptive treatment manuals or other predefined programs of psychotherapy.

Treatment seeking in cannabis dependence: The role of social cognition

BACKGROUND AND AIMS

Relatively few cannabis dependent individuals seek treatment and little is known about the determinants of treatment seeking. Social Cognitive Theory (SCT) provides a useful framework for examining human behaviour and motivation which may be helpful in explaining treatment seeking. This study examined the differences in cannabis outcome expectancies and cannabis refusal self-efficacy between treatment seekers and non-treatment seekers with cannabis dependence.

DESIGN

Non-treatment seekers were referred to an illicit drug diversion program. Treatment seekers commenced an outpatient cannabis treatment program and completed a comprehensive assessment that included measures of cannabis outcome expectancies and refusal self-efficacy.

SETTING

A public hospital alcohol and drug outpatient clinic.

PARTICIPANTS

269 non-treatment seekers and 195 individuals commencing cannabis dependence treatment.

MEASUREMENTS

The Cannabis Expectancy Questionnaire (CEQ), Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), Severity of Dependence Scale - Cannabis (SDS-C), General Health Questionnaire (GHQ-28) and Readiness to Change Questionnaire (RTC) were completed.

FINDINGS

Treatment seekers had significantly higher levels of negative cannabis outcome expectancies and significantly lower levels of emotional relief refusal self-efficacy (belief in ability to resist using cannabis when experiencing negative affect) (ps<0.001). Treatment seekers had significantly higher levels of psychological distress and self-perceived cannabis dependence compared to non-treatment seekers (ps<0.001).

CONCLUSIONS

High negative cannabis outcome expectancies and low emotional relief refusal self-efficacy may play a key role in motivation to seek treatment.

Effectiveness of the behavior change intervention to improve harm reduction self-efficacy among people who inject drugs in Thailand

BACKGROUND

People who inject drugs (PWID) in Thailand reported unsafe injection practices resulting in injection-related health consequences. Harm reduction self-efficacy plays an important role and could be improved to reduce harm associated with injecting drugs. Evidence-based interventions targeting PWID are needed. This study sought to evaluate the effectiveness of the behavior change intervention within the PWID population.

METHODS

The behavior change intervention, Triple-S, was designed to improve harm reduction self-efficacy among PWID. This quasi-experimental study was a pre- and post-comparison with a control group design. Participants were PWID, aged 18-45 years, and located in Bangkok. Changes in harm reduction self-efficacy of the intervention group were compared with the control group using paired and independent t-test.

RESULTS

Most of PWID were male (84%), had a secondary school and lower education (71%), were single, and had a mean age of 41 years. They had been injecting drugs for an average of 20 years, and the median of drug injections per week was ten times in the past month. Pre- and post-intervention effects were measured and results showed that the intervention group reported improvement in harm reduction self-efficacy in negative emotional conditions (P=0.048).

CONCLUSION

Our findings suggest that Triple-S intervention can significantly improve harm reduction self-efficacy in negative emotional conditions. The results may suggest the importance of behavior change intervention, especially when integrated with services provided by drop-in centers. The intervention can be further developed to cover other harm reduction behaviors and improve harm reduction self-efficacy.

Alcohol use potentiates marijuana problem severity in young adult women

BACKGROUND

Most young adult women who smoke marijuana also drink alcohol. Marijuana-related problems are associated with marijuana use frequency. We hypothesized that increased alcohol use frequency potentiates the association between frequency of marijuana use and marijuana-related problem severity.

METHODS

We recruited women aged 18 to 24 who smoked marijuana at least monthly and were not treatment seeking. Marijuana and alcohol use were measured using the timeline follow-back method. Problems associated with marijuana use were assessed using the Marijuana Problems Scale.

FINDINGS

Participants (n = 332) averaged 20.5 ± 1.8 years of age, were 66.7% non-Hispanic White, and reported using marijuana on 51.5 ± 30.6 and alcohol on 18.9 ± 16.8 of the 90 previous days. Controlling for education, ethnicity, years of marijuana use, and other drug use, frequency of marijuana use (b = .22; p < .01) and frequency of alcohol use (b = 0.13; p < .05) had significant, positive effects on marijuana problem severity. In a separate multivariate model, the linear by linear interaction of marijuana by alcohol use frequency was significant (b = 0.18; p < .01), consistent with the hypothesis.

CONCLUSIONS

Concurrent alcohol use impacts the experience of negative consequences from marijuana use in a community sample of young women. Discussions of marijuana use in young adults should consider the possible potentiating effects of alcohol use.