The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.

An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

Background-Cannabis withdrawal is not recognized in DSM-IV because of doubts about its clinical significance.Objectives-Assess the phenomenon of cannabis withdrawal and its relationship to relapse in nontreatment-seeking adults.Subjects-Convenience sample of 469 adult cannabis smokers who had made a quit attempt while not in a controlled environment.Methods-Subjects completed a 176-item Marijuana Quit Questionnaire collecting information on sociodemographic characteristics, cannabis use history, and their "most difficult" cannabis quit attempt.Results-42.4% of subjects had experienced a lifetime withdrawal syndrome, of whom 70.4% reported using cannabis in response to withdrawal. During the index quit attempt, 95.5% of subjects reported ≥1 individual withdrawal symptom (mean [SD] 9.5 [6.1], median 9.0); 43.1% reported ≥10. Number of withdrawal symptoms was significantly associated with greater frequency and amount of cannabis use, but symptoms occurred even in those using less than weekly. Symptoms were usually of ≥ moderate intensity and often prompted actions to relieve them. Alcohol (41.5 %) and tobacco (48.2%) were used more often than cannabis (33.3%) for this purpose. There was little change during withdrawal in use of other legal or illegal substances. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. ContributorsAuthors Gorelick, Levin, Copersino, and Heishman designed the study and wrote the protocol. Author Levin was responsible for data collection oversight and data base management. Authors Liu and Levin performed the statistical analyses. Authors Levin and Gorelick wrote the first draft of the manuscript. Authors Copersino, Kelly, and Boggs reviewed the manuscript for substantive intellectual content. All authors reviewed and approved the final manuscript. Conclusions-Cannabis withdrawal is a common syndrome among adults not seeking treatment. The intention to relieve withdrawal symptoms can drive relapse during quit attempts, giving cannabis withdrawal clinical significance as a target of treatment. Conflict of interest

This study investigates the clinical significance of a cannabis withdrawal syndrome in 104 adult, non-treatment-seeking, primarily cannabis users who reported at least one serious attempt to stop using cannabis. Retrospective self-report data were obtained on eighteen potential cannabis withdrawal symptoms derived from the literature, including co-occurrence, time course, and any actions taken to relieve the symptom. Study findings provide evidence for the clinical significance of a cannabis withdrawal syndrome, based on the high prevalence and co-occurrence of multiple symptoms that follow a consistent time course and that prompt action by the subjects to obtain relief, including serving as negative reinforcement for cannabis use.

Background The Marijuana Craving Questionnaire (MCQ) is a valid and reliable, 47-item self-report instrument that assesses marijuana craving along four dimensions: compulsivity, emotionality, expectancy, and purposefulness. For use in research and clinical settings, we constructed a 12-item version of the MCQ by selecting three items from each of the four factors that exhibited the greatest within-factor internal consistency (Cronbach's alpha coefficient). Methods Adult marijuana users (n = 490), who had made at least one serious attempt to quit marijuana use but were not seeking treatment, completed the MCQ-Short Form (MCQ-SF) in a single session. Results Confirmatory factor analysis of the MCQ-SF indicated good fit with the 4-factor MCQ model, and the coefficient of congruence indicated moderate similarity in factor patterns and loadings between the MCQ and MCQ-SF. Homogeneity (unidimensionality and internal consistency) of MCQ-SF factors was also consistent with reliability values obtained in the initial validation of the MCQ. Conclusions Findings of psychometric fidelity indicate that the MCQ-SF is a reliable and valid measure of the same multidimensional aspects of marijuana craving as the MCQ in marijuana users not seeking treatment.

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To date, there has not been a time-efficient and resource-conscious way to identify cognitive impairment in patients with substance use disorders (SUD). The present study assesses the validity, accuracy, and clinical utility of a brief (10 min) screening instrument, the Montreal Cognitive Assessment (MoCA), in identifying cognitive impairment among SUD patients. The Neuropsychological Assessment Battery-Screening Module (NAB-SM), a 45-minute battery with known sensitivity to the mild-to-moderate deficits observed in SUD patients, was used as the reference criterion for determining agreement, rates of correct and incorrect decision classifications, and criterion-related validity for the MoCA. Classification accuracy of the MoCA, based on receiver-operating characteristic (ROC) analysis, was strong, with an area under the ROC curve = 0.86 [95% CI: 0.75-0.97]. The MoCA also showed acceptable sensitivity (83.3%) and specificity (72.9%) for the identification of cognitive impairment. Using a cut-off of 25 on the MoCA, the overall agreement was 75.0%; chance-corrected agreement (kappa) was 41.9%. These findings indicate that the MoCA provides a time-efficient and resource-conscious way to identify SUD patients with neuropsychological impairment, thus addressing a critical need in the addiction treatment research community.

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