Brief Motivational Intervention and telemedicine: A new perspective of treatment to marijuana users

Abstract

The main purpose of this study was to evaluate the telephone Brief Motivational Intervention (BMI) efficacy in marijuana consumption cessation. A clinical trial was performed on Brazilian citizens, who were randomly divided into experimental (BMI) and minimal intervention (reference material) treatment groups; the study involved 524 participants who were monitored for 6 months. In addition, the data was collected by a free-service call center; both marijuana consumption and level of motivation for behavior change were evaluated, based on the telephone service offered. The proportion of abstainers in the BMI group was significantly greater than in the control group: 73% of the individuals in the BMI group were abstainers. In the control group, 59% of them ceased on using marijuana. The ratio of probability for marijuana cessation was 1.6 times higher in the BMI group. There was no significant difference on the motivation for behavior change in both groups. The collected data demonstrated the telephone BMI's positive efficacy in marijuana consumption cessation.

Introduction

Marijuana usage is associated to important psychosocial problems (Babor, 2004, Budney et al., 2003, McCambridge et al., 2008, Vandrey and Haney, 2009) and its consumption is increasing worldwide (Almeida et al., 2008, Budney et al., 2007, Copeland and Maxwell, 2007, Galduróz et al., 2004, Hall and Degenhardt, 2009, Steinberg et al., 2005). Surveys estimate that approximately 2.1 million people in the world initiated marijuana use in 2007 (SAMHSA, 2008). Marijuana users frequently do not know how, where and what kind of treatment to look for (Macleod et al., 2004), which may be associated with the fact that there are a small amount of specific treatments for marijuana dependence, since many programs are often directed to users, such as alcohol and cocaine (Hall and Degenhardt, 2009, Steinberg et al., 2005).

The difficulty in obtaining drug dependence services at governmental health care facilities is due to the high costs, therefore, alternative measures to promote marijuana consumption cessation are necessary (Budney et al., 2007). In general, brief interventions have been developed for drug dependence treatment (McCambridge and Strang, 2004, McCambridge et al., 2008, Steinberg et al., 2005; Budney et al., 2007, Miller et al., 2003). In addition, face-to-face Brief Motivational Intervention (BMI) has shown to be effective on marijuana cessation after a follow-up about 3 to 6 months (Stephens et al., 2000, Vandrey and Haney, 2009).

Another option for drug dependence treatment is through telemedicine, offering a personalized assistance. Different services are supplied, such as advices provided through telephone calls (Bishof et al., 2008, Mar, 1, Lancaster and Stead, 2005) combined or not with supporting materials (Britt, Hudson, & Blampied, 2004). Although BMI is currently shown as effective in marijuana abuse/dependence, its practice through telephone-based services still lacks evaluation. The purpose of this study is to verify whether the BMI offered through telephone counseling increases the chances of marijuana cessation and relapse prevention, when compared to the control group.

We hypothesized that telephone-based BMI would entail a higher efficacy than a self-help material (minimal intervention) for marijuana use abstinence and relapse prevention; also it would induce a greater compliance for telephone-based follow-up as well as a most likely chance to reach higher motivation stages to change drug use behaviors.