Assessment of Cannabis Use in Adolescents

1. Assessment of Cannabis Use in Adolescents Denise Walker, Ph.D. University of Washington Research Associate Professor, School of Social Work Director, Innovative Programs Research Group NIDA 1RO1DA014296-01A1 ddwalker@uw.edu | 206.543.7511

2. Overview • Similarities in Adult and Adolescent Assessment • How does the Treatment Literature inform Cannabis Assessment in Adolescents? • Assessment Considerations - Setting • Other Outcomes

3. Known Quantities

4. Nemesis of Assessment

5. Days of Use Methods of Use Lifetime Use

6. Frequency Times of Day Hours High Money Spent

7. Quantity New Products: Dabs, Tinctures, Vape/Oils, Edibles

8. Outpatient Treatment Behavioral Interventions Family Therapy Multidimensional Family Therapy Functional Family Therapy Multi-Systemic Therapy Combinations of Family and Behavioral Interventions • Cognitive Behavioral Therapy (CBT) • Motivational Enhancement Therapy/CBT • Adolescent Community Reinforcement Approach • MET/CBT with Contingency Management

9. Continuing Care/Adaptive Treatments Inpatient Outpatient Continuing Care for Treatment Completers Adaptive Treatments for Poor Responders “Check-Ins” following Teen Marijuana Check-up • Assertive Continuing Care

10. Effective Treatments • Multiple treatments have been identified to reduce marijuana use • Interventions such as MDFT and MET/CBT have been evaluated domestically and internationally • All manualized treatments, many manuals are available free • Behavioral interventions are less expensive to deliver, with similar benefit

11. And there are some BIG Buts…

12. Caveats to the Treatment Literature • Treatment samples were largely male (80% typically) • Abstinence was rare • Reductions in days of use were small to moderate • Treatment effects wane over time • Majority are court-involved or “referred”

13. Differences in Adolescent Assessment • Family Functioning • Parenting • Externalizing Behavior • Academic Achievement/Involvement

16. Substance Abuse Treatment Need in U.S. NSDUH 2013 22.7million persons aged 12 or older needed treatment for a substance use problem. 2.5 million persons received treatment

17. Reaching Non-Treatment Seeking Adolescents

18. The Challenge: • Need for interventions that: • Reach more adolescents • Increase motivation for change • Encourage treatment entry when appropriate

19. Teen Marijuana Check-Up • Brief intervention designed to attract users who would not seek treatment. • Advertised as an opportunity to receive objective feedback about marijuana use; not offered as treatment. • Involves one session of assessment and two sessions of MET (Motivational Interviewing + Personalized Feedback)

20. What we know:Teen Marijuana Check-Up… Attracts teens with no treatment history. Attracts heavy users. Decreases use. High cannabis-use disorders.

21. Setting • Schools • Primary Care • Other Opportunistic Settings

23. Snacktastrophe How many days in the past 30 did you consume "junk food" when having the munchies?  On a typical munchie eating episode, how many ounces of Cheetos did you consume?  On a typical munchie eating episode what proportion of your snacks were organic?  Free-trade?  GMO-free? Gluten-free? Locally sourced?

24. Patient-Centered Outcomes • Marijuana Checklist • Motives • Life Goals • Relationship to Marijuana Use

25. Summary • Assessing cannabis use in adolescents has similar challenges • Additional research needed to identify ways to improve outcomes and capture clinically meaningful changes • Treatment setting should be considered when developing new assessments • Exploration of teen-centered outcomes is needed

26. Special thanks to my colleagues, Roger Roffman, DSW, & Robert Stephens, Ph.D. National Institutes of Drug Abuse (NIDA) Contact: Denise Walker, PhD ddwalker@uw.edu Acknowledgements

27. Questions?