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A new potential treatment for marijuana dependence, and the success of network therapy, which engages family and friends in a patient’s substance abuse treatment, were two of the topics discussed at the recent annual meeting of the New York Society of Addiction Medicine. This is the second of a two-part report on the meeting, “Addiction Medicine 2013: Emerging Problems, Current Treatment.”

Researchers at Columbia University in New York are studying a new treatment for marijuana dependence.

Margaret Haney, PhD, led a study of 11 people, which has not yet been published, of a synthetic version of THC—the active ingredient in marijuana—called nabilone. Marijuana-dependent patients received either a placebo or one of two doses of nabilone.

Nabilone decreased marijuana withdrawal symptoms, such as increasing sleep and appetite, and decreased marijuana self-administration, in a laboratory model of relapse. Patients did not experience a “high” from nabilone, indicating it does not have a high abuse potential. The study was funded by the National Institute on Drug Abuse.

Dr. Haney’s colleague, Ziva Cooper, PhD, of Columbia University, Department of Psychiatry, New York State Psychiatric Institute, noted that while many people do not regard marijuana dependence as a major problem, it can lead to significant impairment or distress. “Marijuana dependence is likely to become more common as marijuana becomes legal in more states,” she said at the recent New York Society of Addiction Medicine meeting.

Marijuana potency has been increasing over the last 40 to 50 years, Dr. Cooper said. There is currently no medication approved by the U.S. Food and Drug Administration for treatment of marijuana dependence. Of people who do seek treatment for marijuana dependence, many are unable to stay abstinent, Dr. Cooper observed. In one study, 71 percent returned to marijuana use within six months.

Another treatment that has shown potential for marijuana dependence is a combination of oral THC and lofexidine, a drug used in the United Kingdom for opiate withdrawal, which is not approved in the United States. In a small study, patients who took the combination treatment had decreased cravings for marijuana and cigarettes, decreased relapse rate and improved sleep compared with either THC or lofexidine alone.

Network Therapy: Involving Family and Friends in Substance Abuse Treatment

Engaging close family and friends in substance abuse counseling—a process called network therapy—can help improve abstinence rates while providing much-needed support, according to an expert at New York University School of Medicine.

Marc Galanter, MD, a psychiatrist who originated network therapy, says including family and friends provides a valuable resource for patients if they relapse, while keeping them accountable. The therapy also provides support to those affected by patients’ substance use disorders.

Dr. Galanter conducted a study, published in 2004, that found substance abuse patients who engaged in network therapy were twice as likely to be abstinent compared with those who did not engage in the treatment.

“Participants in network therapy should have a close, ongoing relationship with the patient, and should not have a substance use disorder, so they don’t undermine the course of treatment,” Dr. Galanter said at the recent annual meeting of the New York Society of Addiction Medicine.

He continues treating patients separately in addition to seeing them as part of network therapy. The friends and family members who agree to be part of network therapy must agree to be available if the patient needs help. “They secure compliance—such as making sure the patient doesn’t go to a bar,” says Dr. Galanter. They also can suggest solutions to help the patient achieve and maintain abstinence.

Patients who know their drug test results will be shared with their network will be more motivated to pass the test, because they won’t want to let their family and friends down, Dr. Galanter observed.

Network therapy can help enforce patient agreements for future behavior, he added. “For instance, a patient may agree that if he can’t become abstinent within a few weeks, he will go into residential treatment. If he backs down, it’s harder for him to dismiss what he initially agreed to if he did so in front of his network.”

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