A meta-analysis of 22 trials found that cognitive-behavioral therapy combined with motivational enhancement (MET-CBT) significantly increased cannabis abstinence, with point abstinence odds 18 times higher than inactive treatment.
Addiction therapists, CUD treatment programs, clinical psychologists, individuals seeking CUD treatment
What the researchers found
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.
Why it matters
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 numbers in context
22 RCTs; 3,304 participants; MET-CBT point abstinence OR=18.27 (95% CI: 9.00-37.07); continuous abstinence OR=2.72 (1.20-6.19); treatment completion OR=0.53 (0.35-0.85); DBT/ACT point abstinence OR=4.34 (1.74-10.80); no adverse events reported
How the study worked
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.
What this study cannot tell us
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.
How to read the evidence
Strong: systematic review with meta-analysis of RCTs, PROSPERO-registered, though overall evidence certainty was low to very low.
When this study was published
2025 publication with literature search through June 2024
The bigger picture
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.
Questions still open
- How can MET-CBT retention be improved without reducing effectiveness?
- Would digital or app-based CBT delivery improve completion rates?
Read the original research
Effectiveness and safety of psychosocial interventions for the treatment of cannabis use disorder: A systematic review and meta-analysis.
Addiction (Abingdon, England), 120(11), 2181-2201
Citation
Halicka, Monika; Parkhouse, Thomas L; Webster, Katie; Spiga, Francesca; Hines, Lindsey A; Freeman, Tom P; Sanghera, Sabina; Dawson, Sarah; Paterson, Craig; Savović, Jelena; Higgins, Julian P T; Caldwell, Deborah M. (2025). Effectiveness and safety of psychosocial interventions for the treatment of cannabis use disorder: A systematic review and meta-analysis.. Addiction (Abingdon, England), 120(11), 2181-2201. https://doi.org/10.1111/add.70084
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