Sir—While there is evidence that counselling can help reduce problematic cannabis use [1,2], the majority of cannabis users, including those meeting criteria for cannabis dependence, will never seek treatment [3], perhaps because of stigma or embarrassment [4,5] or fear of legal or employment consequences. There is ongoing research exploring ways to help this large population of untreated problem cannabis users. Stephens and colleagues [6] employed a Marijuana Check-up and found that this motivational intervention attracted problem cannabis users who were ambivalent about their use. What other profitable approaches might be added to a continuum of care for cannabis problems? Self-change interventions may have great potential to aid the many cannabis users who do not seek formal treatment. Because self-change interventions circumvent some of the barriers associated with traditional treatment services, they may help reduce the harm associated with cannabis abuse among untreated individuals. Self-change/self-help materials have the added advantage of being relatively inexpensive, increasing their potential for wide distribution. It is important to know whether there is a demand for these materials.

As part of a provincial random digit dialling telephone survey on substance use and mental health conducted in Ontario, Canada (n = 2411) [7], current cannabis users were asked if they were interested in four different types of services to help them evaluate their cannabis use—a self-help book, a computerized summary comparing their cannabis use to the general population, a telephone interview or face-to-face contact. The sample contained 292 past year cannabis users, 18 years or older. Ninety-four of these respondents used cannabis at least once per week. Weekly cannabis users were likely to be interested in receiving ‘a self-help book that helped you evaluate your marijuana use’ (42.8% of weekly users versus 19.0% of less regular users, P < 0.001) and receiving ‘a computerized summary that compared your marijuana use to other Canadians’ (52.7% weekly versus 28.1% less regular, P < 0.001). There was only modest interest in receiving ‘a telephone call from a counsellor to help you assess your marijuana use’ (17.7% weekly versus 8.8% less regular, P < 0.05) or ‘talking face-to-face with a counsellor to help you assess your marijuana use’ (15.3% weekly versus 10.5% less regular, P >  0.05).

Interventions that do not require direct contact with a treatment agency, i.e. computerized summaries and self-help books, were regarded as being of potential interest to regular cannabis users, although in this survey these services were presented as more in the nature of awareness-raising tools than methods of controlling use. This offers some prospect that self-help materials would reach users that could not be reached otherwise. It was interesting that telephone contact was not more attractive than face-to-face contact given that it would presumably be more anonymous and convenient. However, perhaps both telephone and face-to-face options were viewed unfavourably because cannabis users might assume that they would be pushed to enter treatment or stop using. If true, this point illustrates the need to emphasize the non-judgemental nature of any services for cannabis users in order to attract those who might benefit from them.


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