مداخله انگیزشی و ذهن آگاهی برای زنان جوان مصرف کننده ماری جوانا

This pilot study tested the efficacy of a brief intervention using motivational interviewing (MI) plus mindfulness meditation (MM) to reduce marijuana use among young adult females. Thirty-four female marijuana users between the ages of 18 and 29 were randomized to either the intervention group (n = 22), consisting of two sessions of MI-MM, or an assessment-only control group (n = 12). The participants' marijuana use was assessed at baseline and at 1, 2, and 3 months posttreatment. Fixed-effects regression modeling was used to analyze treatment effects. Participants randomized to the intervention group were found to use marijuana on 6.15 (z = −2.42, p = .015), 7.81 (z = −2.78, p = .005), and 6.83 (z = −2.23, p = .026) fewer days at Months 1, 2, and 3, respectively, than controls. Findings from this pilot study provide preliminary evidence for the feasibility and effectiveness of a brief MI-MM for young adult female marijuana users.

Marijuana is the most widely used illicit substance in the United States. In 2009, approximately 6.6% (16.7 million) of Americans older than 12 years reported using marijuana at least once in the past month (Substance Abuse and Mental Health Services Administration [SAMHSA], 2010). Regular marijuana use is associated with respiratory illnesses such as bronchitis, emphysema, and lung infections (Brook et al., 2008, Moore et al., 2005 and Tashkin, 2005), as well as neurocognitive deficits (Brook et al., 2008 and Solowij et al., 2002). The use of marijuana has also been linked with psychosocial problems including occupational absenteeism, work-related accidents (Lehman & Simpson, 1992 and Zwerling et al., 1990), poor educational achievement (Brook et al., 2008, Fergusson et al., 2003 and Lynskey & Hall, 2000), and increased likelihood of mental health conditions, including anxiety, depression, and suicidal behavior (Brook et al., 2008, Fergusson et al., 2002 and King et al., 2001). Given these associations and the high prevalence of use, marijuana use represents a significant public health problem. In 2009, young adults between the ages of 18 and 25 years had the highest rate of marijuana use, with approximately 18.1% reporting use at least once in the past month (SAMHSA, 2010). This rate is a significant increase from the previous 2 years (2007, 16.5%; 2008, 16.4%), indicating an upward trend in marijuana use among young adults. Not surprisingly, marijuana users of this age group have been the focus of research and clinical efforts aimed at understanding, reducing, and treating substance use. However, studies focusing on young adult marijuana users have struggled to recruit women (Fattore, Fadda, & Fratta, 2009). Knowledge regarding marijuana use in this group is important because use is highly prevalent in women between the ages of 18 and 25 years and may pose unique risks. In addition to the potential negative consequences of marijuana use noted above, marijuana use among females has also been linked to increased sexual activity, inconsistent condom use, and greater levels of sexual activity while under the influence (De Genna et al., 2007 and Poulin & Graham, 2001). These types of sexually risky behaviors increase a woman's risk for unplanned pregnancies and the contraction of sexually transmitted diseases. Taken together, the risks associated with marijuana use represent a significant threat to the health and well-being of women in the early stages of adulthood. 1.1. Motivational enhancement Motivational interventions (MIs), with their limited contact time, cost-effectiveness, and client-centered approach, are a promising treatment for marijuana users (Miller & Rollnick, 2002). Moreover, MI has been shown to be particularly effective at reducing marijuana use among adolescents and young adults. In a study of weekly marijuana users between the ages of 16 and 20 years, McCambridge and Strang (2004) demonstrated that a single motivational session significantly reduced marijuana use at 3-month follow-up. In another study testing a brief Marijuana Check-Up, Walker et al. (2006) also found MI decreased marijuana use among 97 adolescents at 3-month follow-up. In a larger trial (N = 188) targeting young adult marijuana users with a brief MI, Stephens et al. (2007) found that MI participants had fewer marijuana use days at 12 months (effect size of .45) compared with either a delayed feedback or an educational control condition. Findings from these studies served as the basis for our recently completed randomized clinical trial of a brief MI for young adult female marijuana users with varying levels of quitting desire (Project MAPLE). In this study, 332 women between the ages of 18 and 24 years were randomized to either a two-session motivationally focused intervention or an assessment-only (AO) condition. Our findings showed that the intervention's effect on marijuana use was not statistically significant at 1 month (odds ratio [OR] = 0.77, p = .17), significant at 3 months (OR = 0.53, p = .01), and no longer significant at 6 months (OR = .74; p = .20). However, among the 61% of participants endorsing any desire to quit using marijuana at baseline, the MI intervention was found to have a significantly greater reductive effect on the likelihood of marijuana use at 1 month (OR = 0.42, p = .03), 3 months (OR = 0.31, p = .02), and 6 months (OR = 0.35, p = .03), indicating that MI provided the greatest overall reduction and sustained reduction for women with a desire to quit ( Stein, Hagerty, Herman, Phipps, &Anderson, In Press). 1.2. Anxiety and marijuana use In a secondary analysis of Project MAPLE (de Dios, Hagerty, et al., 2010), we illustrated the connection between anxiety reduction and marijuana use. We found that 89% of our sample endorsed at least one symptom of general anxiety disorder (GAD), and among those expressing any desire to quit, 93% reported that they used marijuana to help them relax, 84% to relieve anxiety, and 88% to help them be “calm.” Furthermore, these tension reduction and relaxation motives were found to significantly mediate the relationship between GAD symptoms and marijuana use (de Dios, Hagerty, et al., 2010). These findings are consistent with previous studies that have established an association between anxiety disorders and marijuana use (Andrews et al., 1999, Burns & Teesson, 2002, Grant et al., 2004 and Teesson et al., 2000). Using data from the National Comorbidity Study, Agosti, Nunes, and Levin (2002) showed that individuals meeting criteria for cannabis dependence were twice as likely to also have a comorbid anxiety disorder diagnosis. Studies examining the relationship between marijuana use and anxiety-related symptoms and constructs have also yielded significant associations between marijuana use and agoraphobic cognitions (Bonn-Miller, Zvolensky, Bernstein, & Stickle, 2008), anxiety arousal (Bonn-Miller et al., 2008), affective liability (Simons et al., 2005), negative affect (Zvolensky et al., 2007), worry (Bonn-Miller, Zvolensky, & Bernstein, 2007), and anxiety sensitivity (Buckner et al., 2011). Such findings support the notion that individuals experiencing anxiety symptoms use marijuana as a method for coping (Bonn-Miller et al., 2007). Given these associations and the results of Project MAPLE, we sought to develop and test an intervention that addressed the phenomenon of marijuana use as a way to relieve anxiety-related symptoms among young adult female marijuana users. Specifically, we blended our Project MAPLE intervention with mindfulness-based components with the aim of providing young women with an alternative for coping with distressing negative affective states. 1.3. Mindfulness-based meditation Mindfulness-based meditation, which is derived from Buddhist meditation practices, made its first inroads into medical care in the form of mindfulness-based stress reduction (MBSR) in 1979 (Kabat-Zinn, 1990). Today, mindfulness-based approaches have proliferated and include mindfulness-based cognitive therapy (Segal, Williams, & Teasdale, 2002), acceptance and commitment therapy (Hayes, Strosahl, & Wilson, 2003), dialectical behavioral therapy ( Linehan, 1993), mindfulness-based relapse prevention (Witkiewitz & Bowen, 2010 and Witkiewitz et al., 2005), and mindfulness-based therapeutic community treatment (Marcus & Zgierska, 2009). The basis for mindfulness-based approaches is the cultivation of a nonjudgmental awareness, curiosity, openness, and acceptance of internal and external experiences, with the intended goal of eliciting greater reflection and acceptance, especially with regard to negative affect (Praissman, 2008). Mindfulness-based approaches have been applied to the treatment of a number of psychological problems including anxiety and substance use, and numerous studies have demonstrated the efficacy of mindfulness-based interventions in reducing anxiety symptoms (Arch & Craske, 2010, Campbell-Sills et al., 2006, Carmody & Baer, 2008, Kabat-Zinn et al., 1992, Kim et al., 2009 and Miller, 2010) and other negative emotional states such as depression, worry, and rumination (Grossman et al., 2004, Jain et al., 2007, Teasdale et al., 2000 and Witek-Janusek et al., 2008). The success of mindfulness-based approaches in reducing anxiety and negative affective states is attributed to the intervention's focus on training present-moment awareness, which cultivates a more experiential, accepting, and nonjudgmental relationship to negative thoughts and feelings. Rather than focus directly on negative affect reduction, mindfulness seeks to diminish the escalation of negative emotional reactivity (secondary negative affect in reaction to transient negative emotion) during stressful periods. From a behavioral and cognitive perspective, this mechanism of action is synonymous with extinction learning and improved attentional capacities (Treanor, 2011). Mindfulness-based approaches have been successfully applied to the treatment of substance abuse and addiction (see Zgierska et al., 2009 for review; Bowen et al., 2009, Brewer et al., 2009, Britton et al., 2010, Liehr et al., 2010, Marcus & Zgierska, 2009, Marcus et al., 2009, Vieten et al., 2010 and Zgierska & Marcus, 2010). The efficacy of mindfulness-based approaches in substance abuse treatment is attributed to decreasing the impact of negative affect. Such negative affect reactivity is thought to serve as a trigger for substance use, and improving distress tolerance is an important target of mindfulness-based substance abuse treatment (Sinha, 2007). In behavioral terms, mindfulness-based approaches for substance abuse are described as a process of desensitization to negative affect through exposure, which helps to extinguish automatic avoidance of negative emotions and consequential substance use. A key component of all mindfulness-based approaches is teaching a breath awareness meditation, which is a guided exercise that increases mindful attention on the breath and develops a nonjudgmental awareness of cognitions, thoughts, and distractions that may emerge during the meditation (Zeidan, Gordon, Merchant, & Goolkasian, 2010). Brief mindfulness inductions (10–20 minutes in one to two sessions) have been used as experimental manipulations of both acute urge management and acute anxiety or emotional reactivity (Arch & Craske, 2006 and Campbell-Sills et al., 2006). In a recent pilot study, Bowen and Marlatt (2009) found that as little as one 1.5-hour session of mindfulness training resulted in decreases in tobacco use, suggesting that brief mindfulness training can be effective as an intervention. In the current randomized pilot trial, we sought to augment our brief efficacious motivational intervention from Project MAPLE by including key components of mindfulness-based meditation with the aim of providing young women with an alternative method (replacing marijuana use) for coping with distressing negative affective states. We hypothesize that women randomized to the blended motivational intervention plus mindfulness meditation (MI-MM) group will show greater reductions in days of marijuana use as compared with the AO control group. Furthermore, among our MI-MM group, we hypothesize that engaging in meditation on a given day will be associated with a significant decrease in the probability of using marijuana on that day.