Treatment of cannabis use disorder
- Scott A Teitelbaum, MD
Scott A Teitelbaum, MD
- Professor of Psychiatry
- University of Florida
- Robert L DuPont, MD
Robert L DuPont, MD
- Clinical Professor of Psychiatry
- Georgetown University School of Medicine
- John A Bailey, MD
John A Bailey, MD
- Clinical Assistant Professor of Psychiatry
- University of Florida
Cannabis is the most commonly used illegal substance worldwide . Approximately 160 million people or approximately four percent of the world’s population between the ages of 15 and 64 years have been estimated to have used cannabis at least once in the past year.
The psychiatric diagnoses, cannabis abuse and cannabis dependence, in DSM-IV-TR were replaced by one diagnosis, cannabis use disorder, in DSM-5 . Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, cannabis dependence is approximately comparable to cannabis use disorder, moderate to severe subtype, while cannabis abuse is similar to the mild subtype.
The treatment of cannabis use disorder is reviewed here. The epidemiology, comorbidity, health consequences, medico-legal status, clinical manifestations, course, assessment, and diagnosis of cannabis use disorder are discussed separately. Acute cannabis intoxication is also discussed separately. (See "Cannabis use and disorder: Clinical manifestations, course, assessment, and diagnosis" and "Cannabis use and disorder: Pathogenesis and pharmacology" and "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Cannabis (marijuana): Acute intoxication".)
OVERVIEW AND 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 a partial hospital or inpatient setting if the patient is psychotic, suicidal, or agitated, or has been hospitalized for another psychiatric disorder.
The patient's family should be involved in treatment, in order to provide additional history, learn about the disorder, and help monitor the patient's progress.
- Leggett T, United Nations Office on Drugs and Crime. A review of the world cannabis situation. Bull Narc 2006; 58:1.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- American Psychiatric Association. Practice guideline for the treatment of patients with substance use disorders, second edition. Am J Psychiatry 2007; 164(Suppl):1.
- Moore BA, Budney AJ. Abstinence at intake for marijuana dependence treatment predicts response. Drug Alcohol Depend 2002; 67:249.
- Denis C, Lavie E, Fatséas M, Auriacombe M. Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings. Cochrane Database Syst Rev 2006; :CD005336.
- Nordstrom BR, Levin FR. Treatment of cannabis use disorders: a review of the literature. Am J Addict 2007; 16:331.
- Gray KM, Carpenter MJ, Baker NL, et al. A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. Am J Psychiatry 2012; 169:805.
- Cooper, ZD. Cannabis reinforcement and dependence: role of the cannabinoid CB1 receptor. Addict Biology 2008: 13:188.
- Dutra L, Stathopoulou G, Basden SL, et al. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry 2008; 165:179.
- Elkashef A, Vocci F, Huestis M, et al. Marijuana neurobiology and treatment. Subst Abus 2008; 29:17.
- DiClemente, Garay, M, Gemmell, L. Motivational enhancement. In: The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th ed, Galanter, M, Kleber HD (Ed), American Psychiatric Publishing, Washington, DC 2008. p.366.
- Marijuana Treatment Project Research Group. Brief treatments for cannabis dependence: findings from a randomized multisite trial. J Consult Clin Psychol 2004; 72:455.
- Budney AJ, Higgins ST, Radonovich KJ, Novy PL. Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. J Consult Clin Psychol 2000; 68:1051.
- Budney AJ, Moore BA, Rocha HL, Higgins ST. Clinical trial of abstinence-based vouchers and cognitive-behavioral therapy for cannabis dependence. J Consult Clin Psychol 2006; 74:307.
- Carroll KM, Easton CJ, Nich C, et al. The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. J Consult Clin Psychol 2006; 74:955.
- Stanger C, Budney AJ, Kamon JL, Thostensen J. A randomized trial of contingency management for adolescent marijuana abuse and dependence. Drug Alcohol Depend 2009; 105:240.
- Dennis M, Godley SH, Diamond G, et al. The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. J Subst Abuse Treat 2004; 27:197.
- Lichtman AH, Martin BR. Cannabinoid tolerance and dependence. Handb Exp Pharmacol 2005; :691.
- Carpenter KM, McDowell D, Brooks DJ, et al. A preliminary trial: double-blind comparison of nefazodone, bupropion-SR, and placebo in the treatment of cannabis dependence. Am J Addict 2009; 18:53.
- Mason BJ, Crean R, Goodell V, et al. A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology 2012; 37:1689.
- Haney M, Hart CL, Vosburg SK, et al. Marijuana withdrawal in humans: effects of oral THC or divalproex. Neuropsychopharmacology 2004; 29:158.
- Levin FR, McDowell D, Evans SM, et al. Pharmacotherapy for marijuana dependence: a double-blind, placebo-controlled pilot study of divalproex sodium. Am J Addict 2004; 13:21.
- Budney AJ, Vandrey RG, Hughes JR, et al. Oral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms. Drug Alcohol Depend 2007; 86:22.
- Haney M, Hart CL, Vosburg SK, et al. Effects of THC and lofexidine in a human laboratory model of marijuana withdrawal and relapse. Psychopharmacology (Berl) 2008; 197:157.
- Levin FR, Kleber HD. Use of dronabinol for cannabis dependence: two case reports and review. Am J Addict 2008; 17:161.
- OVERVIEW AND GENERAL PRINCIPLES
- PSYCHOSOCIAL INTERVENTIONS
- Cognitive-behavioral therapy
- Motivational interviewing
- Contingency managment
- Mutual help groups
- Family therapy
- Cannabinoid agonists
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS