Psychosocial and pharmacological treatments for cannabis use disorder and mental health comorbidities: a narrative review

Abstract

Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.

Effect of four-week cannabidiol treatment on cognitive function: secondary outcomes from a randomised clinical trial for the treatment of cannabis use disorder

“…Another consideration to note is that all groups (including placebo) received motivational interviewing. This technique has demonstrated efficacy in reducing cannabis use in previous trials (Lees et al 2021); however, whether motivational interviewing improves cognition in people with CUD has not been assessed. It will therefore be valuable to assess the impact of CBD against a placebo-only control group with no concomitant psychological treatment in future research.…”

“…Cannabis use is responsible for a rising number of new treatment entrants to drug services in almost every world region (United Nations 2020). Psychosocial treatment options are available for CUD; however, these show only modest efficacy, and outcomes in the long term are unclear (Lees et al 2021). Furthermore, there is currently no approved pharmacotherapy for the treatment of CUD.…”

Risk of readmission among individuals with cannabis use disorder during a 15‐year cohort study: the impact of socio‐economic factors and psychiatric comorbidity

“…These are broad measures and do not clarify how individuals with this disorder are cared for, making it impossible to evaluate the treatment offered. In spite of the increase in prevalence of and treatment‐seeking for CUD [32, 36], evidence‐based CUD treatment is scarce, consisting mainly of psychotherapy [33] not developed specifically for CUD [37]. Generally, CUD treatment in Sweden is supposed to consist of various psychotherapeutic approaches [32].…”

Attenuation of cannabis withdrawal symptoms by Prosopis farcta extract, its luteolin and melatonin in mice: Involvement of brain‐derived neurotrophic factor and dopamine

“…14 The use of pharmacological treatments in those who have used cannabinoids has always been considered to reduce withdrawal symptoms. 15 Melatonin is one of the neurohormones that is produced in the pineal gland and its secretion is regulated based on the light and dark cycle. 16 In addition to the antioxidant effects and regulation of the body's immunity and induction of sedation, it has also been effective in mood regulation.…”