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Cited by 130Mindfulness and Compassion InterventionsSubstance Abuse Treatment and OutcomesCannabis and Cannabinoid Research

A preliminary investigation of acceptance and commitment therapy as a treatment for Marijuana dependence in adults

Open access
Twohig, Michael P., Shoenberger, Deacon, Hayes, Steven C.·2007·Journal of Applied Behavior Analysis
DOI 10.1901/jaba.2007.619-632PMC PMC2078570
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Abstract

In this investigation, 3 adults who met criteria for marijuana dependence were treated using an abbreviated version of acceptance and commitment therapy (ACT). The treatment was delivered in eight weekly 90-min individual sessions. The effects of the intervention were assessed using a nonconcurrent multiple baseline across participants design. Self-reported marijuana use, confirmed through oral swabs, reached zero levels for all participants at posttreatment. At a 3-month follow-up, 1 participant was still abstinent and the other 2 were using but at a lower average level of consumption compared to baseline. Depression, anxiety, withdrawal symptoms, and general levels of experiential avoidance generally improved. This preliminary test suggests that additional development and testing of ACT for marijuana use are warranted.

Integrity signals

Registry

Crossref · 10.1901/jaba.2007.619-632

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

5 of 35 cited sources checked · 1 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    In controlled trials, abstinence rates immediately following treatment have generally been in the 50% to 70% range for treatments that last for 9 to 14 sessions.

    “Abstinence rates immediately following treatment have generally been in the 50% to 70% range for treatments that last for 9 to 14 sessions (e.g., Stephens et al., 1994Stephens et al., , 2000Stephens et al., , 2002)).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Stephens et al., 1994

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Stephens et al., 2000 source

      The paper’s introductory discussion reports that approximately 65% quit by the end of an earlier controlled treatment trial. But for this paper’s own 14-session treatment, the Results report 44% abstinent in the four weeks immediately before the end-of-treatment follow-up—below the claimed 50%–70% range. Our copy provides no page numbers for these passages. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Stephens et al., 2002 source
  • Findingown data

    All participants reported that they were not receiving any psychiatric medications or psychological services elsewhere.

    “and reported that they were not receiving any psychiatric medications or psychological services elsewhere.”
    Quote in the paperNot a substantial claim
  • Findingown data

    All participants met criteria for marijuana dependence based on an unstructured clinical interview.

    “Based on an unstructured clinical interview, all individuals met criteria for marijuana dependence (as defined in the Diagnostic and Statistical Manual of Mental Disorders, 2000)”
    Quote in the paperSubstantial claim
  • Findingown data

    Self-reported marijuana use, confirmed through oral swabs, reached zero levels for all participants at posttreatment.

    “Self-reported marijuana use, confirmed through oral swabs, reached zero levels for all participants at posttreatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The oral swab test detects marijuana use up to 3 days prior to testing.
  • Findingown data

    The findings on secondary measures do not closely match the main dependent variable.

    “In addition, the findings on these secondary measures do not closely match the main dependent variable.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 18
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Studies that report follow-up data report abstinence rates between 0% and 30% at 3-month follow-up and about half that or less at 9-to 12-month follow-up.

    “Some studies have failed to report follow-up data (Stephens et al., 2002), but those that have report abstinence rates between 0% and 30% at 3-month follow-up (e.g., Budney et al., 2000;Stephens et al., 2000) and about half that or less at 9-to 12-month follow-up (e.g., Budney et al., 2000;Copeland et al., 2001;Stephens et al., 1994Stephens et al., , 2000)).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Budney et al., 2000 source
    • cites Stephens et al., 2000 source

      In “Marijuana outcome comparisons involving the DTC condition” (page unavailable), the paper reports 37% abstinence in each active-treatment group during the 90 days before the 4-month assessment—above the claimed 0%–30% range, though the assessment is not at exactly 3 months. In “Marijuana outcome comparisons involving only RPSG and IAI conditions” (page unavailable), it reports 26% and 28% abstinence at 13 months, not about half the earlier 37% rate or less. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites Copeland et al., 2001 source

      Section 3.4.2 reports continuous abstinence of 6.5% overall and 15.1% in the six-session CBT group, broadly consistent with the low longer-term rates cited. But Section 2.2 specifies a 24-week follow-up, and Section 3.3 reports an actual median of 237 days after treatment; this paper does not establish those rates specifically at 9–12 months. Copeland et al. is not cited for the sentence’s 3-month figure. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Across the ACT literature, problem-specific measures of acceptance, defusion, and values correlate better with outcome than general measures such as the AAQ.

    “For example, across the ACT literature, problemspecific measures of acceptance, defusion, and values correlate better with outcome than general measures such as the AAQ (Hayes, Luoma, Bond, Masuda, & Lillis, 2006).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hayes, Luoma, Bond, Masuda, & Lillis, 2006 source

      The Research on ACT section (pp. 10, 12–13) describes the general AAQ, reports its correlations with outcomes, and notes that a pain-specific variant predicts outcomes in chronic-pain patients. It does not establish that problem-specific measures of acceptance, defusion, and values correlate better with outcomes than the general AAQ across the ACT literature. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Treatment options for marijuana dependence include relapse prevention, motivational enhancement procedures, cognitive behavior therapy and coping skills training, and voucher-based motivational incentives.

    “Treatment options include relapse prevention (Stephens et al., 1994(Stephens et al., , 2000)), motivational enhancement procedures (Budney et al., 2000;Stephens et al., 2002), cognitive behavior therapy and coping skills training (Budney et al.;Copeland et al., 2001;Stephens et al., 2002), and voucher-based motivational incentives (Budney et al.).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Stephens et al., 1994

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Budney et al., 2000 source
    • cites Copeland et al., 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All participants reported that they had never received formal treatment for marijuana use.

    “All participants reported that they had never received formal treatment for marijuana use.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At a 3-month follow-up, 1 participant was still abstinent and the other 2 were using but at a lower average level of consumption compared to baseline.

    “At a 3month follow-up, 1 participant was still abstinent and the other 2 were using but at a lower average level of consumption compared to baseline.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Depression, anxiety, withdrawal symptoms, and general levels of experiential avoidance generally improved.

    “Depression, anxiety, withdrawal symptoms, and general levels of experiential avoidance generally improved.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Smoking marijuana seemed to decrease certain private events that the participant reported as being establishing operations for using.

    “Smoking marijuana seemed to decrease certain private events that the participant reported as being establishing operations for using.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingreasoning

    In general, all of these procedures were either ineffective or effective only in the short term for decreasing these particular thoughts and feelings.

    “In general, all of these procedures were either ineffective or effective only in the short term for decreasing these particular thoughts and feelings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Unanimously they agreed that their struggles with these thoughts and feelings were becoming harder with time.

    “Unanimously they agreed that their struggles with these thoughts and feelings were becoming harder with time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At 3-month follow-up, one participant was still abstinent, and the other two were still using, although at lower self-reported levels.

    “One was still abstinent at a 3-month follow-up, and the other 2 were still using, although at lower self-reported levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All participants reported and oral swabs confirmed abstinence at posttreatment.

    “All participants reported (and oral swabs confirmed) abstinence at posttreatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The means for all participants on secondary measures decreased from pre- to posttreatment with stable or continued decreases at follow-up, but individual patterns are not all consistent with this finding.

    “The means for all participants decreased from pre-to posttreatment with stable or continued decreases at follow-up, but individual patterns are not all consistent with this finding.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The percentage of patients who seek treatment for marijuana dependence has increased from 9% in 1994 to 16% in 2004.

    “the percentage of patients who seek treatment for marijuana dependence has increased from 9% in 1994to 16% in 2004(Substance Abuse and Mental Health Services Administration, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Substance Abuse and Mental Health Services Administration, 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Empirical support for treatment is limited, in that there were no published controlled studies prior to 1994, and only a handful of controlled studies are available today.

    “Unfortunately, empirical support for treatment is limited, in that there were no published controlled studies prior to 1994 (Stephens, Babor, Kadden, Miller, & The Marijuana Treatment Project Research Group, 2002), and only a handful of controlled studies are available today (see McRae et al., 2003, for a review).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Stephens et al., 2002 source
    • cites McRae et al., 2003 source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The intervention was evaluated using a nonconcurrent multiple baseline across participants design.

    “The intervention was evaluated using a nonconcurrent multiple baseline across participants design.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The BDI-II has shown good test-retest reliability and has demonstrated a high correlation with the original BDI.

    “The BDI-II has shown good test-retest reliability (r 5 .93),and has demonstrated a high correlation with the original BDI (r 5 .93;Beck, 1996).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Beck, 1996

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All sessions were videotaped, and 25% were scored for treatment integrity by the second author.

    “All sessions were videotaped, and 25% (one randomly selected tape of each session) were scored for treatment integrity by the second author.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The BAI has high internal consistency, adequate test-retest reliability, and moderate to high convergent and discriminant validity.

    “The BAI has high internal consistency (Cronbach's alpha , .90),adequate test-retest reliability (rs ..60), and moderate to high convergent and discriminant validity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Beck et al., 1988 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No clinical norms are available for the MWC.

    “No clinical norms are available for this measure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Additional development and testing of ACT for marijuana use are warranted.

    “This preliminary test suggests that additional development and testing of ACT for marijuana use are warranted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Cognitive defusion has been found to decrease the believability of one's thoughts and reduce the need to react to them while persisting with an aversive task.

    “In accord with ACT theory, cognitive defusion has been found to decrease the believability of one's thoughts (e.g., Masuda, Hayes, Sackett, & Twohig, 2004) and reduce the need to react to them while persisting with an aversive task (e.g., Gutie ´rrez, Luciano, Rodrı ´guez, & Fink, 2004).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Masuda et al., 2004 source
    • cites Gutiérrez et al., 2004 source

  • May combine two claims.

    Premisecitation

    Regular marijuana use has a significant negative impact physically, psychologically, and socially.

    “Regular marijuana use has a significant negative impact physically (e.g., Tapert, Aaron, Sedlar, & Brown, 2001;Tashkin et al., 1990), psychologically (e.g., Pope & Yurgelun-Todd, 2004;Solowij, Michie, & Foxe, 1995), and socially (e.g., Haas & Hendin, 1987;Lynskey, Coffey, Degenhardt, Carlin, & Patton, 2003;Rainone, Deren, Kleinman, & Wish, 1987).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Tapert et al., 2001 source
    • cites Tashkin et al., 1990

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Pope & Yurgelun-Todd, 2004 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The AAQ has been found to be internally consistent and has good convergent and discriminant validity.

    “The AAQ has been found to be internally consistent and has good convergent and discriminant validity (Hayes, Strosahl, et al., 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hayes, Strosahl, et al., 2004 source

  • The quote only partly states this claim.

    Study design and conductown data

    Self-reported marijuana intake was confirmed through objective oral swab tests.

    “Results from this measure were confirmed through objective oral swab tests.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The oral swab test detects marijuana use up to 3 days prior to testing.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    No formal assessment of co-occurring psychological conditions was conducted.

    “No formal assessment of co-occurring psychological conditions was conducted”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Acceptance procedures decrease the aversive properties of negative private events and increase the client's willingness and ability to engage in difficult activities while experiencing them.

    “The empirically demonstrated benefit of acceptance is that it decreases the aversive properties of negative private events and increases the client's willingness and ability to engage in difficult activities while experiencing them (Eifert & Heffner, 2003;Levitt, Brown, Orsillo, & Barlow, 2004).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Eifert & Heffner, 2003 source
    • cites Levitt et al., 2004 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The metric used for self-monitoring (bowls or inhalations) was not exact but was applied consistently across time to allow detection of changes.

    “This metric, although not exact, was applied consistently across time so as to allow the detection of changes in the most applicable measurement unit for each participant as a function of the introduction of the independent variable (ACT).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    It is safe to say that the intervention was useful but the exact amount of reduction remains questionable.

    “Thus, it is safe to say that the intervention was useful but the exact amount of reduction remains questionable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation

    Marijuana dependence is an enormous problem, and effective treatment procedures are needed.

    “Marijuana dependence is an enormous problem, and effective treatment procedures are needed (McRae et al., 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites McRae et al., 2003 source

  • May combine two claims.

    Study design and conductown data

    The therapist's overall adherence to the manual and overall competence were rated very highly (adherence M = 4.6, SD = 0.5; competence M = 4.8, SD = 0.4).

    “The therapist's overall adherence to the manual and overall competence were rated very highly, Ms 5 4.6 (SD 5 0.5) and 4.8 (SD 5 0.4), respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two other participants dropped out of treatment in the early stages.

    “Two other participants dropped out of treatment in the early stages.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    High attrition is a common problem in marijuana abuse treatment research.

    “However, high attrition is a common problem in marijuana abuse treatment research (e.g., Budney et al., 2000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Budney et al., 2000 source

  • May combine two claims.

    Premisecitation

    All existing approaches for marijuana dependence suffer from limited effectiveness in both the short and long term as well as other limitations including high attrition.

    “Unfortunately, all these approaches suffer from limited effectiveness in both the short and long term as well as other limitations including high attrition (McRae et al.).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites McRae et al.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductcitation

    Session tapes were scored using a validated and reliable scoring system that has been previously used in ACT research.

    “Session tapes were scored for the quantity and quality of the coverage of each component of ACT using a validated and reliable scoring system (Pierson, Bunting, Smith, Gifford, & Hayes, 2004) that has been previously used in ACT research (Twohig et al., 2006)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Pierson, Bunting, Smith, Gifford, & Hayes, 2004

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Twohig et al., 2006 source
34 of 34

  • The paper relies on this without support.

    The oral swab test detects marijuana use up to 3 days prior to testing.

    “This test can detect marijuana use up to 3 days prior to testing, and only the presence or absence of marijuana metabolites (a dichotomous rather than a continuous measure) was reported by the laboratory.”

  • The paper relies on this without support.

    ACT does not attempt to reduce or control private events associated with substance use, but rather helps create a verbal context in which urges to use and thoughts about using can be experienced and not acted on.

    “Specifically, ACT does not attempt to reduce or control private events that are associated with substance use, but rather helps to create a verbal context in which urges to use and thoughts about using can be experienced and not acted on.”

  • The paper relies on this without support.

    Maintenance of treatment gains has been an issue in all other marijuana abuse treatment studies.

    “Even though it is not reasonable to compare studies, maintenance of treatment gains has been an issue in all other marijuana abuse treatment studies.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Participant 2's baseline intake differs from the table

    Major

    The results report a baseline mean of eight inhalations per day for Participant 2, whereas Table 2 gives 6.7 for the same participant's pretreatment mean intake.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Hayes S. C., 1994, Acceptance and change: Content and context in psychotherapy
  2. Tashkin D. P., 1990, Research findings on smoking of abused substances, 63

Cited by

Sorted by citations

Related

Authors
Twohig, M. P., Shoenberger, D., & Hayes, S. C.
Affiliations
University of Nevada, Reno (US)
Corresponding author
Twohig, Michael P.
ORCID
Venue
Journal of Applied Behavior Analysis
Publisher
Wiley
Published
2007-12
Volume
40
Issue
4
Pages
619-632
ISSN
  • 0021-8855 (ISSN-L)
  • 1938-3703
DOI
10.1901/jaba.2007.619-632
PMC
PMC2078570
OpenAlex
W2130877230
Cited by
130
References
57
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 34 · 2020: 4 · 2019: 2 · 2018: 7 · 2017: 3 · 2016: 2 · 2015: 8 · 2014: 12 · 2013: 10 · 2012: 7
FWCI
8.71
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1915 d)
Locations
  • Journal of Applied Behavior Analysis (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
Keywords
acceptance and commitment therapy, cannabis use disorder, addiction treatment, experiential avoidance, depression, anxiety, withdrawal symptoms, abstinence, individual psychotherapy
MeSH terms
Adult, Attitude to Health, Marijuana Abuse, Female, Humans, Male, Motivation, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Treatment Outcome

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