Evidence Rating for Outcomes
Drugs & Substance Abuse | Marijuana |
Drugs & Substance Abuse | Symptoms of dependence |
Drugs & Substance Abuse | Abstinence |
Date:
This practice involves the use of psychosocial interventions to treat cannabis use disorder. Psychosocial treatments may include many forms of therapy, such as cognitive–behavioral therapy, contingency management, and relapse prevention. The practice is rated Effective for reducing the use of cannabis and the symptoms of dependence, and increasing the prevalence of abstinence.
Practice Goals
Cannabis use disorder (CUD) is one of the most common substance use disorders in the general population (Gates et al. 2016). CUD is characterized by a pattern of cannabis/marijuana use that can lead to psychiatric distress (e.g., depression, anxiety, or psychoticism) and social impairment (e.g., impaired work performance or unemployment), in addition to other negative consequences (e.g., memory loss or cognitive impairment) and unsuccessful attempts to stop using. The overall goal of psychosocial treatments for CUD is to reduce the use of cannabis and increase abstinence rates (Gates et al. 2016; Sherman and McRae-Clark 2016).
Services Provided
Psychosocial treatments to treat CUD include cognitive–behavioral, motivational interviewing/motivational enhancement, and relapse prevention approaches. Cognitive–behavioral therapy (CBT) and relapse prevention approaches focus on identifying and managing the patterns, thoughts, and external triggers that can lead to cannabis use. These approaches teach coping and problem-solving skills and promote healthier alternative prosocial behaviors. Techniques involved in CBT and relapse prevention include self-monitoring, cognitive restructuring, role playing, and modeling. CBT may also include homework assignments, to practice the use of coping skills.
Motivational interviewing (MI) attempts to help people change problem behaviors and focuses on the importance of self-efficacy and positive change. MI seeks to enhance the motivation of a person seeking treatment for CUD by exploring and resolving any issues of ambivalence. Motivational enhancement therapy is based on the principles of MI and provides personalized feedback and education about a person’s pattern of cannabis use. MI and motivation enhancement therapy can be delivered in an individual or group format, and may include family and friends for social support.
Additional secondary approaches include mindfulness-based meditation (which promotes inner reflection and acceptance of experiences, to decrease the triggers of cannabis use) and drug counseling (which is often a simple face-to-face education strategy about drug use and health risks, including suggestions to minimize harm and brief components from cognitive–behavioral and MI approaches).
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Drugs & Substance Abuse | Marijuana
Across five randomized controlled trials (RCTs), Dutra and colleagues (2008) found a statistically significant average effect size of 0.81 for rates of cannabis use. This means that participants with cannabis use disorder who participated in psychosocial interventions had lower rates of cannabis use, compared with control group participants who did not participate in psychosocial interventions. Similarly, across six RCTs, Gates and colleagues (2016) found a statistically significant standard mean difference of 5.67, indicating that participants with cannabis use disorder who participated in psychosocial interventions reported fewer days of cannabis use (in the prior 30 days) at the follow up, compared with participants in the inactive control condition. |
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Drugs & Substance Abuse | Symptoms of dependence
Across four RCTs, Gates and colleagues (2016) found a statistically significant standard mean difference of 4.15 for symptoms of dependence on cannabis. This means that participants with cannabis use disorder who participated in psychosocial interventions reported fewer symptoms of dependence on cannabis, compared with participants in the inactive control condition, at the follow up. |
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Drugs & Substance Abuse | Abstinence
Across six RCTs, Gates and colleagues (2016) found a statistically significant standard mean difference of 2.55 for achieving point-prevalence (i.e., the proportion of participants reporting continuous abstinence from treatment to the final follow-up assessment). This means that participants with cannabis use disorder who participated in psychosocial interventions were 1.96 times more likely to achieve point-prevalence abstinence at the follow up, compared with participants in the inactive control condition. |
Literature Coverage Dates | Number of Studies | Number of Study Participants | |
---|---|---|---|
Meta Analysis 1 | 1998-2003 | 5 | 470 |
Meta Analysis 2 | 1988-2014 | 23 | 4045 |
Using meta-analytic techniques, Dutra and colleagues (2008) analyzed the effect of psychosocial interventions on illicit substance use disorders, including use of cocaine, opiates, and cannabis; and on polysubstance abuse and dependence (the CrimeSolutions review of this meta-analysis focused on the effects of psychosocial interventions on cannabis use disorder). To identify studies, PsycINFO was used to find articles published up to March 2005, using a variety of key search terms, including but not limited to cocaine, substance use, substance abuse, treatment outcome, contingency, and voucher. Additionally, MEDLINE was used to identify articles available between 1966 and March 2005, and the Cochrane Central Register of Controlled Trials was used to identify studies for the first quarter of 2005. Both PsychINFO and MEDLINE searches were limited to those published in English.
To be eligible for inclusion in the meta-analysis, studies had to be investigations of the efficacy of individual psychosocial treatments for substance abuse/dependence (not including alcohol or nicotine abuse/dependence) and have used randomized controlled trials (RCTs), including a comparison group. Moreover, studies were limited to adult participants and to investigations on the efficacy of nonintensive outpatient treatments. Nonintensive outpatient treatment was defined as a maximum of three, 2-hour per week treatment sessions. Finally, studies had to include self-report outcomes of interest or toxicology screening outcomes of interest. Self-report outcomes of interest included 1) mean maximum number of days or weeks abstinent throughout treatment, 2) mean percent of days abstinent throughout treatment, 3) percent of sample that demonstrated abstinence for 3 or more weeks throughout treatment, 4) percent of sample that demonstrated posttreatment/clinically significant abstinence, and 5) posttreatment scores on the Addiction Severity Index. Toxicology outcomes of interest included 1) mean number of negative drug screens throughout treatment, 2) mean percent of negative drug screens throughout treatment, and 3) percent of sample that demonstrated clinically significant abstinence.
A total of 34 RCTs were included in the review, which involved 2,340 total participants. The majority of participants across all studies were male (62.2 percent) and white (61.0 percent). The average age of the participants was 34.9 years and self-reported an average of 10.1 years of substance use. Of the 34 total studies, five specifically examined the effects of psychosocial interventions for cannabis use disorder. Across the five studies, the intent-to-treat sample (i.e., the sample size of the treatment condition) included 470 participants (this did not include the sample size of participants in the control condition, which was not provided). For treatment type, one study looked at contingency management, two studies looked at cognitive–behavioral therapy (CBT) interventions, and two studies looked at relapse prevention. In two studies, the control condition received motivational enhancement interviewing, two studies included wait-list control conditions, and one study included a treatment-as-usual control condition. The weeks of treatment ranged from 4 to 18, with one session per week.
The effect sizes for the outcome variable (cannabis use) were calculated using Cohen’s d. Aggregated mean effect sizes were determined when studies presented data on two or more of the chosen outcome variables.
Meta Analysis 2Gates and colleagues (2016) conducted a meta-analysis to determine the effectiveness of psychosocial interventions for cannabis use disorder. Studies were obtained through the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and reference lists of articles. Only studies of psychosocial interventions that used RCTs were included. Studies were eligible for inclusion if they included participants who received treatment (in an outpatient or community setting) and were 18 years of age or older and met diagnostic criteria for cannabis abuse or dependence by clinical assessment, or were at least near daily cannabis users or seeking treatment for their cannabis use.
A total of 23 RCTs were included in the review, which involved 4,045 participants. Of these studies, 15 were conducted in the United States, 2 studies were conducted in Germany, and 1 study each in Brazil, Canada, Ireland, and Switzerland. The average age of participants was 28.2 years. Of the total participants, the average use of cannabis at baseline was reported as 20.8 days of the past 30 days. Psychosocial interventions and therapies included in the meta-analysis were CBT, motivational enhancement therapy (MET), a combination of CBT and MET, contingency management, social support, mindfulness-based meditation, and drug education and counseling. Study results were pooled based on the comparisons between any psychosocial intervention versus inactive control (10 studies); any psychosocial intervention versus treatment as usual (3 studies); and any psychosocial intervention versus another intervention (9 studies).The CrimeSolutions review of this meta-analysis focused on the difference between the psychosocial intervention versus the inactive control.
The outcomes of interest included the use of cannabis (measured as self-reported use, including number of days, rate of abstinence, times per day), without or without confirmation by an objective means (such as urinalysis); the point-prevalence abstinence (which is the proportion of participants reporting continuous abstinence from treatment to final follow-up assessment); and severity of cannabis use disorder (measured by the symptoms of dependence). For continuous data, the effect size was calculated as standardized mean differences.
These sources were used in the development of the practice profile:
Dutra, Lissa, Georgia Stathopoulou, Shawnee L. Basden, Teresa M. Leyro, Mark B. Powers, and Michael W. Otto. 2008. “A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorder.” American Journal of Psychiatry 165(2):179–87.
Gates, Peter J., Pamela Sabioni, Jan Copeland, Bernard Le Foll, and Linda Gowing. 2016. “Psychosocial Interventions for Cannabis Use Disorder.” Cochrane Database of Systematic Reviews 5:1–121.
Age: 18 - 45
Gender: Male, Female
Race/Ethnicity: White, Other
Targeted Population: Alcohol and Other Drug (AOD) Offenders
Setting (Delivery): Other Community Setting, Inpatient/Outpatient
Practice Type: Alcohol and Drug Therapy/Treatment, Group Therapy, Individual Therapy
Unit of Analysis: Persons