Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

Abstract

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

Vaping among youth: reasons, realization and intention to quit

“…SCT, conceptualized by Bandura (1986), is a well-accepted model of individual behavior and is often used to explain various behavioral patterns (Kulviwat et al, 2014). SCT has also been used in several addiction-related studies related to the internet (Yang and Kim, 2018;LaRose et al, 2001), social media usage (Saleem et al, 2021), drug abuse (Bashirian et al, 2021), cannabis (Gullo et al, 2017;Gullo et al, 2021), alcohol (Burke and Stephens, 1999), smoking (Van Zundert et al, 2009) and smartphones (Mahapatra, 2019), among others. The theory asserts that human behavior is an outcome of the interaction between individual and environmental factors and explains behavior in terms of reciprocal causation among individuals, their environment and their behaviors (Bandura, 1986(Bandura, , 1989(Bandura, , 1999, and this triadic relationship is mediated by symbolizing capabilities that transform experiences into cognitive models that guide behaviors.…”

Clinical management of cannabis withdrawal

“…Given the heterogeneity of cannabis withdrawal features and substantial individual variations between patients, new developments in the management of cannabis use disorder and withdrawal are likely to include more targeted behavioural approaches (e.g. [ 77 , 88 ]). The provision of increased online and digital approaches to assist patients in managing cannabis withdrawal may improve accessibility and reduce costs, compared to face-to-face health services.…”

Profiles of cannabis users and impact on cannabis cessation

“…Few (10%) cannabis users enter formal treatment and psychotherapeutic cannabis interventions have moderate efficacy at reducing cannabis use and modest efficacy at reaching complete abstinence [ 16 ]. One potential avenue to improving treatment efficacy is further consideration of individual differences of personal, biological and social factors in implementing treatment targets [ 17 ]. Treatment matching has been suggested as one avenue to improve cannabis treatment outcomes [ 18 ].…”