Motivating Behaviour Change in Young Cannabis Users

This study aims to determine if the addition of CM to BI improves retention and treatment outcomes, in young people who use cannabis use. We expect young people receiving BI+CM will have better treatment attendance, engagement and completion rates; and improved cannabis use, depressive symptoms and functioning, compared with BI alone, at 1, 3, 6 and 12 months. Young people who meet inclusion criteria and provide written informed consent to participate in the study will receive a 30-45 minute baseline assessment, administered by a research officer. Once participants have been deemed elligible for inclusion in the study, they will be randomly allocated to either BI or BI + CM. Allocation will be concealed to the research assistant using an opaque sealed envelope. All participants will receive Quik-Fix, a BI targeting alcohol/cannabis use in young people. They will receive two 1-hour face-to-face sessions (1 x 1hour session per week) of motivational interviewing with a psychologist to: (1) build readiness and commitment to make a change (pros and cons decisional balance); (2) set change goals, and (3) develop a plan for making a change. The intervention is based on the Stages of Change Model, which recommends clinicians focus on increasing the young person’s motivation to make a change (1 above), until the young person is committed to making a change in their alcohol/cannabis use. It also provides brief coping skills training for managing alcohol/cannabis use (looking after yourself, positive event scheduling, stress-less, belly breathing, looking on the bright side). All participants will be administered a breathalyser and saliva drug test at the beginning of each session. Young people in the BMI + CM condition will receive Quik Fix plus a three-track incentive system to provide high levels of exposure to reinforcement (and protocol treatments) by reinforcing attendance at treatment sessions, abstinence from cannabis use and completion of homework tasks. 1. Attendance: Participants in the BMI + CM condition will receive a $5 gift voucher redeemable for goods and services for attending Quik Fix Session 1 and providing a breathalyser and saliva sample. If they attend Session 2 and provide a breathalyzer and saliva sample, they will receive an additional $5 (total $10) to reinforce treatment attendance and completion. 2. Abstinence from alcohol and drug use: If the specimens (both breathalyser and saliva drug test) the young person provides at Session 1 are drug-free they receive an additional $5 to reinforce abstinence from alcohol and drug use. If the specimens provided at Session 2 are drug-free, the young person will receive an additional $5 (total $10) to increase the likelihood of continued abstinence. If a participant misses a session, does not provide a breathalyser and saliva drug sample or returns a positive specimen, the value of vouchers is reset back to their original value at the beginning of Session 2 (maximum $5 voucher reinforcement for attending the session and providing a breathalyzer/saliva sample). 3. Homework task: Young people in the CM condition also have access to third incentive system at Session 2 for completing a homework task. They will receive $5 for providing objective evidence (e.g., a photograph) of the completion of an objective, treatment-plan-related homework task that was developed in collaboration with their therapist at the end of Session 1. The three reinforcement tracks are independent of each other so that the participant is still rewarded for attending sessions even if a positive specimen is returned or a homework task is not completed. Young people in the BI only condition will receive a $5 gift voucher redeemable for goods and services for attending each session and providing a breathalyser and saliva sample. To control for the reinforcing properties of the dollar value of the voucher reinforcement system in the BI + CM condition, those in the BI only condition will be randomly matched to receive the same dollar value of voucher reinforcement as a participant in the BI + CM condition. Thus, young people in the BI only condition are eligible to receive the same amount of non-contingent voucher reinforcement as those in the BI + CM group. The research therapists will complete checklists on all sessions. Audiotape ratings will be used to confirm the therapist checklists, and will check that features of non-allocated treatments did not appear. All assessment and treatment sessions will be audio-recorded. An independent psychologist will rate a random selection of 20% of the participants’ treatment sessions for treatment fidelity. Reliability of the baseline research assessments will also be assessed on a random sample of 20% of participants. An assessor, blind to treatment allocation, will conduct follow-up assessments via telephone at 1, 3, 6 and 12 months post-Baseline. Retention for assessments of >70-80% will be aided by obtaining as many contact methods as possible (fixed phone, mobile, email, address, friend/relative), payment for assessments, and asking if participants ceasing treatment will consent to follow-up. Care will be taken to ensure young people are in an appropriate setting at the time of the telephone consultation with respect to their privacy and confidentiality. Participants will be asked not to divulge information about their treatment, and violations of blind assessment will be recorded. Appointments will be made by phone 2 weeks beforehand, with a reminder at 1 week, 2 days and 1 day before the appointment. Participants will be reimbursed $20 cash for their time and travel-related expenses towards the cost of completing each 30-45 minute research interview. They will receive a total of $100 cash for completing all of the baseline and follow up assessments over the 12 month time period.