From the Guidelines
Treatment of cannabis addiction should primarily involve cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET), as these approaches have been shown to be effective in addressing cannabis use disorder. The most effective approach begins with these therapies, typically delivered in 12-16 weekly sessions 1. Contingency management, which provides tangible rewards for abstinence, can be particularly effective when combined with these therapies. For withdrawal symptoms, which may include irritability, sleep disturbances, decreased appetite, and anxiety, symptomatic treatment may be helpful - such as using sleep aids like melatonin (3-10mg before bedtime) for insomnia or short-term anxiolytics for severe anxiety under medical supervision.
Some key points to consider in the treatment of cannabis addiction include:
- The importance of addressing stigma associated with behavioral health, including substance use disorder, as highlighted by the American College of Physicians 1
- The need for public information campaigns to increase awareness about cannabis use disorder and the efficacy of treatment
- The importance of embedding content on cannabis and cannabinoids into substance use curricula at all levels of physician education, as recommended by the American College of Physicians 1
- The potential benefits of combining pharmacotherapy and cognitive behavioral therapy for adults with substance use disorders, as suggested by a systematic review and meta-analysis published in JAMA Network Open 1
Overall, the goal of treatment should be to provide a comprehensive and supportive approach that addresses the physical, emotional, and social aspects of cannabis addiction, with a focus on promoting long-term recovery and reducing relapse rates. CBT and MET should be considered the first-line treatments for cannabis use disorder, given their established efficacy and the lack of FDA-approved medications specifically for this condition.
From the Research
Treatment Approaches for Cannabis Addiction
- Behavioral therapies, such as motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), have been shown to be effective in treating cannabis use disorder (CUD) 2, 3.
- A meta-analysis of randomized controlled trials found that behavioral therapies, including contingency management, relapse prevention, and motivational interviewing, produced better outcomes than control conditions for CUDs 3.
- Psychosocial treatments, such as CBT, MET, and contingency management, are currently the most effective strategy for treating CUD, but are of limited benefit when comorbid with psychosis 4.
- Integrated cognitive-behavioral therapy for comorbid cannabis use and anxiety disorders has been shown to be efficacious, particularly for patients with more severe baseline cannabis use and use-related problems 5.
Pharmacological Treatments
- Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD 4.
- Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis 4.
- Targeted treatments for anxiety and depression when comorbid with CUD are feasible 4.
Emerging Research Areas
- Brief interventions and technology-delivered interventions are emerging research areas in the treatment of CUD 6.
- Future research needs include testing active approaches to reengaging participants with treatment when initial outcomes are less than optimal 2.
- Further research is needed to determine the most effective treatment approaches for CUD, particularly for patients with comorbid mental health disorders 4, 5.