Clinically significant improvements in function Kathleen M Carrroll PhD, Yale University Supported by NIDA DA039136 NIDA P50 DA009241 NIDA U10 DA015831 NIDA DA041661 MTP Research Group

Clinically significant outcomes ‘Safe’ levels of use Short versus long term consequences Defining ‘success’, responder Feel and function Cannabis dependence symptoms Cannabis-related problems Craving and withdrawal symptoms, sleep quality ASI days of problems (floor effects for composites?) Quality of life (Brezing et al, 2018)

MTP (JCCP, 2004): N=450 outpatient cannabis dependent individuals, 3 sites

MTP: Change in DSM-IV Dependence symptoms by treatment

DSM-IV Abuse Symptoms by time

Abstinent versus improved (no DSM dependence symptoms) versus not improved, past 90 days

Marijuana Problems Scale-MTP

Young probation referred marijuana users, N=136 Average age 21 (range 18-25) 90% male 60% African American, 13% Latin American 50% did not complete high school 51% unemployed Average 5 previous arrests Average total months incarceration=9

Treatment conditions CBT/MET TAU CM Attendance + abstinence No

Retention: Percent completing treatment Carroll et al, JCCP, 2006

“CM response” outcome: Completing treatment and submission of 1 or more marijuana free urine specimens Carroll et al, JCCP, 2006

Point-prevalence (marijuana-free urines specimens at 6 month follow-up) Carroll et al, JCCP, 2006

Marijuana Problem Scale by group

Cannabis tx datasets, N=264 (90% fup) Instrument Pretx Weekly Posttx F-up 1, 3, 6 Baseline Screening Form x   Attitudes & Expectations SCID-Axis I X canabis only SCID-Axis II CPI-So Perceived Stress Scale Reasons for Quitting Marijuana Problems Scale Marijuana Withdrawal Questionnaire  x x  Marijuana Craving Questionnaire Urine monitoring ASI Pre Post F-up TLFB Beck Depression Inv. Brief Symptom Inv. Potential outcomes “Problem free functioning” Change in DSM symptoms count Reduction in cannabis-related consequences, problems Quality of life

How many days were you paid for working in the past 28? DOMAIN ITEM Medical Status   * How many days in the past 28 have you been hospitalized overnight for physical medical problems? How many days in the past 28 have you had any medical problems that were serious enough to keep you home from work or interfere with things you wanted to do? Employment Status How many days were you paid for working in the past 28? * How many days have you experienced employment problems in the past 28? Legal Status * In the past 28 days, how many times have you been arrested and charged with criminal offenses like shoplifting or vandalism, parole or probation violations, drug charges, prostitution, contempt of court, forgery, weapons offenses, burglary, larceny, breaking and entering, robbery, assault, arson, rape, homicide, or manslaughter? *In the past 28 days, how many times have you been charged with disorderly conduct, vagrancy, public intoxication, driving while intoxicated, or major driving violations? * How many days have you spent in prison in the past 28? How many days did you engage in illegal activities for profit in the past 28? How much money did you receive from illegal sources in the past 28 days? (Will be recoded to YES/NO to indicate receipt of any money from illegal sources) Family/Social Relationships * Do you live with anyone who has a drug problem? * How many close friends do you have? In the past 28 days, have you had significant periods during which you had serious conflicts with the following people (mother, father, siblings, partner/spouse, children, other significant family, close friends, neighbors, co-workers)? How many days in the past 28 have you had serious conflicts with your family? * How many days in the past 28 have you had serious conflicts with other people? Psychological Problems * How many times in the past 28 days have you received inpatient or outpatient treatment for any psychological or emotional problems? In the past 28 days, have you had significant periods during which you had any of the following problems: 1 – serious depression, 2 – serious anxiety or tension, 3 – seeing or hearing things that were not there, 4 – trouble understanding, concentrating, remembering, 5 – trouble controlling violent behavior, 6 – serious thoughts of suicide, 7 – suicide attempts, 8 – been prescribed medications for any psychological/emotional problems? (Will be recoded to a count of the number of “yes” responses) How many days in the past 28 have you had any such psychological or emotional problems?