Treatment of Cannabis Use Disorder: Current Science and Future Outlook

Abstract

Cannabis is the most commonly used illicit substance in the United States. Rates of cannabis use and cannabis use disorder have increased in the past decade, paralleling changes in the legal and political climate favoring legalization. Almost 20 million people aged 12 years or older report past-month cannabis use, and 8 million report daily or near-daily use. Concurrently, the perception that cannabis use poses a significant risk of negative consequences has decreased. Contrary to this perception, heavy cannabis use is associated with cognitive impairment, increased risk for psychotic disorders and other mental health problems, lower education attainment, and unemployment. Clinical trials of various treatments for cannabis use disorder have likewise increased, focusing primarily on psychotherapy treatments, specifically, motivational enhancement therapy, cognitive behavioral therapy, and contingency management. Their findings suggest that a combination of these three modalities produces the best abstinence outcomes, although abstinence rates remain modest and decline after treatment. More recently, pharmacotherapy trials have been conducted as adjunctive interventions to psychosocial treatment. N-acetylcysteine and gabapentin are two of the most promising medications, although no pharmacologic treatment has emerged as clearly efficacious. In this review, we provide a detailed summary of clinical trials that evaluated psychotherapy and pharmacotherapy for treating cannabis use disorder and discuss emerging areas of clinical research and cannabis-specific barriers to treatment.

The Impact of Cannabis Use Disorder on Suicidal and Nonsuicidal Self‐Injury in Iraq/Afghanistan‐Era Veterans with and without Mental Health Disorders

“…Cannabis is the most widely used illicit drug in the world (Curran et al., ; Hoch et al., ; Sherman & McRae‐Clark, ; United Nations, ). It is currently being legalized for medicinal and recreational use in many areas, including the United States, where 27 states and the District of Columbia have now legalized some form of cannabis use (Sherman & McRae‐Clark, ).…”

“…Cannabis is the most widely used illicit drug in the world (Curran et al., ; Hoch et al., ; Sherman & McRae‐Clark, ; United Nations, ). It is currently being legalized for medicinal and recreational use in many areas, including the United States, where 27 states and the District of Columbia have now legalized some form of cannabis use (Sherman & McRae‐Clark, ). Despite the strong political push for legalization of cannabis, many questions and concerns have been raised regarding the safety of the drug, as heavy cannabis use has been associated with an array of physical and mental health problems, including pulmonary problems, cognitive impairment, lower levels of educational attainment, unemployment, and increased risk for mental health disorders, such as cannabis use disorder (CUD) and psychotic disorders (e.g., Borges, Bagge, & Orozco, ; Curran et al., ; Gentes et al., ; Goldman et al., ; Hoch et al., ; Joshi, Joshi, & Bartter, ; Sherman & McRae‐Clark, ).…”

A scoping review and meta-analysis of psychosocial and pharmacological treatments for cannabis and tobacco use among African Americans.

“…Across adolescent and adult samples (Budney et al, 2015; Copeland, Gates, & Pokorski, 2017), the most promising results have been found when MET, CBT, and CM are combined to treat cannabis use. However, studies suggest that the positive effects of MET/CBT/CM for cannabis treatment diminish over time (Sherman & McRae-Clark, 2016). …”

Effect of oxytocin pretreatment on cannabis outcomes in a brief motivational intervention

“…Despite the high demand for treatment, abstinence rates remain modest and durability is limited (Sherman and McRae-Clark, 2016). There is a clear need for novel interventions to improve treatment outcomes.…”

“…MET has shown efficacy in reducing cannabis use (MTPRG, 2004), yet there is considerable room for improvement (Sherman and McRae-Clark, 2016). The current pilot study investigated whether oxytocin would enhance the efficacy of MET for cannabis dependence.…”