Cited by 114Substance Abuse Treatment and OutcomesCannabis and Cannabinoid ResearchSmoking Behavior and Cessation

The DOI matches its Crossref record, with a small difference in title or year; 66 of the 66 references it cites were found in a registry or an index; none of the 29 sources its claims cite is checked for support yet.

Behavioral Therapies for Treatment-Seeking Cannabis Users: A Meta-Analysis of Randomized Controlled Trials

Open access

Abstract

Narrative reviews conclude that behavioral therapies (BTs) produce better outcomes than control conditions for cannabis use disorders (CUDs). However, the strength and consistency of this effect has not been directly empirically examined. The present meta-analysis combined multiple well-controlled studies to help clarify the overall impact of behavioral interventions in the treatment of CUDs. A comprehensive literature search produced 10 randomized controlled trials (RCTs; n = 2,027) that were included in the final analyses. Analyses indicated an effect of BTs (including contingency management, relapse prevention, and motivational interviewing, and combinations of these strategies with cognitive behavioral therapy) over control conditions (including waitlist [WL], psychological placebo, and treatment as usual) across pooled outcomes and time points (Hedges’ g = 0.44). These results suggest that the average patient receiving a behavioral intervention fared better than 66% of those in the control conditions. BT also outperformed control conditions when examining primary outcomes alone (frequency and severity of use) and secondary outcomes alone (psychosocial functioning). Effect sizes were not moderated by inclusion of a diagnosis (RCTs including treatment-seeking cannabis users who were not assessed for abuse or dependence vs. RCTs including individuals diagnosed as dependent), dose (number of treatment sessions), treatment format (either group vs. individual treatment or in-person vs. non-in-person treatment), sample size, or publication year. Effect sizes were significantly larger for studies that included a WL control comparison versus those including active control comparisons, such that BT significantly outperformed WL controls but not active control comparisons.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 10 randomized controlled trials (n = 2,027) found that behavioral therapies for treatment-seeking cannabis users outperformed control conditions across pooled outcomes and time points. Effects were medium overall, but behavioral therapies significantly outperformed waitlist controls and not active controls.

Key findings

  • Across all outcomes and time points, behavioral therapies outperformed controls with Hedges’ g = 0.44 (SE = 0.09, 95% CI [0.26, 0.62], p < .001); the average patient receiving behavioral therapy fared better than 66% of controls.
  • Behavioral therapies also outperformed controls on primary outcomes (frequency and severity of use; g = 0.49, SE = 0.11, 95% CI [0.26, 0.71], p < .001; better than approximately 69% of controls) and secondary outcomes (psychosocial functioning; g = 0.42, SE = 0.12, 95% CI [0.19, 0.65], p < .001; better than 66% of controls).
  • Effect sizes were not significantly moderated by dose (β = .02, p = .43), publication year (β = .01, p = .73), sample size (β = .00, p = .70), diagnosis inclusion (p = .29), in-person versus non-in-person treatment (p = .80), or group versus individual in-person treatment (p = .78).
  • Behavioral therapies significantly outperformed waitlist controls (g = 0.56, SE = 0.09, p < .001) but not active controls (g = 0.14, SE = 0.12, p = .25). Publication-bias analysis indicated more than 101 unpublished null studies would be needed to reduce the overall effect to nonsignificance, exceeding the suggested threshold of 60.

Methods

  • Meta-analysis of randomized controlled trials identified through Scopus, Medline, PsychINFO, PubMed, the Cochrane Register of Controlled Trials, and Dissertation Abstracts International, searched from first available date until March 15, 2013, using terms random* and cannabis or marijuana; 763 potential articles were identified and 10 RCTs (n = 2,027) were included.
  • Inclusion criteria required at least one behavioral component (e.g., contingency management, relapse prevention, motivational interviewing, or combinations with cognitive behavioral therapy), random assignment, an active or inactive control group (waitlist, psychological placebo, or treatment as usual), and a treatment-seeking sample.
  • Between-group effect sizes were computed with Hedges’ g using random-effects analyses; heterogeneity was assessed with Q and I², moderators were examined with unrestricted maximum likelihood meta-regressions, and publication bias was assessed with fail-safe N.

Limitations

  • The paper states that most RCTs compared two behavioral therapies without a control group and were excluded; only 10 trials with controls were available, which may have limited power to detect moderators.
  • The paper states it did not compare different forms of behavioral treatment because versions were not uniform across studies; two included studies used web-based or telephone-based rather than in-person treatment.
  • The paper states that some RCTs did not assess abuse/dependence and included cannabis “users,” while others included only dependent participants; it also notes that active-control comparisons were limited to three studies and should be interpreted cautiously.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/0163278714529970

Cites

66 of 66 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

29 Own result · 18 Own interpretation · 17 Not checked yet · 8 Own method · 1 No basis given

Verify all 29 references — free account
  • It may state two separate claims as one. 13
  • Probably not a substantial claim. 9
  • The quote only partly states this claim. 1
22 of 22
  • The authors state this as an assumption.

    The studies included in the random effects analysis are only a sample of the entire population of studies.

    “Effect sizes were calculated with random effects analyses, which estimate the overall effect size assuming the studies included are only a sample of the entire population of studies.”
  • The paper relies on this without support.

    The control conditions classified as treatment as usual or author-developed controls did not include the active components of behavioral therapy.

    “We chose to only include studies with a control condition (i.e., any conditions that did not appear to include the active components of BT) in order to compare controlled effect sizes.”
  • The authors state this as an assumption.

    The effect sizes of all current or future unpublished studies are equal to 0.

    “A conservative method of addressing this problem is to assume that the effect sizes of all current or future unpublished studies are equal to 0”
  • The paper relies on this without support.

    The vast majority of persons with any substance use disorder do not fully benefit from existing intervention protocols.

    “Indeed, the vast majority of persons with any SUD do not fully benefit from existing intervention protocols.”
4 of 4

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentQ(9) = 16.44reported p = .06 · recomputed p = .058

    “Q(9) = 16.44, p = .06”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Show all 65 references

Research works printed but not linked: 4

  1. Bakan D., 1967, On method
  2. Borenstein M., 1999, Comprehensive meta-analysis, a computer program for research synthesis
  3. Johnston L. D., 1995, National survey results on drug use from the monitoring the future study, 1975-1994
  4. Johnston L. D., 2003, Monitoring the future: National survey results on drug use, 1975-2002

Cited by

Sorted by citations

See all 114

Metadata

Authors
Davis, M. L., Powers, M. B., Handelsman, P., Medina, J. L., Zvolensky, M., & Smits, J. A. J.
Affiliations
  • The University of Texas at Austin (US)
  • Roosevelt University (US)
  • University of Houston (US)
Corresponding author
Davis, Michelle L.
Venue
Evaluation & the Health Professions
Published
2014-04-02
Volume
38
Issue
1
Pages
94-114
ISSN
  • 0163-2787 (ISSN-L)
  • 1552-3918
OpenAlex
W2170981263
Cited by
114
References
65
Citations by year
2026: 7 · 2025: 8 · 2024: 8 · 2023: 9 · 2022: 5 · 2021: 10 · 2020: 12 · 2019: 15 · 2018: 13 · 2017: 12 · 2016: 7 · 2015: 6 · 2014: 2
FWCI
1.20
Type
journal article
Language
en
Open access
Locations
  • Evaluation & the Health Professions (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
  • National Institutes of Health (5r01da027533-04)
  • National Institute on Drug Abuse (R01-DA027533, R34DA031038, F31DA036919, K01DA035930)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Keywords
cannabis use disorder, behavior therapy, contingency management, relapse prevention, motivational interviewing, cognitive behavioral therapy, treatment effectiveness, waitlist control, active control, psychosocial functioning
MeSH terms
Marijuana Abuse, Humans, Patient Acceptance of Health Care, Severity of Illness Index, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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