Journal of Computer-Mediated CommunicationSpecial SectionCounseling Young Cannabis Users by TextMessageDitte LaursenUniversity of Southern Denmark, ILKM - Institut for Litteratur, Kultur og Medier, Odense, DenmarkThis article presents a study of 2 Short Message Services (SMS) aimed at providing youngpeople with information on cannabis and helping them to reduce their consumption ofthe drug. The study is based on qualitative interviews with 12 young people. The attitudeof the participants in the study towards the predefined messages is generally positive, butthey prefer factual i nformation to advice and counseling. The messages prompt reflectionand awareness among the recipients, and their repetitive, serial nature plays a significantpart in the process of change.The SMS services offer a less demanding, potentially lessconfrontational alternative to traditional forms of counseling and treatment. The articlecompares text message counseling with web-based interventions and telephone help lines.doi:10.1111/j.1083-6101.2009.01510.xText messaging is part of an emerging wave of technology that allows consumersto get health information instantly through their mobile phones (Terry, 2008).Text messaging was first used in a medical context for making and cancellingface-to-face appointments (Anthony, 2006), b ut it has gone on to prove effectivein self-monitoring and following -up roles in the treatment of conditions includingdiabetes, asthma, bulimia nervosa and psychiatric illness (Bjerke, Kummervold,Christiansen, & Hjortdahl, 2008; Robinson, et al., 2006). There is also evidence thattext-message reminders increase patient compliance in taking medication for suchdiseases as tuberculosis and HIV (Group, 2006).Text messaging is particularly popular among young people, and services havebeen developed targeting this group accordingly. As early as 2002, a UK charitylaunched an information service providing young people with sexual health infor-mation and support by telephone, Internet, and text message (Kinkade & Verclas,2008), a similar service exists in the US (Levine, McCright, Dobkin, Woodruff, &Klausner, 2008). In Spain, Finland and Denmark, text messaging is now used withthe aim of preventing drug abuse amongst young people1.Text messaging could prove to be an innovative way of reaching young people,but little is known about the actual effects of the text messages or the ways in646 Journal of Computer-Mediated Communication 15 (2010) 646–665 © 2010 International Communication Associationwhich they are received. This article presents a study of an anonymous support andcounseling project for young cannabis users intended to reduce the harmful effectsof the drug and to provide them with information and support. In Europe andAmerica, cannabis is by far the most c ommonly used illicit drug, and use of the drugis disproportionately high among young people (NIDA, 2006; EMCDDA, 2008). Theproject is centered on subscription to t wo SMS packages. The article will show howthe young people received and used the two services, and the ways in which theyprofited from them in terms of changing their drug-abusing behavior. Furthermore,the article will explore the participants’ views on how the SMS services compare withtraditional forms of counseling and treatment. Before moving on to empirical areas,the article gives a brief overview of the literature. Given the paucity of studies ontext message counseling, the review will focus on literature on web-based anti-druginterventions and literature on counseling supplied by telephone.Mediated Antidrugs Interventions for Young PeopleA number of innovative programs have attempted to exploit new tools of com-munication in order to engage with young cannabis users. Especially the Internethas established itself as a key medium for anti-drug interventions. In addition tobasic sites for information provision, a number of clinical applications can beenfound for the web, featuring more complex and interactive health interventions andtreatment programs: drug self-tests, interactive diaries, phone/e-mail/chat contactwith a c ounselor, preprogrammed software packages with little or no direct thera-pist involvement, etc2. There is a significant target audience for such interventions.Drug treatment demand has risen, particularly among young and socially integratedcannabis users (Leuschner, Tossmann, & EMCDDA, 2009).In general, little has been done to examine the efficacy of the Internet-baseddrug treatment programs in leading to changes in substance use behavior (Copeland& Martin, 2004). An exception is the evaluation of the German ‘‘Quit the Shit’’initiative, an online withdrawal program with an interactive diary for juvenilecannabis consumers: 32 % of participants were reported as abstinent after completingthe program (Leuschner, et al., 2009).While the literature on Internet-based substance use interventions is sparse andflawed, the potential impact of effective intervention is considerable. In the US alone,among the 90% of all 15–24 year-olds who have ever gone online, three out of four(75%) have used the Internet to find health information. Among these 75%, 4 outof 10 say they generally find online health information ‘‘very useful’’, and 4 out of10 say they have changed their personal behavior because of health information theygot online (Rideout, 2001). Additionally, there is an increasing b ody of evidenceindicating that using text to conduct a clinical or t herapeutic relationship is notonly possible but in many cases more desirable, from the points of view of clientsand practitioners alike (Horton & Feltham, 2006). Online services are convenientand flexible, and attractive to clients who wish to remain anonymous (Hunt, 2002;Skinner & Zack, 2004). Also, written information can improve health knowledgeJournal of Computer-Mediated Communication 15 (2010) 646– 665 © 2010 International Communication Association 647and information recall, and alternative-format resources such as e-mail and chatcan improve health knowledge, user satisfaction, self-efficacy and health behavior(Colledge, Car, Donnelly, & Majeed, 2008).A more established medium for counseling is the t elephone—the telephone hasbeen acknowledged for over 40 years as having a role in providing help at times ofcrisis (Anthony & Goss, 2003). Smoking cessation help lines have been empiricallyshown to increase abstinence (Lichtenstein, Glasgow, Lando, OssipKlein, & Boles,1996; Meites