Current Addiction Reports

, Volume 4, Issue 2, pp 82–89 | Cite as

Overview of Current State-of-the-Art Treatments for Cannabis Use Disorders, and Future Directions

Cannabis (J Cousijn, Section Editor)
First Online:
Part of the following topical collections:
  1. Topical Collection on Cannabis

Abstract

Background

As policy responses to cannabis use and availability change internationally, the prevalence of cannabis use disorder (CUD) and the number of individuals seeking treatment for cannabis-related problems may increase.

Purpose of the Review

Our aim was to provide a narrative review of developments in the treatment of CUD over the past 5 years, including findings of a recent meta-analysis on psychosocial interventions and adjunctive pharmacotherapies for the management of cannabis withdrawal and CUD. Identification of key knowledge gaps and recommendations for further studies will also be addressed.

Recent Findings

Multiple behavioral interventions, particularly those involving motivational enhancement and cognitive behavioral therapies and their combination, appear helpful for CUD. As yet, there is no evidence-based pharmacotherapy in treating cannabis withdrawal and CUD. Preliminary results for some drugs, particularly agonists, are promising but require further extensive investigation.

Summary

Despite the prevalence and impact of CUD, the evidence base for treatments is not strong, and standardization of measures and endpoints in future randomized controlled trials of psychosocial and pharmacological agents is needed.

Keywords

Cannabis use disorder addiction dependence cognitive behavioral therapy cannabinoid replacement therapy 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

The National Cannabis Prevention and Information Centre was funded by the Australian Government Department of Health 2007–2016.

Compliance with Ethical Standards

Conflicts of Interest

Izabella Pokorski and Lisa Gibson declare that they have no conflicts of interest. Jan Copeland declares grants from the National Cannabis Prevention and Information Centre. She received in-kind contribution of Sativex from GW Pharmaceuticals for a National Health and Medical Research Council-funded clinical trial.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    McKiernan A, Fleming K. Canadian Youth Perceptions on Cannabis. Ottawa: Canadian Centre on Substance Abuse; 2017.Google Scholar
  2. 2.
    Thompson L, Rivara FP, Whitehill JM. Prevalence of marijuana-related traffic on Twitter, 2012-2013: a content analysis. Cyberpsychol Behav Soc Netw. 2015;18(6):311–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Swift W, Hall W, Teesson M. Cannabis use and dependence among Australian adults: results from the National Survey of Mental Health and Wellbeing. Addiction. 2001;96(5):737–48.CrossRefPubMedGoogle Scholar
  4. 4.
    United Nations Office on Drugs and Crime. World Drug Report 2015 (United Nations publication, Sales No. E.15.XI.6. Vienna; 2015.Google Scholar
  5. 5.
    Teesson M, Slade T, Swift W, Mills K, Memedovic S, Mewton L, et al. Prevalence, correlates and comorbidity of DSM-IV cannabis use and cannabis use disorders in Australia. Aust N Z J Psychiatry. 2012;46(12):1182–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72(12):1235–42.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: results from the 2015 national survey on drug use and health. No. SMA 16-4984, NSDUH Series H-51. 2016. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm.
  8. 8.
    European Monitoring Centre for Drugs and Drug Addiction. European Drug Report 2015. Trends and Developments. Portugal: European Monitoring of Drugs and Drugs Addiction; 2015.Google Scholar
  9. 9.
    Australian Institute of Health and Welfare. Alcohol and other drug treatment services in Australia 2013–14. Canberra, ACT: Australian Institute of Health and Welfare; 2013.Google Scholar
  10. 10.
    Degenhardt L, Ferrari AJ, Calabria B, Hall WD, Norman RE, McGrath J, et al. The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: results from the GBD 2010 study. PLoS One. 2013;8(10), e76635.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering R, Smith SM, et al. Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Am J Psychiatry. 2016;173(6):588–99.CrossRefPubMedGoogle Scholar
  12. 12.
    Fogerty S. Cannabis addiction support centre to close doors after government cuts funding. ABC News Online. 1996 Nov. Available at: http://www.abc.net.au/news/2016-11-04/cannabis-support-centre-to-close-after-funding-cut/7994558.Google Scholar
  13. 13.
    Silins E, Horwood LJ, Patton GC, Fergusson DM, Olsson CA, Hutchinson DM, et al. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry. 2014;1(4):286–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Wall MM, Mauro C, Hasin DS, Keyes KM, Cerda M, Martins SS, et al. Prevalence of marijuana use does not differentially increase among youth after states pass medical marijuana laws: commentary on and reanalysis of US National Survey on Drug Use in Households data 2002-2011. Int J Drug Policy. 2016;29:9–13.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report 2013. Series 28. Canberra, ACT: Australian Institute of Health and Welfare; 2014.Google Scholar
  16. 16.
    Burkinshaw P, Knight J, Anders P, Eastwood B, V, Musto, Martin White JM. An evidence review of the outcomes that can be expected of drug misuse treatment in England. London: Public Health England; 2017.Google Scholar
  17. 17.
    Fairman BJ. Trends in registered medical marijuana participation across 13 US states and District of Columbia. Drug Alcohol Depend. 2016;159:72–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Copeland J, Swift W. Cannabis use disorder: epidemiology and management. Int Rev Psychiatry. 2009;21(2):96–103.CrossRefPubMedGoogle Scholar
  19. 19.
    Stephens R. S, Roffman, Roger, Simpson E. Adult marijuana users seeking treatment. J Consult Clin Psychol. 1993;61(6):1100–004.CrossRefPubMedGoogle Scholar
  20. 20.
    Stinson FS, Ruan WJ, Pickering R, Grant BF. Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med. 2006;36(10):1447–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Copeland J, Swift W, Rees V. Clinical profile of participants in a brief intervention program for cannabis use disorder. J Subst Abuse Treat. 2001;20(1):45–52.CrossRefPubMedGoogle Scholar
  22. 22.
    McKetin R, Dunlop AJ, Holland RM, Sutherland RA, Baker AL, Salmon AM, et al. Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia. Drug Alcohol Rev. 2013;32(1):80–7.CrossRefPubMedGoogle Scholar
  23. 23.
    • Gates PJ, Sabioni P, Copeland J, Le Foll B, Gowing L. Psychosocial interventions for cannabis use disorder. Cochrane Database Syst Rev. 2016;(5):CD005336. This is the latest meta-analysis for the Cochrane Collaboration on this topic. Google Scholar
  24. 24.
    Copeland J, Pokorski I. Progress toward pharmacotherapies for cannabis-use disorder: an evidence-based review. Subst Abuse Rehabil. 2016;7:41–53.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Walther L, Gantner A, Heinz A, Majić T. Evidence-based treatment options in cannabis dependency. Dtsch Arztebl Int. 2016;113(39):653–9.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Miller W, Rollnick S. Motivational interviewing: helping people change. J Healthc Qual. 2003;25(3):46.CrossRefGoogle Scholar
  27. 27.
    Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. J Psychoactive Drugs;44(4):307–17.Google Scholar
  28. 28.
    Miller WR, Sanchez VC. Motivating young adults for treatment and lifestyle change. In: Howard G, editor. Issues in alcohol use and misuse in young adults. Notre Dame: University of Notre Dame Press; 1993.Google Scholar
  29. 29.
    Bray JW, Del Boca FK, McRee BG, Hayashi SW, Babor TF. Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross-site evaluation. Addiction. 2017;112 Suppl 2:3–11.CrossRefPubMedGoogle Scholar
  30. 30.
    Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30.CrossRefPubMedGoogle Scholar
  31. 31.
    Miller WR, Zweben A, Di Clemente CC, Rychtarik RG. Motivational Enhancement Therapy Manual. Project MATCH Monograph Series Editor: Mattson ME. National Institute on Alcohol Abuse and Alcoholism, US Department of Health and Human Services; 2014.Google Scholar
  32. 32.
    Walker DD, Stephens RS, Blevins CE, Banes KE, Matthews L, Roffman RA. Augmenting brief interventions for adolescent marijuana users: the impact of motivational check-ins. J Consult Clin Psychol. 2016;84(11):983–92.CrossRefPubMedGoogle Scholar
  33. 33.
    Webb L, Bertoni M, Copeland J. 20 minutes or less: evidence of the need for a very brief intervention (VBI) for cannabis users. 2015. Available at: file:///C:/Users/z8903265/Desktop/bulletin-23_vbi.pdf.Google Scholar
  34. 34.
    Beck AT, Wright F, Newman C, Liese B. Cognitive therapy of substance abuse. New York: The Guilford Press; 1993.Google Scholar
  35. 35.
    Marlatt A, Gordon J. Relapse prevention: maintenance strategies in the treatment of addictive behaviours. New York: The Guilford Press; 1985.Google Scholar
  36. 36.
    Copeland J. Marijuana brief intervention: an SBIRT approach. Center City, MN: Hazelden Publishing; 2017.Google Scholar
  37. 37.
    Copeland J, Swift W, Roffman R, Stephens R. A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder. J Subst Abuse Treat. 2001;21(2):55–64. 6.Google Scholar
  38. 38.
    Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. J Consult Clin Psychol. 2000;68(5):898–908.CrossRefPubMedGoogle Scholar
  39. 39.
    Hoch E, Noack R, Henker J, Pixa A, Höfler M, Behrendt S, et al. Efficacy of a targeted cognitive-behavioral treatment program for cannabis use disorders (CANDIS). Eur Neuropsychopharmacol. 2012;22(4):267–80.CrossRefPubMedGoogle Scholar
  40. 40.
    Hoch E, Bühringer G, Pixa A, Dittmer K, Henker J, Seifert A, et al. CANDIS treatment program for cannabis use disorders: findings from a randomized multi-site translational trial. Drug Alcohol Depend. 2014;134:185–93.CrossRefPubMedGoogle Scholar
  41. 41.
    Stephens RS, Roffman RA, Copeland J, Swift W. Cognitive-behavioral and motivational enhancement treatments for cannabis dependence. In: Cannabis dependence: its nature, consequences, and treatment. Cambridge: Cambridge University Press; 2006. p. 131–53.CrossRefGoogle Scholar
  42. 42.
    Copeland J, Gates P, Pokorski I. A narrative review of psychological cannabis use treatments with and without pharmaceutical adjunct. Curr Pharm Des. 2016;22(42):6397–408.CrossRefPubMedGoogle Scholar
  43. 43.
    Danovitch I, Gorelick DA. State of the art treatments for cannabis dependence. Psychiatr Clin North Am. 2012;35(2):309–26.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Liddle HA, Dakof GA, Turner RM, Henderson CE, Greenbaum PE. Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction. 2008;103(10):1660–70.CrossRefPubMedGoogle Scholar
  45. 45.
    Dale V, Heather N, Adamson S, Coulton S, Copello A, Godfrey C, et al. Predicting drinking outcomes: evidence from the United Kingdom Alcohol Treatment Trial (UKATT). Addict Behav. 2017;71:61–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Litt MD, Kadden RM, Kabela-Cormier E, Petry NM. Coping skills training and contingency management treatments for marijuana dependence: exploring mechanisms of behavior change. Addiction. 2008;103(4):638–48.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Budney AJ, Stanger C, Tilford JM, Scherer EB, Brown PC, Li Z, et al. Computer-assisted behavioral therapy and contingency management for cannabis use disorder. Psychol Addict Behav. 2015;29(3):501–11.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Fletcher L, Hayes SC. Relational frame theory, acceptance and commitment therapy, and a functional analytic definition of mindfulness. J Ration Emotive Cogn Behav Ther. 2005;23(4):315–36.CrossRefGoogle Scholar
  49. 49.
    Copeland J, Martin G. Web-based interventions for substance use disorders: a qualitative review. J Subst Abuse Treat. 2004;26(2):109–16.CrossRefPubMedGoogle Scholar
  50. 50.
    Rooke SE, Gates PJ, Norberg MM, Copeland J. Applying technology to the treatment of cannabis use disorder: comparing telephone versus Internet delivery using data from two completed trials. J Subst Abuse Treat. 2014;46(1):78–84.CrossRefPubMedGoogle Scholar
  51. 51.
    Center for Substance Abuse Treatment. Using technology-based therapeutic tools in behavioral health services. Rockville. MD; Center for Substance Abuse Treatment; 2015.Google Scholar
  52. 52.
    Myung S-K, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169(10):929–37.CrossRefPubMedGoogle Scholar
  53. 53.
    Rooke S, Thorsteinsson E, Karpin A, Copeland J, Allsop D. Computer-delivered interventions for alcohol and tobacco use: a meta-analysis. Addiction. 2010;105(8):1381–90.CrossRefPubMedGoogle Scholar
  54. 54.
    Wood SK, Eckley L, Hughes K, Hardcastle KA, Bellis MA, Schrooten J, et al. Computer-based programmes for the prevention and management of illicit recreational drug use: a systematic review. Addict Behav. 2014;39(1):30–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Newman MG, Szkodny LE, Llera SJ, Przeworski A. A review of technology-assisted self-help and minimal contact therapies for drug and alcohol abuse and smoking addiction: is human contact necessary for therapeutic efficacy? Clin Psychol Rev. 2011;31(1):178–86.CrossRefPubMedGoogle Scholar
  56. 56.
    Tait RJ, Spijkerman R, Riper H. Internet and computer based interventions for cannabis use: a meta-analysis. Drug Alcohol Depend. 2013;133(2):295–304.CrossRefPubMedGoogle Scholar
  57. 57.
    Gates P, Albertella L. The effectiveness of telephone counselling in the treatment of illicit drug and alcohol use concerns. J Telemed Telecare. 2016;22(2):67–85.CrossRefPubMedGoogle Scholar
  58. 58.
    Gates PJ, Norberg MM, Copeland J, Digiusto E. Randomized controlled trial of a novel cannabis use intervention delivered by telephone. Addiction. 2012;107(12):2149–58.CrossRefPubMedGoogle Scholar
  59. 59.
    Balter RE, Cooper ZD, Haney M. Novel pharmacologic approaches to treating cannabis use disorder. Curr Addict Rep. 2014;1(2):137–43.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Allsop DJ, Copeland J, Norberg MM, Fu S, Molnar A, Lewis J, et al. Quantifying the clinical significance of cannabis withdrawal. PLoS One. 2012;7(9):e44864.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Haney M, Bedi G, Cooper ZD, Glass A, Vosburg SK, Comer SD, et al. Predictors of marijuana relapse in the human laboratory: robust impact of tobacco cigarette smoking status. Biol Psychiatry. 2013;73(3):242–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014;12:CD008940.Google Scholar
  63. 63.
    Levin FR, Mariani J, Brooks DJ, Pavlicova M, Nunes EV, Agosti V, et al. A randomized double-blind, placebo-controlled trial of venlafaxine-extended release for co-occurring cannabis dependence and depressive disorders. Addiction. 2013;108(6):1084–94.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Allsop DJ, Copeland J, Lintzeris N, Dunlop AJ, Montebello M, Sadler C, et al. Nabiximols as an agonist replacement therapy during cannabis withdrawal: a randomized clinical trial. JAMA Psychiatry. 2014;71(3):281–91.CrossRefPubMedGoogle Scholar
  65. 65.
    Trigo JM, Lagzdins D, Rehm J, Selby P, Gamaleddin I, Fischer B, et al. Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and cravings. Drug Alcohol Depend. 2016;161:298–306.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Crippa JAS, Hallak JEC, Machado-De-Sousa JP, Queiroz RHC, Bergamaschi M, Chagas MHN, et al. Cannabidiol for the treatment of cannabis withdrawal syndrome: a case report. J Clin Pharm Ther. 2013;38(2):162–4.CrossRefPubMedGoogle Scholar
  67. 67.
    Pierre JM, Gandal M, Son M. Cannabis-induced psychosis associated with high potency “wax dabs”. Schizophr Res. 2016;172(1–3):211–2.CrossRefPubMedGoogle Scholar
  68. 68.
    Ninnemann AL, Lechner WV, Borges A, Lejuez CW. Synthetic cannabinoids to avoid urine drug screens: implications for contingency management and other treatments for drug dependence. Addict Behav. 2016;63:72–3.CrossRefPubMedGoogle Scholar
  69. 69.
    Karila L, Benyamina A, Blecha L, Cottencin O, Billieux J. The synthetic cannabinoids phenomenon. Curr Pharm Des. 2016;22(42):6420–5.CrossRefPubMedGoogle Scholar
  70. 70.
    Cooper ZD. Adverse effects of synthetic cannabinoids: management of acute toxicity and withdrawal. Curr Psychiatry Rep. 2016;18(5):52.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Schauer GL, Rosenberry ZR, Peters EN. Marijuana and tobacco co-administration in blunts, spliffs, and mulled cigarettes: a systematic literature review. Addict Behav. 2016;64:200–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Jan Copeland
    • 1
    • 2
  • Izabella Pokorski
    • 1
    • 3
  • Lisa Gibson
    • 1
  1. 1.National Cannabis Prevention and Information CentreUniversity of New South WalesSydneyAustralia
  2. 2.Cannabis Information and SupportSt IvesAustralia
  3. 3.Brain Mind CentreUniversity of SydneySydneyAustralia

Personalised recommendations