Social cognitive predictors of treatment outcome in cannabis dependence. (1st January 2017)

• Record Type: Journal Article
• Authors: Gullo, Matthew J.; Matveeva, Marya; Feeney, Gerald F.X.; Young, Ross McD.; Connor, Jason P.
• Is Part Of: Drug and alcohol dependence. Volume 170(2017)
• Page Start: 74
• Page End: 81
• Publication Date: 2017-01-01
• Subjects: Cannabis dependence -- Expectancies -- Self-efficacy -- Treatment -- CBT; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2016.10.030
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Expectancies and self-efficacy are key cognitive constructs in cannabis dependence. First study to measure both constructs as treatment outcome predictors. Emotional relief refusal self-efficacy was robust predictor of treatment outcome. Negative cannabis expectancy predicted lower likelihood of lapse. Self-efficacy may mediate risk conveyed by positive cannabis expectancy. Abstract: Background: Drug-related outcomes expectancies and refusal self-efficacy are core components of Social Cognitive Theory. Both predict treatment outcome in alcohol use disorders. Few studies have reported expectancies and refusal self-efficacy in cannabis dependence. None have examined both, although both constructs are key targets in Cognitive-Behavioural Therapy (CBT). This study tests the predictive role of expectancies and refusal self-efficacy in treatment outcome for cannabis dependence. Design: Outpatients completed a comprehensive assessment when commencing cannabis treatment and predictors of treatment outcome were tested. Setting: A university hospital alcohol and drug outpatient clinic. Participants: 221 cannabis-dependent patients participated in a 6-week CBT program where the goal was abstinence. Measurements: Cannabis Expectancy Questionnaire and Cannabis Refusal Self-Efficacy Questionnaire, cannabis dependence severity [Severity of Dependence Scale], psychological distress [General Health Questionnaire] at baseline; the timeline follow-back procedure at baseline and each session. Findings: Patients reporting lower confidence in their ability to resist cannabis during high negative affect ( emotional relief refusal self-efficacy ) had a lower likelihood of abstinence ( p = 0.004), more days of use ( p < 0.001), and larger amount used ( p < 0.001). Negative cannabis expectancies predicted greater likelihood of abstinence ( p = 0.024). Higher positive expectancies were associated with lower emotional relief self-efficacy, mediating its association with outcome ( p < 0.001). Conclusions: Emotional relief refusal self-efficacy and negative expectancies are predictive of better treatment outcomes for cannabis dependence. Positive expectancies may indirectly predict poorer outcome because of a negative association with self-efficacy, but this conclusion remains tentative as directionality could not be established.