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Cited by 282Substance Abuse Treatment and OutcomesCannabis and Cannabinoid ResearchSmoking Behavior and Cessation

Psychosocial interventions for cannabis use disorder

Open access
Gates, Peter J, Sabioni, Pamela, Copeland, Jan, Le Foll, Bernard, Gowing, Linda·2016·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd005336.pub4PMC PMC4914383
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Abstract

BACKGROUND: Cannabis use disorder is the most commonly reported illegal substance use disorder in the general population; although demand for assistance from health services is increasing internationally, only a minority of those with the disorder seek professional assistance. Treatment studies have been published, but pressure to establish public policy requires an updated systematic review of cannabis-specific treatments for adults. OBJECTIVES: To evaluate the efficacy of psychosocial interventions for cannabis use disorder (compared with inactive control and/or alternative treatment) delivered to adults in an out-patient or community setting. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 6), MEDLINE, EMBASE, PsycINFO, the Cumulaive Index to Nursing and Allied Health Literature (CINAHL) and reference lists of articles. Searched literature included all articles published before July 2015. SELECTION CRITERIA: All randomised controlled studies examining a psychosocial intervention for cannabis use disorder (without pharmacological intervention) in comparison with a minimal or inactive treatment control or alternative combinations of psychosocial interventions. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by The Cochrane Collaboration. MAIN RESULTS: We included 23 randomised controlled trials involving 4045 participants. A total of 15 studies took place in the United States, two in Australia, two in Germany and one each in Switzerland, Canada, Brazil and Ireland. Investigators delivered treatments over approximately seven sessions (range, one to 14) for approximately 12 weeks (range, one to 56).Overall, risk of bias across studies was moderate, that is, no trial was at high risk of selection bias, attrition bias or reporting bias. Further, trials included a large total number of participants, and each trial ensured the fidelity of treatments provided. In contrast, because of the nature of the interventions provided, participant blinding was not possible, and reports of researcher blinding often were unclear or were not provided. Half of the reviewed studies included collateral verification or urinalysis to confirm self report data, leading to concern about performance and detection bias. Finally, concerns of other bias were based on relatively consistent lack of assessment of non-cannabis substance use or use of additional treatments before or during the trial period.A subset of studies provided sufficient detail for comparison of effects of any intervention versus inactive control on primary outcomes of interest at early follow-up (median, four months). Results showed moderate-quality evidence that approximately seven out of 10 intervention participants completed treatment as intended (effect size (ES) 0.71, 95% confidence interval (CI) 0.63 to 0.78, 11 studies, 1424 participants), and that those receiving psychosocial intervention used cannabis on fewer days compared with those given inactive control (mean difference (MD) 5.67, 95% CI 3.08 to 8.26, six studies, 1144 participants). In addition, low-quality evidence revealed that those receiving intervention were more likely to report point-prevalence abstinence (risk ratio (RR) 2.55, 95% CI 1.34 to 4.83, six studies, 1166 participants) and reported fewer symptoms of dependence (standardised mean difference (SMD) 4.15, 95% CI 1.67 to 6.63, four studies, 889 participants) and cannabis-related problems compared with those given inactive control (SMD 3.34, 95% CI 1.26 to 5.42, six studies, 2202 participants). Finally, very low-quality evidence indicated that those receiving intervention reported using fewer joints per day compared with those given inactive control (SMD 3.55, 95% CI 2.51 to 4.59, eight studies, 1600 participants). Notably, subgroup analyses found that interventions of more than four sessions delivered over longer than one month (high intensity) produced consistently improved outcomes (particularly in terms of cannabis use frequency and severity of dependence) in the short term as compared with low-intensity interventions.The most consistent evidence supports the use of cognitive-behavioural therapy (CBT), motivational enhancement therapy (MET) and particularly their combination for assisting with reduction of cannabis use frequency at early follow-up (MET: MD 4.45, 95% CI 1.90 to 7.00, four studies, 612 participants; CBT: MD 10.94, 95% CI 7.44 to 14.44, one study, 134 participants; MET + CBT: MD 7.38, 95% CI 3.18 to 11.57, three studies, 398 participants) and severity of dependence (MET: SMD 4.07, 95% CI 1.97 to 6.17, two studies, 316 participants; MET + CBT: SMD 7.89, 95% CI 0.93 to 14.85, three studies, 573 participants), although no particular intervention was consistently effective at nine-month follow-up or later. In addition, data from five out of six studies supported the utility of adding voucher-based incentives for cannabis-negative urines to

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Crossref · 10.1002/14651858.cd005336.pub4

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184 of 184 references verified0 citation errors · 0 not checkable

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  • Psychosocial treatments such as motivational enhancement therapy, cognitive behavioral therapy, and contingency management produce greater reductions in cannabis use than control treatments.

    “Psychosocial treatments such as motivational enhancement therapy, cognitive behavioral therapy, and contingency management produce greater reductions in cannabis use than control treatments [60].”

    From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [60]

    The Results (Effects of interventions; page unavailable) report fewer days of cannabis use after psychosocial intervention than after inactive control, with short-term reductions for MET and CBT. The Abstract (Main results; page unavailable) supports contingency management as an addition that can enhance treatment effects, but not as a stand-alone treatment shown to outperform controls; it also notes that no intervention was consistently effective at nine months or later. (LLM, conf=0.86)

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  • There is strong support in the literature and clinical practice for psychosocial interventions for the management of CUD.

    “There is strong support in the literature and clinical practice for psychosocial interventions for the management of CUD 29, 30.”

    From Psychosocial and pharmacological interventions for the treatment of cannabis use disorder (2018) · cites this paper as [30]

    The Background (no page supplied) describes psychosocial approaches as primary treatment options for cannabis use disorder, and the Authors’ Conclusions report benefits over minimal treatment controls. But the Background also says the supporting evidence lacks methodological rigour, and the Discussion rates the included trials’ validity from very low to moderate. Thus, the paper supports psychosocial treatment, but the unqualified description of that support as strong overstates its evidence. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The current best psychosocial intervention to reduce cannabis use is the combination of motivational enhancement therapy and cognitive-behavioral therapy, preferably accompanied by a contingency management approach.

    “An analysis of the evidence shows that the current best psychosocial intervention to reduce cannabis use is the combination of motivational enhancement therapy and cognitive-behavioral therapy, preferably accompanied by a contingency management approach.”

    From Psychosocial and pharmacological interventions for the treatment of cannabis use disorder (2018) · cites this paper as [30]

  • The criteria for problematic methamphetamine use (PMU) are less well defined than MUD and have been defined in the literature according to thresholds of use, consequences of use, or measures taken to provide treatment.

    “The criteria for problematic methamphetamine use (PMU) is less well defined; in the literature, it has been defined according to thresholds of use (e.g., daily, monthly), consequences of use (e.g., substance use-related emergency department visit), or measures taken to provide treatment (e.g., in-treatment or treatment seeking) [20, 21].”

    From Psychosocial and pharmacologic interventions for problematic methamphetamine use: Findings from a scoping review of the literature (2023) · cites this paper as [20]

    The Background (Description of the condition; page not provided) discusses diagnostic criteria for cannabis use disorder, not problematic methamphetamine use. Searches for PMU, methamphetamine use disorder, and the proposed thresholds and consequences found no passage addressing how PMU is defined. (LLM, conf=0.77)

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Cites

1 retracted

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Research works printed but not linked: 6

  1. Peters EN Nich C Carroll KM Primary outcomes in two randomized controlled trials of treatments for cannabis use disorders. Drug and Alcohol Dependence 2011 118 408 16 21620591 PMC3189305
  2. Comely C Assessment and treatment of cannabis abuse and dependence - a practitioner's perspective. Australian Journal of Psychology 2006 58 125
  3. Smeerdijk M Keet R De Haan L Schippers G Linszen D Family motivation intervention in early onset psychosis and cannabis abuse: a randomized clinical trial. Schizophrenia Bulletin 2009 35 371
  4. Wittchen H Targeted cognitive-behavioral treatment for cannabis use disorders (CANDIS): efficacy, long term stability, and efficiency. European Neuropsychopharmacology 2010 20 s206 21865014
  5. Copeland J Swift W Rees V Clinical profile of participants in a brief intervention program for cannabis use disorder. Journal of Substance Abuse Treatment 2001 20 1 45 52 11239727
  6. Substance Abuse and Mental Health Services Administration The TEDS Report: Marijuana Admissions Aged 18 to 30: Early vs. Adult Initiation 2013 SAMHSA Rockville, MD 27631060

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Authors
Gates, P. J., Sabioni, P., Copeland, J., Le Foll, B., & Gowing, L.
Affiliations
  • UNSW Sydney (AU)
  • Centre for Addiction and Mental Health (CA)
  • University of Toronto (CA)
  • Centre for Addiction and Mental Health; University of Toronto; Translational Addiction Research Laboratory; 33 Russell Street Toronto ON Canada
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2016-05-05
Issue
5
Pages
CD005336-CD005336
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd005336.pub4
PMC
PMC4914383
OpenAlex
W2414702405
Cited by
282
References
182
Citations by year
2026: 13 · 2025: 24 · 2024: 33 · 2023: 28 · 2022: 35 · 2021: 31 · 2020: 34 · 2019: 36 · 2018: 27 · 2017: 18 · 2016: 2 · 2015: 1
FWCI
3.75
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
National Institute on Drug Abuse (R21DA031906)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Keywords
cannabis use disorder, psychosocial interventions, treatment efficacy, outpatient care, community-based treatment, treatment completion, relapse, medication adherence, substance use disorders
MeSH terms
Ambulatory Care, Marijuana Abuse, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Motivational Interviewing

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