Academic journal article International Journal of Clinical and Health Psychology

Evidence-Based Treatments for Adolescents with Cannabis Use Disorders in the Spanish Public Health System

Academic journal article International Journal of Clinical and Health Psychology

Evidence-Based Treatments for Adolescents with Cannabis Use Disorders in the Spanish Public Health System

Article excerpt

In Spain, 92% of adolescents in treatment under 15 years of age and 79% of those aged 15-19 report cannabis as their primary drug of abuse (European Monitoring Centre for Drugs and Drug Addiction, 2012). However, a review of the liter- ature shows that no evidence-based treatment (EBT) aimed at this population has been implemented in our country. The need for such treatment programs for adolescent Cannabis Use Disorders (CUD) in Spain is very urgent. In the past years, several controlled studies have focused on treatment for CUD for adolescents (Dennis et al., 2004; Hendriks, van der Schee, & Blanken 2011; Martin & Copeland, 2005; Rigter et al., 2013; Walker et al., 2011). Among these, the Cannabis Youth Treatment study (CYT) is the largest published clinical trial (Dennis et al., 2004). Results indicated that Adoles- cent Community Reinforcement Approach (A-CRA) was the most cost-effective intervention, and it showed a non- significant trend for higher rates of recovery one year after treatment, when compared to MET/CBT5 (Motiva- tional Enhancement Therapy/Cognitive Behavioral Therapy) and MDFT (Multidimensional Family Therapy). Despite the general effectiveness, however, the most powerful interven- tions tested so far with adolescent cannabis users achieved only modest abstinence rates and substance use reductions (Stanger & Budney, 2010). In this context, the integra- tion of abstinence-based contingency management (CM) is a promising approach (Nordstrom & Levin, 2007; Stanger & Budney, 2010) that has proved to be an efficacious model for adolescent marijuana abuse (Kamon, Budney, & Stanger 2005; Stanger, Budney, Kamon, & Thostensen, 2009).

The goal of the present study was to describe a pilot implementation of two EBTs for adolescent CUDs in the Spanish Public Health System. A-CRA was chosen given its positive implementation rates and effectiveness (Godley, Garner, Smith, Meyers, & Godley, 2011), as well as its flex- ibility to address clients' individual needs (Godley, White, Diamond, Passetti, & Titus, 2001). A-CRA was then partially combined with an abstinence-based CM program using a quasi-experimental design, given its demonstrated efficacy with adolescents (Stanger & Budney, 2010).We aimed to assess the clinical outcomes, determine the feasibility and limitations of the therapeutic approaches and their integration, and to discuss the barriers encountered in this specific context.



Participants were recruited from those requesting treat- ment in clinical settings and through advertisements in pamphlets, on radio and in local newspapers. Any demand of treatment from an adolescent or their families related to drug use problems was considered for inclusion in the study. Inclusion criteria for individuals to participate were: (1) Being aged 12-18, (2) Individual or family report of cannabis use in the previous 30 days or delivering a positive urinal- ysis at intake, and (3) Living with a responsible adult who agreed to participate. Exclusion criteria included (1) Pre- senting a mental or physical disorder requiring more specific treatment, (2) Having a substance-use disorder requiring more intense or inpatient treatment, (3) Not living within 30 minutes of the treatment facility, and (4) Not being flu- ent in Spanish. All participants and their families provided informed consent.

In the Principality of Asturias, 70 participants requested treatment and 19 (27.1%) met the inclusion criteria. In Madrid, 63 requested treatment and 7 (11.1%) met the inclusion criteria. All adolescents and their families meet- ing inclusion criteria agreed to participate. A total of 26 participants (19.55%) were allocated to one of the two treat- ment conditions. Two adolescents abandoned the study after allocation and before completing intake assessment (see Figure 1).


A quasi-experimental design with two treatment conditions was implemented. …

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