CBT with Motivational Enhancement Is the Best-Supported Psychotherapy for Cannabis Use Disorder

Across 22 RCTs with 3,304 participants, MET-CBT significantly increased point abstinence (OR=18.27) and continuous abstinence (OR=2.72) compared to inactive/non-specific comparators. Dialectical behavioral/acceptance and commitment therapy also increased point abstinence (OR=4.34). Adding contingency management to MET-CBT showed trends toward benefit but was not statistically significant. MET-CBT reduced treatment completion (OR=0.53), suggesting its demands may lead to dropout. No adverse events were reported across any studies.

Systematic review and pairwise meta-analysis of 22 RCTs (3,304 participants) of psychosocial interventions for CUD lasting more than 4 sessions. Searched MEDLINE, PsycINFO, and Cochrane CENTRAL through June 2024. Assessed using Risk of Bias 2. Registered with PROSPERO.

With no approved medications for CUD, psychosocial interventions are the primary treatment option. This meta-analysis identifies MET-CBT as the most evidence-supported approach while highlighting an important tension: the most effective therapy also had the highest dropout rate.

The very high point abstinence OR for MET-CBT is encouraging, but the lower treatment completion rate means the real-world effectiveness may be more modest than efficacy data suggest. Finding ways to retain patients in MET-CBT could substantially improve CUD outcomes.

Low to very low certainty evidence overall. Only one study had low risk of bias. Small number of studies for each comparison. Point abstinence (negative urine at end of treatment) may overestimate sustained abstinence. No studies reported withdrawal intensity.