Adolescents with cannabis use disorders: Adaptive treatment for poor responders

- Poor response to initial evidence-based treatment for adolescents with CUD is approximately 50%;
- Poor responders to initial treatment manifest both poor retention and abstinence rates for continuity of care;
- There was no significant difference in retention and abstinence rates between the AT conditions ACRA and CBT;
- Examining innovative AT potential integrative approaches should be further studied to improve treatment outcomes.

ObjectiveTreatment response as measured by both retention and abstinence attainment rates for adolescents with cannabis use disorders (CUD) has been unsatisfactory. This study tested the hypothesis that adaptive treatment (AT) will improve outcomes for poor responders (PR) to evidence-based practice interventions.MethodA total of 161 adolescents, 13-18 years of age, diagnosed with DSM-IV CUD, enrolled in this outpatient, randomized, AT study. Following a 7-session weekly motivational enhancement and cognitive behavioral therapy intervention (MET/CBT-7) only poor responders (defined as failing to achieve abstinence at week seven for any reason) were randomized into a 10-week AT phase of either an individualized enhanced CBT or an Adolescent Community Reinforcement Approach (ACRA) intervention. Good responders (GR) enrolled only in follow-up assessments starting at the completion of the AT phase (week 17).ResultsEighty adolescents (50%) met the criterion for poor response to treatment. Thirty seven percent of poor responders completed the AT phase and 27% of them achieved abstinence. There was no significant difference in retention and abstinence rates between the AT conditions. Although the majority of GR relapsed by week 17, they significantly differed from PR both for drug use (71% vs. 91%, respectively; p < 0.05) and reporting to scheduled assessment on that week (78% vs. 54%, respectively; p < 0.01).ConclusionContinuity of care to achieve abstinence among poor responders remains a therapeutic necessity and a research challenge. Examining innovative AT designed interventions including potential integrative approaches should be further studied in order to improve treatment outcomes.