Marijuana-dependent young adults (N = 136), all referred by the criminal justice system, were randomized to 1 of 4 treatment conditions: a motivational/skills-building intervention (motivational enhancement therapy/cognitive-behavioral therapy; MET/CBT) plus incentives contingent on session attendance or submission of marijuana-free urine specimens (contingency management; CM), MET/CBT without CM, individual drug counseling (DC) plus CM, and DC without CM. There was a significant main effect of CM on treatment retention and marijuana-free urine specimens. Moreover, the combination of MET/CBT plus CM was significantly more effective than MET/CBT without CM or DC plus CM, which were in turn more effective than DC without CM for treatment attendance and percentage of marijuana-free urine specimens. Participants assigned to MET/CBT continued to reduce the frequency of their marijuana use through a 6-month follow-up. Keywordscognitive-behavioral therapy; contingency management; criminal justice populations; marijuana dependence; motivational enhancement therapy Marijuana is the most commonly used illicit substance in the United States, with approximately 5.5 million regular weekly users (Anthony, Warner, & Kessler, 1994) and high prevalence among young adults (Kandel, Chen, Warner, Kessler, & Grant, 1997). In recent years, there has been a significant increase in marijuana use as well as in rates of marijuana use disorders among adults in the 18-to 29-year-old age range, most markedly among members of ethnic minority groups (Compton, Grant, Colliver, Glantz, & Stinson, 2004). Increased prevalence of marijuana use is significant because longitudinal epidemiological studies have consistently identified marijuana as a gateway drug for progression to use of other illicit substances among young adults (Kandel & Faust, 1975;Kandel, Yamaguchi, & Chen, 1992). Furthermore, frequent marijuana use during young adulthood significantly increases the risk of lifetime experiences and greater involvement with other illicit drugs, earlier onset of substance dependence, poorer educational and occupational outcomes, multiple health and psychiatric problems, and higher levels of involvement with the criminal justice system (Chen & Kandel, 1995;Ellickson, Martino, & Collins, 2004;Windle & Wiesner, 2004).Because frequent marijuana use in early adulthood is the best predictor of persistent use, and initiation of marijuana use after age 29 is comparatively rare, providing effective interventions for marijuana use disorders to young adults is a strategy of great potential significance in , 1988). The point at which drug abusers confront legal consequences of their substance use may be a particularly important opportunity to intervene, given that more drug users are involved with the legal system than with the drug abuse treatment system (Weisner & Schmidt, 1995).However, despite increased demand for effective interventions for marijuana dependence, only a few randomized clinical trials evaluating well-defined treatments for individu...

Although preliminary, these findings are the first to document lofexidine's potential in addressing stress-related opioid craving and relapse outcomes in humans. The results also suggest that combination therapies that target both drug-related reinforcement (naltrexone) and stress- and cue-related aspects of drug seeking could be beneficial in addiction relapse prevention. Further development of lofexidine to address stress-related opioid craving and relapse is warranted.

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Naltrexone-treated opioid abusers demonstrate vulnerability to stress and drug-cue-induced craving and arousal responses that may contribute to the high rates of noncompliance and relapse among opioid-dependent individuals undergoing naltrexone treatment. Pharmacological and behavioral interventions that specifically target the negative affectivity that co-occurs with drug-cue and stress-induced craving could be of benefit in improving naltrexone treatment outcomes in opioid dependence.

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