State of the art in treating cannabis dependence: what works, what does not, and what is needed | Research

The takeaway

Fewer than 20% of treated individuals achieved long-term abstinence, but combination therapies starting with motivational interviewing and adding cognitive-behavioral skills showed the best results.

Read this if you are trying to quit cannabis and want to know which treatment approaches have the best evidence.

Fewer than 20% achieved long-term abstinence in clinical trials

What the researchers found

This comprehensive review painted a sobering but nuanced picture of cannabis dependence treatment. Long-term abstinence rates in clinical trials were below 20%, and most people who could benefit from treatment never received it.

The most effective approaches combined motivational enhancement therapy with cognitive-behavioral coping skills and contingency management (incentive-based programs). Among adolescents, engaging families and community stakeholders added substantial value.

A meta-analysis found that treatments for cannabis dependence actually had larger effect sizes than treatments for other substance use disorders, suggesting the treatments work, just not well enough. No pharmacological treatment had been firmly established, though several were under development.

The review highlighted that about 9% of cannabis users develop dependence, but given how many people use cannabis, the absolute number needing help exceeds treatment system capacity.

Why it matters

This review captured the gap between treatment demand and treatment efficacy for cannabis dependence. It identified the best available approaches while acknowledging their limitations, and pointed to innovations (phone/computer-based interventions, primary care integration) that could expand access.

The numbers in context

Long-term abstinence: <20% in clinical trials. Cannabis dependence rate: ~9% of users. Treatment effect sizes for cannabis were larger than for other substance use disorders.

How the study worked

Comprehensive narrative review of psychosocial interventions, pharmacological treatments, and delivery innovations for cannabis dependence. Covered adolescent and adult populations, including those with co-occurring disorders.

What this study cannot tell us

Narrative review without systematic search methodology. Focused primarily on English-language literature. The 20% abstinence figure came from controlled trials, which may not represent real-world outcomes. Long-term follow-up data was limited.

How to read the evidence

Comprehensive narrative review drawing on multiple clinical trials and a meta-analysis. Provides good overview but is not itself a systematic review.

When this study was published

Published in 2012. Digital and app-based interventions for cannabis use have expanded significantly since.

The bigger picture

The finding that cannabis dependence treatments had comparatively large effect sizes was counterintuitive given the low abstinence rates. It suggested the problem was not that treatments are ineffective but that addiction is difficult to treat across all substances.

Questions still open

Can digital and phone-based interventions meaningfully expand treatment access? Would longer treatment duration improve outcomes? How should treatment be adapted for the increasing potency of cannabis products?

Common questions

What is the best treatment for cannabis dependence?

Combination approaches worked best: starting with motivational interviewing (building desire to change), adding cognitive-behavioral skills (learning to handle triggers), and using incentives (rewards for abstinence). For adolescents, involving family improved outcomes.

Why are success rates so low?

A less-than-20% long-term abstinence rate is actually comparable to or better than treatment outcomes for many substance use disorders. Addiction involves lasting brain changes that make relapse common across all drugs. The treatments work, but addiction is fundamentally difficult to overcome.

Read the original research

State of the art treatments for cannabis dependence.

The Psychiatric clinics of North America, 35(2), 309-26

View on PubMed ↗Publisher’s paper ↗

Citation

Danovitch, Itai; Gorelick, David A. (2012). State of the art treatments for cannabis dependence.. The Psychiatric clinics of North America, 35(2), 309-26. https://doi.org/10.1016/j.psc.2012.03.003