Cannabis Dependence: Its Nature, Consequences, and Treatment.

Cannabis Dependence: Its Nature, Consequences, and Treatment

Roffman, R.A., & Stephens, R.S. (Eds.). (2006). Cambridge, UK: Cambridge University Press. [Hardbound; ISBN# 0-521-81447-2; $ 95.00]

Rates for use of cannabis or marijuana are rising in the developed countries (Hall, 2006) with over 161 million users worldwide (United Nations Office on Drugs and Crime, 2005). Cannabis is usually taken by the user through smoking a hemp plant-derived cigarette or by oral or intravenous administration of resin with delta-9-tetrahydrocannabinol (THC), the primary psychoactive chemical in cannabis (Gorelick & Heishman, 2006). However, the concept of cannabis dependence is considered controversial. The purpose of this book is to examine in depth the issue of cannabis dependence.

This monograph is organized into five parts with twenty-nine contributors for fifteen chapters in the book. The first part is called the nature of cannabis dependence and has five chapters. The first chapter is about the history of cannabis dependence and starts from Arabic stories in the 13th century to use by European and American writers in the mid 1800s to the establishment of the Indian Hemp Drugs Commission in 1893. The chapter also discusses the Panama Canal Zone Report of 1925, the US Surgeon General Report of 1929, the LaGuardia committee report of 1944 pertaining to Marijuana problem in New York City and the 1972 Report of the National Commission on Marijuana and Drug Abuse.

The second chapter is about the diagnosis of cannabis dependence and discusses criteria from ICD-10 (World Health Organization, 1992) and DSM-IV (American Psychiatric Association, 1994). The third chapter pertains to pharmacology and physiology of cannabis dependence. Aspects of physical dependence and withdrawal are presented in this chapter. The fourth chapter is about the epidemiology of cannabis dependence. Time, place, and person distribution of cannabis users and reasons behind cannabis use are discussed in this chapter. The fifth chapter is about adverse health and psychological consequences of cannabis dependence.

The second part of the book is about interventions with cannabis-dependent adults. The first chapter in this part or the sixth chapter of the book deals with cognitive-behavioral treatment (CBT) and motivational enhancement treatment (MET) for cannabis dependence. CBT develops coping skills for dealing with high-risk situations and is helpful for individuals who are already motivated. MET uses motivational interviewing and helps deal with ambivalence regarding change and helps individuals who need to be motivated.

The seventh chapter is about contingency management interventions for cannabis dependence that are mainly helpful in preventing relapse. The conceptual framework of these interventions, basic principles, efficacy, and implementation techniques are presented. The eighth chapter is entitled, "The marijuana check-up" that describes a low-cost, low-demand intervention designed to work with adults who are on cannabis and experiencing some negative effects but not willing to make the change. It is based on stages of change model (Prochaska & Di Clemente, 1984). Stages of change model or the transtheoretical model (as it is sometimes called) has been used with substance abuse and many other health behavior change issues and is a fairly robust model.

Chapter nine is about guided self change (GSC), a brief motivational intervention for cannabis abuse. The chapter presents a rationale for GSC treatment, its fundamental technique, application and results from a controlled trial. The intervention is based on stages of change (Prochaska & Di Clemente, 1984) and Bandura's (1986) social cognitive theory. The intervention shows promise for replication. The tenth chapter deals with supportive-expressive psychotherapy for cannabis dependence. In this therapy the client is helped to achieve mastery over their difficulties, gain self understanding and practice self control over cannabis. It is not clear why only one form of psychotherapy has been included in the chapter when a myriad of approaches exist.

The third part of the book is about interventions with cannabis dependent adolescents and young adults. The eleventh chapter is about the cannabis youth treatment (CYT) study and discusses its treatment models and preliminary findings. Once again the approach is based on stages of change model (Prochaska & Di Clemente, 1984). The CYT model appears to be a promising model. The twelfth chapter of the book is about teen cannabis check-up program an intervention based on motivational enhancement therapy (MET) specifically for young people who use cannabis. Presented in the chapter is the epidemiology of adolescent cannabis use, negative consequences from adolescent cannabis use, intervention research with adolescents, the check-up program, and issues in implementing the check-up programs. Its applications in United States and Australia have been described that appear to be potentially effective.

The thirteenth chapter is about engaging young probation referred marijuana abusing individuals in treatment. In the chapter reasons for targeting young adult marijuana users, reasons for focusing on those referred by legal system, and application of motivational enhancement (MET) and contingency management (CM) approaches are presented.

The fourth part of the book is about policy and has a solitary chapter that deals with policy implications. The chapter on the whole is a bit brief and should have been divided into more than one chapter with clear demarcation of environmental and policy approaches. The chapter begins with a section on epidemiology of cannabis use and dependence, which is redundant.

The final part of the book is called conclusion and has a solitary chapter that focuses on future research and policy. A firm conclusion is presented that cannabis dependence does exist and there are potential negative consequences. It is recommended that more efficacious and effective interventions be designed for addressing the issue of cannabis dependence.

The book is a valuable resource for practitioners, researchers, and policy makers in the area of substance abuse particularly cannabis. It is also useful for graduate students in health, education, social work, counseling, addictive behaviors, sociology and psychology who are studying prevention and treatment aspects of cannabis. The book has been written by several contributors and the write-up could be more uniform with reduction in redundancy. On the whole, this monograph will serve as an important book in this area.

References

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

Goelick, D. A., & Heishman, S.J. (2006). Methods for clinical research involving cannabis administration. Methods in Molecular Medicine, 123, 235-253.

Hall, W. D. (2006). Cannabis use and the mental health of young people. The Australian and New Zealand Journal of Psychiatry, 40(2), 105-113.

Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing the traditional boundaries of therapy. Malabar, FL: Krieger.

United Nations Office of Drugs and Crime. (2005). 2005 world drug report. Retrieved May 6, 2006 from http://www.unodc.org/unodc/ de/world_drug_report.html

World Health Organization. (1992). The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health Organization.

Manoj Sharma, University of Cincinnati