Welcome North Carolina! - Prevention Research Institute

prime
prime times
March 2009
a newsletter from Prevention Research Institute
www.primeforlife.org
Welcome North Carolina!
It all began at The Alcove
Horizons Center, Inc. in Wilmington, made the following announcement:
As PRI celebrates 25 years, we
welcome North Carolina as the
“As you may have read in last month’s email sent
latest state to adopt PRIME For
by Lynn Jones, the DWI Services office was grantLife for impaired driving offended approval by the North Carolina Departers statewide. Lynn Jones,
ment of Health and Human Services
“PRIME
DWI Services Program
NCDHHS Rules Commission to
Manager for North
For Life does
adopt a new Alcohol and Drug
Carolina, stated,
not teach DWI clients
Education Traffic School
“We wanted to
(ADETS) curriculum.
about the change process.
make sure that
After a rigorous evaluaIt helps move them through it.
whatever protion process, the PRIME
I now see that just teaching the
gram we adFor Life curriculum
Stages of Change is not nearly as
opted for the
created by Prevention
powerful as helping them move from
state could
Research Institute (PRI)
demonstrate
one stage to another. That’s the
was chosen. We are
using best
power of PRIME For Life, and I
thrilled to have the oppractices in the
portunity to work with PRI
am excited to harness that
content, delivand
this nationally renowned,
power for my
ery, and on-going
evidence-based, and SAMHSAclients!”
support, and that
registered1 first offender education
there was research-based
program.”
evidence of program effecIn September and October 2008, 100 new instructors
tiveness.”
from throughIn October 2006, PRI conout the state
On the Inside
ducted a pilot training in
were trained
Chapel Hill for a small group
in Asheville,
of impaired driving instruc2
Author’s Notes
Raleigh, Wilmtors who then delivered the
ington, and
3
PRIME For Life Army
PRIME For Life program
Charlotte. Two
to clients for the next year.
4
Ask PRI
additional New
Client data were collected
Instructor Train6
Reflecting on the Past
and analyzed over the comings and two coning months. In July 2008,
8
Moving ForWarD
tinuing education
Dale Willetts, Director,
conferences are
PRIME Solutions Release
10
North Carolina Treatscheduled in
ment Accountability
2009. PRIME
12
Sweden Celebrates 10
for Safer CommuniFor Life will
ties (TASC) Training
14
Research Reviews
be taught in 16
Institute at Coastal
hours to ADETS
18
In the News
continued on page 23
New PRI Staff
22
A
uthor’s Notes
I don’t know
about you, but
I am ready for
spring! I am
ready for the
new offerings
Mother Nature
has in store
for us—the
first glimpse of
crocuses and
daffodils, the
buds on the
trees, and fresh
PRIME For Life Co-Author Ray Daugherty
asparagus! I am
also ready to
share some exciting new programming and services from
PRI.
New Treatment Program
We have released PRIME Solutions, an innovative program
for addictions treatment, after 4 years of development.
This first version of Solutions represents a tremendous
amount of work by an incredible team, and I am honored
to have played a role in guiding the development. We are
all honored and humbled at the response we are getting
from clients and instructors after attending a Solutions
training or “webinar.” Check out page 10 to see what
Solutions offers, or visit www.primeforlife.org for more
details.
New Partners
We also proudly welcome two new systems as PRIME For
Life partners. North Carolina (see cover story) has held
its initial New Instructor Trainings, and we look forward
to the first continuing education conference coming up.
What a unique opportunity to have worked with Lynn
Jones in establishing PRIME for Life in two states: Utah
and North Carolina.
We are also delighted the U.S. Army has joined our ranks
(pun intended!). Many of you know the Army is near and
dear to me as I started my career in this field at Camp
Zama, Japan, and we couldn’t be happier to be implementing PRIME For Life for our soldiers worldwide. These
men and women are doing an incredible job and dealing
with a remarkable amount of stress. My son-in-law is just
returning from Iraq so, like many of you, I have experienced the challenges soldiers and their families face
when in a war zone. We are so honored to work with the
2
www.primeforlife.org
Celebrating the New and Treasuring the Old
Army to bring PRIME for Life to the troops. Read more on
page 3.
New Staff
And, it is always exciting to announce new staff joining
PRI (see page 22). Dr. David Rosengren will serve as our
staff Clinical Research Specialist. He will focus on PRIME
Solutions and lead the evaluation effort for E-PRIME,
our independent learning version of PRIME For Life being developed for the U.S. Army for use first with troops
in combat areas. David brings a wealth of knowledge and
experience to this new position, and we enthusiastically
welcome him on board. Instructors will have a chance to
meet David at future continuing education conferences
where he will share many Motivational Interviewing skills
and techniques.
In This Issue
Truth be told, I am always excited to share PRIME Times
with our readers. In this issue, our primary alcohol research
analyst, Mark Nason, summarizes a study which explores the
incidences of alcohol-related problems resulting from “risk”
drinking. Allan Barger, PRI’s primary drug and brain research
analyst, discusses genetics and marijuana use. In addition to
these articles and our regular “In the News” and “Ask PRI”
features, we have two more special articles in this edition.
On page 6, we continue to celebrate PRI’s 25th anniversary,
and three people who have been with us since the beginning share their reflections on delivering and implementing
PRIME For Life and the changes over the years. We also
honor Sweden’s 10th PRIME For Life anniversary and their
progress over the years on page 12.
Finally, it is impossible for any of us to ignore the economy
right now. People ask us how this will affect drinking patterns. We have been tracking research on this, but this
recession seems to be breaking the pattern. For decades
when the economy goes down, beer sales have gone up—
but not this time. Over the last few months, beer sales
have taken a significant drop, and no one knows quite how
to explain it. We do know it is an international trend. It
will be interesting to see how, if at all, drinking trends and
problems will evolve in this economy. Also, the incredibly
high gas prices of last year made some changes in driving
habits and people are still driving fewer miles. This combination may well affect drinking and driving which is a good
reminder that human behavior is affected by many different factors. Regardless, we will continue to be here for all
of you to support your efforts and commitment to reducing
alcohol- and drug-related problems around the world. PRI
P
RIME For Life Army
PRIME For Life Chosen As Standardized U.S. Army Substance Abuse Program
We have come a long
way since nearly 38 years
ago when PRI President
Ray Daugherty helped
establish the U.S. Army’s
alcohol and drug program
in Japan. Now, PRIME
For Life is the standardized, world-wide substance abuse program for
policy violators, command referrals, and self-referrals to the Alcohol and
other Drug Abuse Prevention Training (ADAPT).
The U.S. Army’s decision to choose PRIME For
Life followed a multi-year process in which the
Army thoroughly examined available programs and
conducted an evaluation of PRIME For Life with
soldiers. In the words of Tom Marquez, Director of
Prevention and Research for the U.S. Army Center
for Substance Abuse Programs (ACSAP), “Of all the
programs available, PRIME For Life was the best fit
for the U.S. Army; it is our program.”
Prevention Research Institute has facilitated New
Instructor Trainings and workshops with Army per-
sonnel for almost 20 years. Ray Daugherty and Terry
O’Bryan facilitated the first New Instructor Trainings
for Army personnel at Ft. Knox, Kentucky and
Schoefield Barracks, Hawaii in 1987. Since then, military trainings and workshops have been held in the
United States, the Netherlands, Germany, and Japan,
and instructors have been delivering and promoting
PRIME For Life throughout the world as a result. In
1998, the Swedish Armed Forces adopted PRIME
For Life for all military personnel from the 10-month
Conscripts to the Supreme Commander. The results
of this Swedish initiative (see page 12) helped inform
ongoing work with the U.S. Army.
There are simply too many people and not adequate
space to thank all those who helped make the military
implementation a reality. A preliminary list includes
Mike Biggerstaff, Timothy Block, Pam Budda, Bill
Castro, Paula Duncan, Tracy Felton, Collette Gill,
Dianne Hayward, Ramon Maisonet, Tom Marquez,
Linda Martinez, Les McFarling,, Michael Noyes,
Joanne Shimasaki, Richard Stock, Wayne Stramer, and
Patrick Teel. We thank all those involved with helping
us deliver the PRIME For Life message. It is an honor
and a privilege to serve our military personnel. PRI
Feedback from the Experts
Before Dr. Carlo DiClemente, co-developer of the
Transtheoretical Model (TTM) of Change, and Dr.
Theresa Moyers, Motivational Interviewing (MI) expert, decided to collaborate with us, they wanted to
experience a PRIME For Life class. Now you can hear
their comments regarding their PRIME For Life experience in a brief video on our home page at www.
primeforlife.org. We are delighted both experts
decided to partner with us to help develop PRIME
Solutions, our recently-released treatment program,
and to continue working with us on new projects. PRI
March 2009
33
A
sk PRI
Q: If a person has one biological risk factor and therefore should not drink on a daily basis and not have
more than two drinks on any day, what is the maximum number of drinks that person should have in one
week?
A: First of all, we want to be clear that 0-1-2-3 is the
research-based, low-risk guideline for most people, most
of the time. We do not have definitive data on specific
quantities below 0-1-2-3. Rather, the recommendation
is to decrease quantity and frequency as biological risk
increases. The more a person decreases alcohol use, the
more the risk is reduced.
As an example, a person who has no more than two drinks
per day (spaced an hour apart) and no more than four days
per week would consume eight drinks per week. Note,
however, this quantity and frequency is only a recommendation. The research suggests those who consistently follow the 0-1-2-3 guidelines, even with increased biological
risk, are significantly less likely to have alcohol-related
problems than those exceeding the low-risk guidelines.
Q: Someone in my group argued the human body
produces its own THC. Is there a certain amount of
natural THC in the brain, and if so, what is its purpose?
A: There is no natural THC in the human brain. THC is
a specific plant compound not found in humans or any
animals of which we are aware. There has been some
confusion about this since researchers discovered natural
cannabis-like substances in the brain and body, but it is
not THC. Just as our brains produce their own natural opiates such as endorphins, they also produce natural compounds known as cannabinoids (can-nab’-i-noids). The
best known of these are 2-AG (2-arachidonoylglycerol)
and anandamide. These natural substances do not get us
“high” like THC, but help to regulate other substances in
our brains such as dopamine, serotonin, and natural opiates. These substances help with emotional balance, play
a role in our reward system, and help control appetite,
pain, and inflammation.
Q: A student asked me exactly how abstract thinking impairment occurs. Can you explain it?
4
www.primeforlife.org
A: High-risk alcohol (and some drug) choices affect the
frontal lobes of the brain where our higher thinking skills
such as executive functions and abstract thinking are centered. Over time, numerous episodes of high-risk drinking
seem to put this part of the brain in a permanently slowed
down state, decreasing ability to process information and
make mental connections. We are not aware of neurological research that has defined the actual mechanics of loss
of processing power, but we can measure it in laboratory
settings. Fortunately, this deficit in function frequently recovers fully with abstinence or other low-risk choices in
which the person is not getting impaired.
Mental function is impaired before physical function,
so the low-risk guidelines, and “no more than one drink
per hour” in particular, are useful for preventing abstract
thinking impairment. However, research shows high-risk
drinking over long periods of time can lead to permanent
brain damage.
Q: I am working with a gentleman in his 50s who is
a life-long marijuana smoker, active in the legalization
movement. He reports having never seen any convincing
information that THC is bad for his health, but stated
if he received such information he may consider quitting. He strongly believes smoking marijuana should be
a freedom. Can you direct me to research information
to answer his request?
A: This is a tough question and a position in which many
PRIME For Life instructors and professional counselors
find themselves. Your client is understandably convinced
of his position but may not have balanced information.
Many pro-marijuana websites and publications play
down or ignore risks found in research. Since politically
active users such as your client tend to get their information from sources summarizing research to support a
legalization agenda rather than directly from the original
published journals, they often do not see both pros and
cons or the validity of the risks. While some research is
countered by other findings, after controlling for a variety
of factors, current research does substantiate the risks associated with using marijuana.
Research is limited on people the age of your client because most people his age are not using marijuana or, for
that matter, any other illegal drug. Just over 1 in 20 (6%)
Q
Answering Questions or Concerns Raised by PRIME For Life Instructors
of the adult U.S. population aged 50-54 uses any illegal
drug. The number drops to 2.4% for those aged 55-59.1
In other words, 94% to 97% of the U.S. population his
age are not using marijuana or any other illegal drug.
Thus, research tends to focus on young adults, the largest cannabis-using age group. However, the human body
is normally more resilient at younger ages, so one would
expect to find similar or perhaps even worse problems as
a person ages. Below are some points your client might
find of interest:
cial sources could be cited, but there is not room here.
For one of the best compilations of research on this
subject, we recommend the book Cannabis Dependence: Its Nature, Consequences and Treatment.6
Q&
•
•
•
If a person smokes both tobacco and marijuana, the effects are additive. In an Australian study that included some older age groups, half of the group who had
smoked tobacco and marijuana for 20 years had symptoms of chronic bronchitis.2
Research suggests those with cannabis dependence
have respiratory symptoms similar to and sometimes
greater than those smoking 1-10 tobacco cigarettes per
day. After controlling for tobacco use, cannabis-dependent users had higher rates of wheezing, shortness of
breath, chest tightness, and morning sputum production compared to non-smokers.7,8
•
Certain cancer risks also surface for regular marijuana
users. Sidney and colleagues3 found most types of cancer occurred no more frequently in cannabis users than
in non-users. However, men who were current cannabis users had a 4.7 relative risk of prostate cancer. That
is, for every one occurrence of prostate cancer among
cannabis non-users, prostate cancer happened almost 5
times in the cannabis-using group.
There is another risk that may not directly impact your
client at his age but may give him pause about legalizing marijuana for everyone. In the past decade a growing body of research suggests marijuana may increase
risk for the onset of schizophrenia in those with a predisposition to it or in those who start using before the
age of 15.9,10
•
Finally, since your client is active in the legalization
movement, he has probably heard the statement from
the 1995 The Lancet, one of Great Britain’s leading
medical journals, “The smoking of cannabis, even long
term, is not harmful to health.”11 This assertion has
been widely quoted in the pro-marijuana movement.
Note that all of the research cited above was published
after the original 1995 Lancet editorial. What your
client may not have heard is in 2007—based on new
research—The Lancet retracted its earlier position saying: “In 1995, we began a Lancet editorial with the
since much-quoted words: ‘The smoking of cannabis,
even long term, is not harmful to health.’ Research
published since 1995, including Moore’s systematic
review in this issue, leads us now to conclude that cannabis use could increase the risk of psychotic illness.
Further research is needed on the effects of cannabis
on affective disorders.”12 While several pro-marijuana
websites still list the original 1995 editorial, virtually
none state this later position, thereby reinforcing the
concern about a lack of balanced views.
•
Regular users have impaired cognitive function. Those
classified as heavy users (having used at least 22 of the
past 30 days) had poorer recall, showed deficient learning, and found it difficult to adopt new ways of thinking/acting when conditions called for it (perseverative
errors).4 Another study examining long-term users
while controlling for aging found those regularly using
cannabis for 24 years showed impairments in attention,
verbal learning, memory retention and retrieval.5 A
regular user may be in a chronically impaired cognitive
state that will seem normal to him or her, especially if
the age of first use was early. Fortunately, most of these
deficits seem to largely repair themselves after 4 to 6
weeks of abstinence, but while a person continues to
use regularly, he or she is likely to have some chronically impaired cognition.
•
Perhaps the health problem most documented in the
past decade has been the risk for cannabis dependence
or addiction. While it is widely believed that marijuana
is not addictive, the research suggests otherwise. A
wealth of studies from both biological and psychoso-
A
The legalization movement has made great in-roads in convincing itself and the public that marijuana is harmless. The
research on several fronts from the past decade suggests
otherwise.
References on bottom of page 11
March 2009
53
R
eflecting on the Past
As PRI celebrates 25 years, we thought it would be in-
tion Pilot Programs was in Athens, Georgia. Terry Daly,
teresting to reflect on the past, present, and future with
who was a trained PRI instructor in Athens, suggested
some long-time PRIME For Life advocates. Carole
piloting the PRI curricu-
Middlebrooks, the Director of the Georgia Network
lum for the RRP. The
for Substance Abuse Prevention in Higher Education,
other pilot sites were us-
attended the very first PRIME For Life training in the
ing our ‘homegrown’ cur-
state of Georgia in October 1985 and has been deliv-
ricula. The PRI program
ering PRIME For Life on campuses and other settings
blew the other curriculum
since then. Debbie Synhorst in the Iowa Department
out of the water, and that
of Public Health and current President of the National
was the beginning of a
Prevention Network attended PRIME For Life in 1988.
beautiful relationship! The
Jane Martin, the Associate Director for Children, Fam-
Georgia Legislature passed
ilies and the Courts in the Georgia Administrative Of-
legislation in March 1990 to
fice of the Courts, was introduced to PRIME For Life
implement the Risk Reduction Program statewide, and
in 1989 and organized efforts to implement PRIME For
Georgia has been using PRIME For Life ever since.
Life statewide in Georgia.
How did you get interested in PRI/
PRIME For Life?
Debbie: I attended training in February 1988 to see if we
wanted to offer the PRI program in Iowa, and this began
a long association of great collaboration on substance
Carole: Terry Daly of the Northeast Georgia Mental
abuse prevention. One participant at my New Instruc-
Health Center in Athens had been looking for the best
tor Training in Colorado was someone special named
alcohol and drug prevention program in the country and
“Frosty!” Speaking of PRI staff, we are proud to claim
felt that the PRI program, TWYKAA (Talking With Your
PRI’s Michelle Ellison as an Iowa gal.
Kids About Alcohol), had the best researched-based factual information, communication skills and design. After
What can you share with us about the
training and teaching parent groups, we received a grant
“early days”?
to pilot On Campus Talking About Alcohol (OCTAA) at
Debbie: Oh those overheads! They were hard to keep in or-
the University of Georgia. My interest and involvement
der, to keep clean, and to carefully position papers to cover
just kept growing.
up the concepts to come. The preparation to deliver the cur-
Jane: I was the director for a pilot project to develop
a DUI Risk Reduction Program (RRP) for the state of
6
Jane Martin, Associate Director
for Children, Families and the
Courts in the Georgia Administrative Office of the Courts
riculum correctly was challenging and, at times, it was a
tough sell to get the needed time.
Georgia as part of the mandatory driver’s license sanc-
Jane: The technology from those early days is now out-
tions for DUI offenders. One of the DUI Risk Reduc-
dated, that’s for sure. But, the curriculum has always been
www.primeforlife.org
PRI 25th Anniversary Reflections
state-of-the-art, and PRI is always reviewing current technology and planning for improving program delivery and
instructor training. I have worked with many providers over
the years, but none that are as innovative and cutting edge
as PRI. PRI also works to develop their staff and bring on
a diverse group of staff and master instructors around the
country to meet the different needs of
a real challenge.
Carole: The program was excellent to begin with but continues to grow and change through the years to add new
research or update some of the old. It kept up to date as
new technology was available—we started off with transparencies! The quality of the process has not been lost in
the changes.
their customers.
Debbie: The concepts, the approach, and
Carole: We were totally amazed at
the integrity have remained constant, but
the reaction of the participants while
the technology and the ways to commu-
presenting the program. When I was
nicate the messages have amazingly im-
teaching OCTAA to policy violators,
proved. There has been more research,
I realized that I was raising the awareness of students that they may have or
be developing a serious problem, and
Debbie Synhorst, Iowa Department of
Public Health and current President of the
National Prevention Network
there was no system in place to follow
up with them. I was getting my certification as an addiction
counselor, so I started requiring them to sign up for an individual appointment with me within the next two weeks. In
those sessions I began to learn amazing things and realized
that you could not go by their behavior in class to determine
more people involved in the research,
more people have been trained, and many
more people across the substance abuse
continuum appreciate and understand what PRI does.
What would you like to say to others
involved in implementing or delivering
PRIME For Life?
their reception to the information. This was inspiring and
Jane: PRI listens to their customers, involves their custom-
motivating to me.
ers in planning and testing, and is ready to develop pro-
What changes have you seen since
those early days?
grams that meet the needs of the evolving addiction field.
New customers will be amazed at the quality of PRIME
For Life and the support and customer service of PRI. I en-
Jane: I am now removed from the day-to-day work with
courage them to embrace the program, go to all the training
PRI, but still in contact with many administrators and in-
they can, and deliver the program as designed. They should
structors who teach PRIME For Life. I hear over and over
stay involved and network with their peers. People involved
that Version 8 is phenomenal. I am very excited about
with PRIME For Life around the country are really a fam-
PRIME Solutions and the opportunity it offers to drug and
ily and believe in the program they are providing to their
DUI courts. Implementing evidence-based practices into
participants. It works!
drug court treatment and doing fidelity monitoring has been
continued on bottom of page 19
March 2009
7
M
oving ForWarD
Over the years systems and instructors have requested reliable tools to help them measure and improve
quality delivery of PRIME For Life. PRI listened to
this feedback and consulted with Dr. Theresa (Terri)
Moyers, known for her expertise in the development
of integrity measures for Motivational Interviewing, a
client-centered counseling style used worldwide. The
result of the collaboration was Moving ForWarD—
a concise and reliable measure of coding instructor
delivery. According to Terri Moyers, “Even the best
programs are only as good as the interventionists that
deliver them. This is especially true when programs
are complex, and providers must have excellent interpersonal skills to convey them, as in
PRIME For Life.”
2009, PRI will continue testing the tool with a larger
pool of 50 PRIME For Life instructor video tape samples which will offer more variability and allow the
use of an intraclass correlation (ICC) to interpret the
data.
Using Moving ForWarD
Many PRIME For Life instructors and administrators
became acquainted with the Moving ForWarD tool in
2008 at New Instructor Trainings, coder trainings, and
continuing education conferences. Moving ForWarD
is designed to offer personal, peer, and expert feedback on PRIME For Life delivery—both content and
process. When co-delivering
PRIME For Life or delivering
segments in continuing education conferences, instructors
have opportunities to offer and
receive actionable feedback
with peers. The framework is
objective and is designed to
be solution focused. Although
it can be challenging, offering
peer guidance is a gift we can
give a co-presenter, and accepting peer feedback is a gift
we can give ourselves.
Establishing Reliability
Using a reliable tool is important
to PRI—after all, “research” is our
middle name—and to the systems
and instructors we serve, so before
Moving ForWarD was widely disseminated, PRI tested its reliability.
Reliability is the scientific term for
the tendency toward consistent results in repeated trials. With the help
of trained and experienced Moving
ForWarD coders Holly Watson from
Utah, Lisa Hagen from New MexiWhen used as a personal feedco, and Andrea Williams from Ken- Terri Moyers demonstrating Moving ForWarD back measure, Moving Fortucky, an initial level of percentage scale for PRI trainers.
WarD assists instructors in
agreement on the coding levels was
measuring how well they are
established. After Melanie Downs and Michelle Ellidelivering PRIME For Life. Moving ForWarD tools
son from PRI and Terri Moyers provided the trained
provide a foundation to build a personal development
coders with a refresher on their skills, the coders spent
action plan to move delivery to the next level.
two days to “code, code, code!” Lisa, Holly, and Andrea then independently coded 12 PRIME For Life
Experienced or “expert” feedback is also available
instructor video samples; their codes were compared
from PRI and from a growing league of trained Movfor agreement and were in an acceptable range for reing ForWarD coders. Coders have been trained in
liability. Because of the small data set and homogeneGeorgia, Kentucky, Maine, and most recently in Sweity (sameness) of the group, the method of percentden (see page 13). PRI encourages instructors to reage agreement was appropriate for the comparison. In
ceive expert feedback by sending us a sample of their
8
www.primeforlife.org
Moving Forward with Moving ForWarD
teaching. Trained coders will “code” the
sample and offer a phone coaching session at no charge. Instructors up for the
challenge should contact Michelle Ellison at [email protected].
Special thanks to the following 12 instructors who submitted the initial tapes
to allow the project to “move forward”:
Buck Avant (ME), Amanda Baker (KY),
Mike Baker (IA), Rene Barrera (UT),
Bill Cavanaugh (IA), Diane DeVries
(KY), Mike Driscoll (ME), Russ Dubois
(ME), Emily Hixon (KY), Ruth Johnson
(ME), BiBi Roberts (KY), and Conway
“Bud” Southard (IA).
Left to right: Lisa Hagen, Holly Watson, Andrea Williams, Terri Moyers, Michelle Ellison, and
Melanie Downs worked together in Albuquerque, New Mexico, to determine reliability of the
Moving ForWarD tool.
Visit the Instructor website at www.
primeforlife.org for more information about Moving ForWarD. Though improving delivery can be a challenge for instructors, increased likelihood of
behavior change in clients will be the ultimate reward. PRI
The Pot Man Needs Your Input
As many readers are aware, information extolling the benefits of
marijuana can easily be found with just a few clicks on the web or a
simple Google search. Alternative bookstores often carry entire magazines
devoted to growing marijuana and the benefits of the drug. Not
surprisingly, such readily-found information presents a one-sided view of
using marijuana.
PRI is exploring the possibility of writing a book and even hosting a website to provide a
balanced, research-based understanding of the risks of using marijuana, but we need your help. Does a
research-based book about marijuana interest you? What would you like to read or explain to your groups
or others in your lives regarding the risks of using marijuana? What questions do you get from clients or
the community regarding marijuana? Send your questions, comments, and suggestions to Allan Barger,
PRI Research Analyst fondly referred to as the Pot Man, at [email protected].
We will keep you posted on the project and appreciate your input.
PRI
March 2009
93
PRIME Solutions is Released
Visit www.primeforlife.org for training schedule and details.
Contact Mark at [email protected] or 800.922.9489.
PRIME
Solutions
TM
Empowering Change
Building Hope
Protecting Lives
TM
PRIME Solutions is an evidence-based, protocol-driven, standardized treatment
program developed by PRI and several leading addiction experts. PRIME
Solutions builds on the PRIME For Life platform and integrates:
• Cognitive Behavioral Therapy
• Contingency Management
• Lifestyle Risk Reduction Model
• Motivational Interviewing
• Persuasion Protocols
• Transtheoretical Model
Online Training on:
• Transtheoretical Model with Carlo C. DiClemente, Ph.D.
• Motivational Interviewing with William Miller, Ph.D. and Theresa Moyers, Ph.D.
• Coping with Craving with Anna Rose Childress, Ph.D.
• 12-Step Research with Scott Tonigan, Ph.D.
• ASAM placement with Gerald Shulman, M.A.
• Contingency Management with Nancy Petry, Ph.D.
• Spirituality in Recovery with Ernie Kurtz, Ph.D.
Contact us to find out what PRIME Solutions can do for you and your clients.
From the staff of
Prevention Research Institute
• Session-specific online training
• More focus; less drift
• Media enhanced
• Bringing science to practice
• Flexible standardization
• Two paths of treatment
• Enriching the treatment experience
• 12-Step integration
Carlo C. DiClemente, Ph.D.
Theresa Moyers, Ph.D., and
Gerald Shulman, M.A.
“ Solutions should empower counselors and
clients to negotiate the change process in an
engaging and effective manner. ”
Carlo DiClemente
10
www.primeforlife.org
P
RIME Moments
Inspirational Comments
From Clients
4Pope,
H. & Yurgelen-Todd, D. (1996). The residual
cognitive effects of heavy marijuana use in college students. Drug and Alcohol Dependence, 38, 25-34.
5Solowij,
N., Stephens, R., Roffman, R., Babor, T., Kadden, R., Miller, M., et al. (2002). Cognitive functioning of
long-term heavy cannabis users seeking treatment. Journal
of the American Medical Association, 287, 1123-1131.
6Rofman,
R. & Stephens, R. (Eds.). (2006). Cannabis Dependence: Its Nature, Consequences and Treatment (International Research Monographs in the Addictions ([IRMA]).
Cambridge, United Kingdom: Cambridge University Press.
7Taylor,
From
a clie
nt, Ju
ne 20
08
D., Poulton, R., Moffitt, E., Ramankutty, P. & Sears,
M. (2000). The respiratory effects of cannabis dependence in
young adults. Addiction, 95, 1669-1677.
8Taylor,
Ask PRI continued from page 5
References
1Substance
Abuse and Mental Health Services Administration (SAMHSA). (2007). Results from the 2006 National Survey on Drug Use and Health (NSDUH): National Findings.
Retrieved August 4, 2008 from http://www.oas.samhsa.gov/
NSDUH/2k6NSDUH/2k6results.cfm#Ch2.
2Swift, W.,
Hall, W., Didcott, P., & Reilly, D. (1998). Patterns and
correlates of cannabis dependence among long-term users in an
Australian rural area. Addiction, 93, 1149-1160.
3Sidney, S., Quisenberry Jr., C., Friedman, G., & Tekawa, I. (1997).
Marijuana use and cancer incidence. Cancer Causes and Control,
8, 722-728.
D., Fergusson, D., Milne, B., Horwood, L. Moffitt,
E., Sears, M., et al. (2002). A longitudinal study of the effects
of tobacco and cannabis exposure on lung function in young
adults. Addiction, 97, 1055-1061.
9Zammit,
S., Allebeck, P., Andreasson, S., Lundberg, I., &
Lewis, G. (2002). Self-reported cannabis use as a risk factor
for schizophrenia in Swedish conscripts of 1969: Historical
cohort study. British Medical Journal, 325, 1199-1203.
10Arsenault,
L., Cannon, M., Poulton, R., Murray, R., Caspi,
A., & Moffitt, T. (2002). Cannabis use in adolescence and risk
for adult psychosis: Longitudinal prospective study. British
Medical Journal, 325, 1212-1213.
11Deglamorising cannabis. (1995, November 11). The Lancet,
346, 1241.
12Rehashing
the evidence on psychosis and cannabis. (2007,
November 3). The Lancet, 370, 292.
March 2009
11
33
S
weden Marks 10
Program Now Delivered To Wide
Range of Swedish Audiences
Ten years ago, a PRIME For Life New Instructor
Training was held in Boson, Sweden, for 16
professional military personnel representing
the Swedish army, navy, and air force.
Testing Service (EDTS) which acquired the PRI
Swedish operations in 2005. The Swedish edition of Version 8 was launched early in 2008
after a thorough translation. Currently about
150 Swedish instructors are certified to teach
Version 8.
Ten-Year Anniversary Celebration
Fast forward a decade. PRIME For Life is now
Just as in most systems in the United
used nationwide in Sweden for impaired
States, continuing education confer“The Swedish
drivers. It is widely used in the
ences are required for Swedish
instructors are extraormilitary and is being delivered
instructors. The 2008 conferdinarily enthusiastic and
as part of the major counselor
training and certification pro- dedicated. The level of emotional ence was held December
commitment, the pride instructors 9-10 in cooperation with the
gram in Stockholm. PRIME
have in teaching PRIME For Swedish Prison and Probation
For Life has been delivered
Service. The theme of the
Life, and the meaning it has
to the Supreme Commander
conference was PRIME For Life
for most of them is striking.”
of Sweden and civilians in
in Sweden: The Past, Present
~ Ray Daugherty ~
Sweden’s businesses and indusand Future. On the first day, Frosty
tries. Most recently, after strinpresented
an inspirational and historic
gent consideration, PRIME For Life was
look at PRIME For Life in Sweden, and PRI
approved for nationwide implementation in
President Ray Daugherty facilitated a session
the Swedish prison and probation system.
of some of the guiding PRIME For Life conAnna Sjöström introduced PRIME For Life to
cepts. According to Ray, “The Swedish instrucSweden after she attended a New Instructor
tors are extraordinarily enthusiastic and dediTraining in
cated. The level of emotional commitment,
Lexington,
the pride instructors have in teaching PRIME
Kentucky in
For Life, and the meaning it has for most of
1997. With guidthem is striking.”
ance from PRI’s
Swedish instructors were treated to presentaTom “Frosty”
tions by PRI consultants Dr. Carlo DiClemente
Frostman, Anna
and Dr. Terri Moyers on the second day of
has diligently
the conference. Specifically, Carlo discussed
guided PRIME
the association between PRIME For Life
For Life efforts
and the Transtheoretical Model (Stages of
in Sweden since
Change), while Terri presented the congruenthen, including
Anna Sjöström proved to be a true “coder
cies between PRIME For Life and Motivational
daily operaqueen” after her Moving ForWarD training
with Michelle Ellison.
Interviewing.
tions at the
European Drug
12
www.primeforlife.org
Sweden Celebrates 10 Years of PRIME For Life
Moving ForWarD in Sweden
In October, Michelle Ellison, PRI’s Instructor
Development Director, facilitated a two-day
Moving ForWarD conference in Stockholm
to introduce the Moving ForWarD instructor
development tool. Participants in the conference were Swedish trainers, trainer candidates, and master instructors. Swedish instructors are required to be observed and receive
a Moving ForWarD code every 24 months to
maintain certification and are encouraged to
regularly send a video tape for coding and
feedback. According to Michelle, “Co-leading
the Moving ForWarD training with coder
‘queen’ Anna Sjöström for the PRI Nordic audience was a remarkable experience. Guiding
instructors while they coded tapes in Swedish
was tremendously validating both to the coder
training process Terri Moyers coached us to
develop and the Moving ForWarD tool itself.
The Swedish instructors struggled and celebrated success in exactly the same points of
the coder training as PRIME For Life instructors did using the tool in English. Requiring a
code as a mandatory component for instructor
certification speaks volumes to how dedicated
Anna and PRI Nordic are to continued instructor skill development.”
Frosty elaborates on the Swedish PRIME
For Life experience, “Ten years ago, had
our Swedish friends viewed PRIME For Life
as an ‘American’ program designed for the
‘American’ culture, it probably would not have
found a home in Sweden. What actually happened is that those taking a critical look at
the utilization of PRIME For Life in Sweden
quickly came to understand that although
the program was developed in America by
Americans, it was based on the best practices
of our field, was research-based, thoroughly
evaluated, and spoke meaningfully to anyone
who not only wished to reduce risk for problems related to alcohol and drug choices, but
who also wanted to protect the things they
value most in life. Reducing risk and protecting life’s treasures resonate across cultures.
On my last day in Sweden, one of our Swedish
instructors shared with me, ‘Frosty, PRIME For
Life changed my life, and I am now empowered to help others make similar changes in
their lives.’ I can’t wait to see what the next
10 years bring with PRIME For Life in Sweden!”
Anna Sjöström deserves special recognition for
her vision, determination, and commitment
to PRIME For Life. Special thanks too to the
numerous instructors, prevention specialists,
military staff, and others who made PRI Nordic
a reality touching the lives of so many people
in Sweden. Tack så mycket. PRI
From left: Anna Sjöström, who translated PRIME For Life to Swedish, and
Christina Larsson, administrator with PRI Nordic, are joined by Carlo DiClemente, Terri Moyers, and Agneta Pilov, current Manager of PRI Nordic.
March 2009
133
A
lcohol Research
Dawson, D. A., Li, T. K., & Grant, B. F.
(2008). A prospective study of risk drinking:
At risk for what? Drug and Alcohol Dependence, 95, 62–72.
Purpose
This study sought to determine the harms associated
with “risk drinking” over a 3-year period. For the purpose of this study, risk drinking was defined for men as
drinking five or more (5+) alcoholic drinks in a single
day and for women as drinking four or more (4+) alcoholic drinks in a single day.
Authors’ Conclusions
“Risk drinking poses a threat of many types of harm,
both directly and indirectly through its association with
smoking initiation and nicotine dependence. These
findings have illustrative value for prevention programs, and they indicate that frequent risk drinking is a
strong marker for alcoholism.”
Implications for PRIME For Life Instructors
The findings of this study support the importance of
reducing drinking to prevent alcohol-related problems
and provide more specifics on the harms common
among “risk drinkers” beyond having a shorter lifespan
as mentioned in PRIME For Life. The study updates
some of the data provided in the PRIME For Life workbook (page 57) on risk for alcohol abuse or dependence
among people engaging in risk drinking.
Unfortunately, the authors chose to use, out of convention, the 5+ measure for men and 4+ for women commonly used in survey research rather than determining
from the data what specific quantity and frequency
of drinking predicts the alcohol-related harms in the
sample they studied. Utilizing these common survey
measurements limits the applicability of the results to
the 0-1-2-3 guidelines.
Future follow-up interviews with this sample will shed
more light on the harms which occur over longer peri-
14
www.primeforlife.org
ods of time. The sample, on average, is fairly young, so
physical illnesses, in particular, should show up much
more frequently among risk drinkers in the future.
For those interested in more details of the study, the
methods, study results, and limitations are described
below.
Methods
This study utilized data collected via in-home interviews
from 43,093 U.S. adults 18 years of age and older in
2001-2002 and complete follow-up interview data on
22,122 of these adults 3 years later. Only adults who
reported some drinking in the first interviews were
included in the follow-up interviews. The initial sample
is representative of adults living in U.S. households.
In addition to measuring the frequency of risk drinking,
the researchers measured the duration of drinking, the
average volume of drinking on non-risk drinking days,
and the mean quantity of drinks consumed on risk drinking days.
The researchers then determined the risk for developing
a number of problems after the initial interview based on
the frequency of risk drinking. These problems included
the development of alcohol abuse or dependence (based
on DSM-IV criteria), beginning to use illegal drugs,
beginning to smoke, becoming divorced or separated,
neglecting school or work responsibilities, having a driver’s license revoked, developing mood or anxiety disorders, or engaging in violent behavior—bullying, forcing
someone to have sex, fighting, harassment, spouse abuse,
or intentionally causing physical injury.
Results
•
•
•
60% of the drinkers did not engage in risk drinking, 26% engaged in infrequent risk drinking
(three times per month or less), and 6% engaged
in frequent risk drinking (three or more times per
week).
On average, non-risk drinkers were older than risk
drinkers (47 years vs. 35 to 42 years, with neardaily to daily risk drinkers averaging 42 years).
While women were nearly as likely to engage in
some risk drinking as were men, men were much
by PRI Research Analyst
Mark Nason
•
•
more likely to be frequent risk drinkers. Over twothirds of the sample who reported risk drinking at
least once a week were men and three-fourths of
those reporting near-daily or daily risk drinking
were men, while 54% of those who engaged in risk
drinking less than once a month were men.
Risk drinkers were more likely to be married but
less likely to be employed than non-risk drinkers. Those engaging in risk drinking three or more
times a week were more likely to be obese or overweight and three times more likely to be smokers.
The greater the frequency of risk drinking, the
greater the mean number of drinks per risk drinking day. Infrequent risk drinkers averaged about
8 drinks per risk drinking day, while frequent risk
drinkers averaged about 13 drinks per risk drinking
day.
Compared to non-risk drinkers, infrequent risk drinkers
were:
• 1.6 to 2.5 times more likely to develop DSM-IV
alcohol abuse;
• 1.4 to 2.1 times more likely to develop DSM-IV
alcohol dependence;
• 1.5 to 2.1 times more likely to begin using tobacco; and
• 1.3 to 1.5 times more likely to develop nicotine
dependence.
Compared to non-risk drinkers, respondents reporting
risk drinking once or twice a week were:
• 3.3 times more likely to develop DSM-IV alcohol
abuse;
• 2.7 times more likely to develop DSM-IV alcohol
dependence;
• 2.7 times more likely to begin using tobacco;
• 1.8 times more likely to develop nicotine dependence;
• 2.8 times more likely to develop liver disease;
• 1.6 times more likely to begin using illegal drugs;
• 2.3 times more likely to develop DSM-IV drug
dependence; and
• 1.8 times more likely to have their license revoked.
Compared to non-risk drinkers, respondents reporting
risk drinking near daily or daily were:
• 3.9 times more likely to develop DSM-IV alcohol
abuse;
• 7.2 times more likely to develop DSM-IV alcohol
•
•
•
•
•
•
•
•
dependence;
4.7 times more likely to begin using tobacco;
3 times more likely to develop nicotine dependence;
4.8 times more likely to develop liver disease;
1.9 times more likely to begin using illegal drugs;
1.6 times more likely to engage in violent behavior;
2.1 times more likely to abuse their spouse;
2.5 times more likely to become separated or
divorced; and
2.1 times more likely to have their license revoked.
Limitations as Noted by the Authors
•
The study relies solely on self report of drinking and
problems.
•
The 3-year follow-up period may be too short to
determine the risks created by risk drinking for a
number of health problems.
•
The calculation of risk for social harms associated
with risk drinking reported in the initial interview
could be affected by whether the drinking pattern
remained the same or increased or decreased over
the course of the 3 years. For instance, if a substantial percentage of respondents decreased their use
soon after their first interview, the calculation of
the association between risk drinking and problems
during the 3-year follow-up period would be inaccurately low.
•
The measure of risk drinking does not include how
fast people were drinking risk amounts. The quicker
the drinking, the higher the blood alcohol level and
the greater the likelihood of impairment-related
problems like violence and arrests for impaired
driving. In the second interview, subjects were
asked how often they engaged in risk drinking within a 2-hour period. The authors state that the percentage who reported risk drinking within a 2-hour
period was much smaller than the percentage who
reported risk drinking in a given day. Consequently,
the data on risks for harm are much lower than what
would be true for those who drink risk amounts
quickly (which is often the case for younger risk
drinkers).
•
This study was not able to determine the interaction
of characteristics such as age, gender, socio-economic status and race/ethnicity in determining risk
for problems. PRI
March 2009
153
D
rug Research
Authors’ Conclusions
•
Longer duration of use was clearly linked to higher
rates of dependence in both men and women.
Virtually no one met dependence criteria within
the first year of use, but among those who used
cannabis 12 or more years, 46% of men and 41%
of women developed dependence (see Table 1,
page 21).
•
Inherited genetic traits contribute to duration of
use in both males and females, but the impact was
more powerful in women, explaining 55% of duration, compared to 41% in men. This suggests environmental factors play less of a role in women’s
duration of use than genetic factors.
•
Inherited genetic traits contributed to cannabis
dependence in both males and females, but the
impact was more powerful in men, explaining 72%
of dependence compared to 62% in women. This
left environmental factors playing less of a role in
men’s dependence than in women’s. However, in
both sexes, biology was by far the greatest predictor of dependence over their environment.
•
While there is a strong relationship between genetic traits that influence duration of use and those
increasing biological risk of dependence, they are
not always the same. For example, the genetically
heritable traits of sensation-seeking or anti-social
behavior could influence duration of use, while
genetic regulation of metabolism could influence
rates of dependence.
•
These data highlight the developmental nature of
cannabis dependence. That is, people are not born
cannabis dependent, but they are influenced by
their genetics both in duration of use and risk for
dependence.
Lynskey, M., Grant, J., Nelson, E., Bucholz,
K., Madden, P., Statham, D., Martin, N., &
Heath, A. (2006). Duration of cannabis use
– a novel phenotype? Addictive Behaviors,
31, 984-994.
Purpose
The research examined male and female identical and
fraternal twin pairs over a 12-year period to clarify
three issues.
1. Researchers explored the relative roles of genetics
and environment in two outcomes related to marijuana use—duration of use and dependence. Duration of
use measures the number of months or years a person
chooses to use cannabis, adding another dimension
to quantity and frequency of use. Frequency measures how often a person uses, but duration measures
how long a person persists in using. For example,
two people may both have an identical 12-month
duration of use but have a different frequency where
one uses weekly while another uses daily.
2. Researchers examined whether genetic responses
and environmental factors contributing to duration
of use also contribute to dependence and vice versa.
In other words, do factors related to dependence
contribute to or correlate with duration? Answers
to these questions can help determine if there is a
genetic type with increased biological risk for cannabis dependence and who might be genetically
influenced in their duration of cannabis use.
3. Researchers also explored whether genetics played
a different role on duration of use or dependence in
the two sexes.
Implications for PRIME For Life Instructors
This article supports the basic concepts in PRIME For
Life and clarifies how they specifically apply to cannabis use. That is, just as with alcohol, more use is
16
www.primeforlife.org
by PRI Research Analyst
Allan Barger
associated with higher rates of dependence. Thus, biology + choices = outcomes. Some people have increased
biological risk—or a lower trigger level—based on
their inherited genetic makeup. Thus the biology sets
varying trigger levels for different individuals that
interact with their choices to determine the total level of
risk for developing cannabis dependence. Note the term
“dependence” here is loosely based on DSM-IV criteria
that could span both Phase 3 and Phase 4 experiences.
These data find a genetic risk for longer duration of
use for those who begin cannabis use. That is, genetic
traits at least partly explain why some people persist
in using cannabis for longer periods of time than others. Data also suggest the longer one uses cannabis the
more likely one is to develop dependence. This makes
sense because those who use the longest are also those
most likely to increase their quantity and frequency of
use over time. Higher quantities and frequencies push
alterations in brain function including tolerance, sensitization, and decreased reward response, all of which
are associated with addiction. While there were some
gender differences in the balance between genetic and
environmental factors, they were overall small differences and these data continue to support the Lifestyle
Risk Reduction formula. By empowering people to
make low-risk choices, they can overcome both genetic
and environmental factors.
Readers may wonder why, after 12 years, only 41 to 46
percent of people developed dependence. These data do
not measure quantity or frequency of use, so a person
who was an occasional smoker would still fall into this
category. For example, someone using cannabis a few
times a year over a 12-year period would still have a
long duration of use, but would probably not become
dependent. Still, such use would present other health
and impairment risks.
Those who use cannabis often believe it is safer and
very different from using alcohol or other drugs. This
study illustrates it is more similar in its outcomes than
suspected. This can increase instructor confidence in
reassuring participants that cannabis can indeed cause
dependence and some people have increased biological
risk.
For those interested in more details of this study, the
methods, study results and limitations are described
below.
Methods
Zygosity: Zygosity refers to the genetic makeup of a
person from birth. Monozygotic twins are identical,
sharing 100% of their genes (MZF for female and
MZM are males), while dizygotic twins are fraternal,
sharing about 50% of their genes (DZF and DZM
respectively, and DZO for fraternal twins of opposite
sex). Opposite sex twins are always dizygotic. Zygosity
was determined with a standard questionnaire with
95% accuracy in making this determination.
Probands: Probands are individuals studied in medical
genetic research. Those studied were 2,706 complete
twin pairs (5,412 individuals) born between 1964 and
1971 who are part of the Australian Twin Study Register.
This includes 688 female (MZF) and 484 male (MZM)
identical twin pairs plus 503 female (DZF) and 388
male (DZM) fraternal twin pairs. In addition there were
643 opposite sex fraternal twin pairs (DZO). Identical
twins share 100% of their genes, while fraternal twins
share about 50% of their genes. Comparing outcomes
between identical and fraternal twins allows researchers to determine the role of genetics, environments
shared by the twins, and environments unique to each
person in the development of health problems.
Assessments: Trained assessors individually interviewed the twin pairs by telephone using an instrument
developed for the study of the genetics of alcoholism
adapted for cannabis use. The following items were
assessed: lifetime history of illicit drug use, abuse and
dependence, lifetime history of alcohol dependence, nicotine dependence, major depression, childhood conduct
continued on page 21
March 2009
173
I
n the News
Marijuana Use Shrinks Brain
Many people saw the headline “Heavy Marijuana Use
Shrinks Brain” in newspapers last summer and are
wondering about it. The study1 indicates those with
a history of very heavy marijuana use—smoking five
or more joints a day for at least two decades—had
shrinkage in two specific brain regions, but not the
whole brain as the headline suggests. The hippocampus and the amygdala were both smaller in these
heavy users. These brain regions work in memory
storage, retrieval, and our fight or flight responses.
They are also rich in cannabinoid receptors as compared to other brain sections. Compared to controls,
those with a smaller left hippocampus scored higher
on standard psychosis scales, although not at a level
high enough to be diagnosed psychotic, i.e. the results were subclinical. The heavy marijuana users
also performed more poorly on verbal learning, but
researchers found no specific link between this problem and the brain changes. Given this information,
keep in mind these points:
• If there was shrinkage, we do not know how
it happened. The researchers found reduced
volume compared to controls but do not know
if this is a loss of neurons (our communicating
cells) or the loss of glial cells (the “girders”
upon which the brain is constructed), or possibly there was no cell loss at all. Cells may have
simply shrunk in size, or the brain may have
pruned away some synaptic connections among
the neurons. This would leave cells intact but
with fewer connections to each other. There is
more than one way to “shrink” a brain.
• We know of no reports of these brain changes
in light marijuana smokers, for example, those
smoking a few times a week or a month or for
shorter periods. If marijuana is the cause of
shrinkage in the hippocampus and amygdala, it
most likely affects those using cannabis heavily
for many years.
Because this is early research, we are not ready to
say “marijuana shrinks the brain” or “marijuana kills
brain cells.” However, this study suggests marijuana
use can damage the function of the brain’s memory,
reward, and emotions and may do structural damage with very heavy use. If we want to avoid loss of
brain function or even the chance of brain shrinkage,
abstinence is the only low-risk choice we can verify from the research. In addition, PRI continues to
assert that abstaining from marijuana prevents impairment problems and the potential for other longterm health problems. The growing body of current
research suggests marijuana is more harmful than is
often thought.
• We do not know the level of use where these
changes begin, but it is a level at which some
people use. The researchers noted the quantity these people smoked occurs naturally in
the communities from which the study group
was drawn.
Reference
• A limitation of this study is it cannot be determined if smaller amygdala or hippocampus
volumes existed before the cannabis smoking.
That is, perhaps less volume in these brain regions causes people to smoke more marijuana.
The appearance of a dose-response curve—the
18
more people smoked, the greater the reduction in these regions—argues against this, but
we cannot rule it out.
www.primeforlife.org
For those interested in similar information about
alcohol, see “Do low levels of drinking shrink the
brain?” posted under “In the News” on the Instructor
website.
1
Yücel, M., Solowij, N., Respondek, C., Whittle, S.,
Fornito, A., Pantelis, C., & Lubman, D. (2008). Regional brain abnormalities associated with long-term
heavy cannabis use. Archives of General Psychiatry,
65, 694-701. PRI
F
or Soldiers
Independent Learning Version of PRIME For Life
Independent Learning Version of PRIME For Life Under Development
ACSAP, the U.S. Army Center for Substance Abuse Programs, has funded development of a multimedia-enriched version of PRIME For Life for soldiers in and returning from war zones. PRI and Windwalker Corporation
will collaborate on the project which is expected to take three years to complete.
This version of PRIME For Life will be developed primarily for independent learning. PRI will work closely with
other established instructional designers who are familiar with PRIME For Life. Dr. Carlo DiClemente (University
of Maryland, Baltimore), Dr. Theresa Moyers (University of New Mexico), and Dr. Tom Greenfield (Berkley) have
agreed to serve as consultants on the project.
We welcome this project foremost to be given the opportunity to provide PRIME For Life to those who unselfishly serve us in the military. However, we are also excited about the opportunity to develop innovative methods
to enhance the delivery of PRIME For Life with our impaired driving, adolescent offender, campus, and other
audiences. Instructors, clients, and delivery systems will benefit from what we learn and develop in this special
project. PRI
Reflecting on the Past from page 7
Debbie: The PRIME For Life training is the single best
campuses, but many students have come back months later
training to prepare prevention specialists to do their work.
to tell me they needed to or had made changes in their
On a personal note, I have used the persuasive sandwich
drinking or drug use. Witnessing these changes in attitudes
in many areas of my life and it works. I just wish I had
and behavior, and knowing it affects many more people
around them makes me proud to be a part of PRI’s 25th
learned it sooner!
Carole: It is a diffi-
Carole Middlebrooks, Director of the
Georgia Network for Substance Abuse
Prevention in Higher Education.
Anniversary celebration!
cult program to learn
From PRI
initially but well worth
Thank you, Carole, Debbie, and Jane. Your unwavering
the investment of time
support and enthusiasm in the early days paved the way
and energy. But most
for thousands of instructors and clients to hear the PRIME
importantly, I would
For Life message. In addition to Carole, Debbie, and Jane,
want to emphasize
PRI acknowledges the vision and commitment of all the
that it is important to
dedicated professionals who have contributed to imple-
learn the material and
mentation of PRIME For Life throughout the world over
not read it, especially
the past quarter century. We look forward to continued
when working with
success in the next 25 years.
PRI
youth and young adults. We often experience a great deal
of resistance in our participants, particularly on college
March 2009
15
3
19
C
ontinuing Education
Coinciding with our reflections on PRI’s 25
years of providing life-changing information,
our conference theme for 2009 is PRIME
Reflections. We will reflect on where we have
been and where we are going with PRIME For
Life and the Lifestyle Risk Reduction Model. By
instructor request, this year’s opening plenary
will feature a research session on drugs and
driving. Conference breakout sessions will focus
on the Motivational Interviewing skill of reflective
listening to manage resistance and encourage
participants to consider new behaviors. We will
conclude the conferences with a special reflection from Tom “Frosty” Frostman on being a PRI
family member for 20 years. Look for more information in the 2009 Schedule for New Instructor Training and Continuing Education mailed in
December 2008 or visit www.primeforlife.org. If
you did not receive a 2009 Training Schedule,
please call us at 800-922-9489 or email Maggie at [email protected].
PRIME REFLECTIONS
2009 Conferences
PRI
2008 Training Snapshots:
Rhode Island instructor Beth Ventrone
celebrates her “coder queen” style after
the Ready, Set, Code! session at the
2008 continuing education conference
in Warwick.
20
www.primeforlife.org
Roddy Sueoka and Brent Oto having fun during the small group peer feedback activity at
the New Instructor Training sponsored by the
National Guard at Bellows Air Force Base,
Waimanalo, Hawaii in September, 2008.
PRIME For Life Utah instructor Brian
Alba demonstrates that “Moving
ForWarD” during the 2008 instructor
coaching session in Park City can be
really amusing!
Drug Research continued from page 17
disorder, and a non-diagnostic history of social anxiety. Those reporting cannabis use were asked age of first use
and last use and divided into categories based on years of use: less than 1 year, 1-3 years, 4-7 years, 8-11 years, and
those using 12 years or more. Dependence was assessed based on criteria modified from DSM-IV dependence—
using more frequently or longer than intended, needing larger quantities for the same effect, continued use despite
emotional problems, and use despite a desire to cut down. Those with two or more of these symptoms were deemed
“dependent.” While not identical to DSM criteria, this system has a greater than 90% correlation to full DSM-IV
cannabis dependence diagnoses.
Statistical Analysis: Odds ratios were used to define correlations between gender and lifetime cannabis use, and
a validated measure was used to determine the role of genetic makeup in influencing the duration of cannabis use
and cannabis dependence. Additional genetic model fitting procedures were used to determine the relative roles of
genetic, shared, and unique environments in the duration of cannabis use and the development of cannabis dependence. All models controlled for age.
Results
• 68.8% of males and 53.2% of females reported cannabis use at some point in life.
• A direct correlation exists between duration of use and developing dependence.
TABLE 1
Less than 1 yr
1-3 years
4-7 years
8-11 years
12+ years
Males
Dependence (%)
Duration (%)
16.7
0.6
17.0
4.9
19.8
16.9
23.0
29.5
23.5
46.2
Females
Dependence (%) Duration (%)
26.3
0.0
19.2
7.7
19.8
13.6
19.0
21.7
15.8
41.1
• There was a significant overlap between genetic makeup for duration of use and dependence, although it
never reached 100% overlap, indicating that while many traits shared the increased risk for both duration and
dependence, some are unique to either one or the other risk.
• Males and females differed in genetic and environmental influences on risk. Shared environment was not
found significant for either gender and was dropped, leaving only the individual’s unique environment as
influence on duration and dependence. In duration of use, males showed 0.41 for genetics and 0.59 for environment, while females showed 0.55 for genetics and 0.45 for environment. Males scored 0.72 on genetic
influence on dependence and 0.28 for environmental influence. Females scored 0.62 for genetic risk of
dependence and 0.38 for environmental influence.
Limitations as Noted by the Authors
More research is needed to determine if there might be different levels of overlap between duration of use and
the full DSM-IV criteria. Also, because the sample was somewhat young at the time of the telephone interviews,
some may go on to develop dependence or halt use over time. While data were controlled for age, there may
still be some patterns hidden by younger age. Finally, self-report was used to determine age of first use. Despite
the subjective nature of this method, other research has shown good reliability in self-report of age of first use. PRI
March 2009
213
E
xpert Joins PRI Staff
We are proud to announce that Dr. David Rosengren has
joined the staff at Prevention Research Institute. David
served as a consultant for PRIME Solutions, PRI’s recently-released treatment program. On staff, he will serve as
a Clinical Research Specialist with a primary focus on
PRIME Solutions and evaluation of the PRIME For Life
expeditionary program for troops in combat areas.
According to Ray Daugherty, “David brings a lot of research knowledge and skills to PRI, especially in the clinical
David completed his graduate work at the University of
Montana, his clinical internship at the Seattle Veteran’s Affairs (VA) Medical Center and a post-doctoral residency at
Western State Hospital in Ft. Steilacoom, Washington.
The consistent themes in David’s work are motivation and
the process of change. His interest in these areas began as
a graduate student working with angry adolescents and has
progressed through work in prisons, VA and state hospitals,
and outpatient settings. His research focus includes addictive behaviors, HIV/AIDS and risk reduction, Intimate Partner Violence (IPV), brief interventions,
and training methods. He has worked clinically
with a range of treatment populations, most recently focusing on adolescents in treatment.
David Rosengren and his daughter Sophia enjoy a special moment
at the duck pond.
arena. He has been involved with major research projects
such as Project MATCH and has participated in projects
designed to evaluate the effectiveness of counselor training. He will be a huge asset to the PRI team and will fit in
nicely with both our staff and the instructors and counselors who use PRIME For Life and PRIME Solutions. David
is adept at making practical applications of clinical issues.
He is also an incredibly down-to-earth, nice person. With
Allan, Mark, and now David, I think we have a phenomenal
research-oriented team.”
David, a Motivational Interviewing (MI) trainer,
completed the initial Training for Trainers of MI
course offered by William Miller and Stephen
Rollnick in 1993 and has provided regular training
in MI since. He has also recently completed a book
for Guilford Press, due out soon, entitled, Building
Motivational Interviewing Skills: A Practitioner
Workbook.
David and his wife Stephanie have two daughters
(18 and 5) and a son (16). Stephanie is a health
educator in a teen clinic in the King County Public Health
Department in Seattle and is also an MI trainer. David has
Type I diabetes and uses an insulin pump; the risk reduction
model is a part of his daily life as a result.
David can be reached at [email protected].
Welcome, David. We are honored and delighted to have
you join our team! PRI
Lowering the Drinking Age: The Amethyst Initiative
You may have heard of the Amethyst Initiative, a proposal to lower the
legal drinking age to 18, with particular support from college presidents.
Click on “In the News” under Research on the PRIME For Life Instructor
website to find out more about this initiative, research to counter the
proposal, and PRI’s suggestion for the initiative.
22
www.primeforlife.org
Welcome David Rosengren
Welcome North Carolina! from cover page
first-time offenders charged with impaired driving who
meet certain criteria in North Carolina.
After a New Instructor Training in Raleigh, North Carolina, in August 2008, a participant proclaimed, “PRIME
For Life does not teach DWI clients about the change
process. It helps move them through it. I now see that just
teaching the Stages of Change is not nearly as powerful as
helping them move from one stage to another. That’s the
power of PRIME For Life, and I am excited to harness that
power for my
clients!”
Another
participant in
the Raleigh
training compared PRIME
For Life with
a previous
impaired drivLynn Jones (left), DWI Services Program Manager for ing program
North Carolina, and Jennifer Resnick, previous conhis agency had
sultant with the Justice Services Innovation Team/DWI
used, “WatchServices Office, spearheaded efforts to implement
ing a street
PRIME For Life in North Carolina.
magician make
a card disappear is an experience. Watching David Copperfield make an elephant disappear is a profound experience.
That’s what PRIME For Life is…a profound experience!”
PRI would like to thank the many people in North Carolina
who have supported our PRIME For Life efforts including
Lynn Jones, DWI Services Program Manager, and Jennifer
Resnick, previous consultant with the Justice Services Innovation Team/DWI Services Office in Raleigh.
North Carolina pilot instructors wore identical t-shirts the last day of their
New Instructor Training.
Welcome, North Carolina! We are proud to be PRIME
For Life partners with you. For additional information
on how PRIME For Life is used with impaired driving
offenders around the country, please visit our website at
www.primeforlife.org or call us toll free at 800-922-9489.
Nakeeta Sharpe practice teaches at the pilot New Instructor
Training in Chapel Hill.
1PRIME
For Life was accepted for review by the Substance
Abuse
and
Mental Health Services Administration (SAMSpecial thanks to the original team of pilot instructors we
trained in Chapel Hill: Ann Adams, Andrea Amburgey, Jose HSA) National Registry of Evidenced-based Programs and
Practices (NREPP) in March 2008. Given the number of
Carreon, Bobby Faison, Tanya Lassiter, Dianne Lyman,
Peggy Mitchell, Chris Moses, Arlene Phillips, Lisa Schrade, programs in the queue for review, NREPP administrators
and Nakeeta Sharpe. “It all began at The Alcove,” we at PRI anticipate the review will be initiated by fall 2009 at the
earliest. PRI
like to reflect with a smile. The Alcove is the name of the
training room, a hotel special events bar, actually, where we
put the facilities to work in the name of prevention.
North Carolina joins several other systems using PRIME
For Life statewide for impaired drivers including Georgia,
Hawaii, Indiana, Iowa, Kentucky, Maine, New Hampshire,
North Dakota, Rhode Island, South Carolina, and Utah.
March 2009
233
17
T
raining Schedule 2009
A current schedule of PRIME For Life New Instructor trainings, continuing education
events, and PRIME Solutions trainings can be found at www.primeforlife.org.
New Instructor Trainings
Continuing Education
Many New Instructor Trainings are for state residents only. Please call PRI if
you are interested in attending an out-of-state training. Training dates and locations are subject to change. Please visit www.primeforlife.org to confirm.
PRI regularly conducts continuing education opportunities for trained PRI
instructors. A current schedule of continuing education events can be
found at www.primeforlife.org.
April 21-24: Winston-Salem, NC
July 13-July 16: Augusta, ME
March 19-20: Winston-Salem, NC
September 9-11: Peachtree City, GA
April 28–May 1: St. George, UT
July 20-23: Duluth, GA
March 24-25, 2009: Lexington, KY
September 24-25: Wilmington, NC
May 12-15: Columbia, SC
July 28-31: Carmel, IN
May 4-5: St. George, UT
October 5: Nashville, TN
May 18–21: Lexington, KY
August 18-21: Florence, KY
June 22: Mandan, ND
October 9-10: Hampton, NH
May 18-21: Hampton, NH
October 19-22: Lexington, KY
June 24-26: Jekyll Island, GA
October 17-18: Portland, ME
June 15–18: Iowa City, IA
October 26-29: Park City, UT
August 17-18: Anchorage, AK
November 14: Ames, IA
June 23-26: Mandan, ND
November 3-6: Raleigh, NC
August 18-19: Indianapolis, IN
December 7-8: Park City, UT
June 29-July 2: Duluth, GA
November 10-13: Ames, IA
PRI is an Authorized Provider of
continuing education and training
programs by the International
Association for Continuing
Education and Training.
a newsletter from Prevention Research Institute
a newsletter from Prevention Research Institute
PRIME TIMES is published by Prevention Research Institute, Inc.,
841 Corporate Drive, Suite 300, Lexington, Kentucky 40503,
859-223-3392. Send correspondence to Jill Crouch at [email protected].
Copyright 2009 by Prevention Research Institute.
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March
2009
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