Treatment of cannabis use disorder
- David A Gorelick, MD, PhD
David A Gorelick, MD, PhD
- Professor of Psychiatry
- University of Maryland School of Medicine
Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance worldwide . Its psychoactive properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of cannabis potency .
Cannabis use disorder develops in approximately 10 percent of regular cannabis users and may be associated with cognitive impairment, poor school or work performance, and psychiatric comorbidity such as mood disorders and psychosis.
The treatment of cannabis use disorder is reviewed here. Clinical manifestations, course, assessment, and diagnosis of cannabis use disorder in adults are reviewed separately. The epidemiology and health consequences of cannabis use and cannabis use disorder are also reviewed separately. The pathogenesis and pharmacology of cannabis use disorder in adults are also reviewed separately. Acute intoxication, from cannabis and synthetic cannabinoids, and cannabis withdrawal are also reviewed separately. (See "Cannabis use and disorder: Clinical manifestations, course, assessment, and diagnosis" and "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Cannabis use and disorder: Pathogenesis and pharmacology" and "Cannabis (marijuana): Acute intoxication" and "Synthetic cannabinoids: Acute intoxication".)
APPROACH TO TREATMENT
General principles — Treatment for cannabis use disorder usually occurs on an outpatient basis, but residential treatment may be required for patients who cannot remain abstinent in an ambulatory setting or those with multiple concurrent substance use disorders. Treatment may occur in an inpatient hospital setting if the patient is psychotic, suicidal, severely depressed or agitated, or requires hospitalization because of another concurrent psychiatric disorder.
The patient's social network, especially family, should be involved in treatment to the extent possible (and agreed to by the patient, if a legally competent adult), in order to provide additional history and therapeutic support and to help monitor the patient's progress and adherence to treatment.
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- APPROACH TO TREATMENT
- General principles
- Specific interventions
- PSYCHOSOCIAL INTERVENTIONS
- Cognitive-behavioral therapy
- Motivational interviewing/motivational enhancement
- Contingency management
- Drug or addiction counseling
- Screening and brief intervention
- Mutual help groups
- Combined interventions
- - Efficacy
- - Side effects
- - Efficacy
- - Side effects
- - Administration
- Cannabinoid agonists
- SUMMARY AND RECOMMENDATIONS