Text-Message Cannabis Treatment Moved Young Adults to Action Stage, Cutting Use by 50%
Young adults receiving a text-message motivational interviewing treatment who advanced to the action/maintenance stage of change had 50% lower odds of high THC levels and used cannabis 4 fewer days per month at 6-month follow-up.
Quick Facts
What This Study Found
Mediation analysis showed that PNC-txt participants who reached the Action/Maintenance stage by 1 month had 50% lower odds of the highest THC metabolite level (300 ng/ml) and reported 4 fewer days of cannabis use in the past 30 days at 6 months, compared to controls.
Key Numbers
N = 1,078 young adults. 4-week PNC-txt intervention. Action/Maintenance stage at 1 month: 50% lower odds of 300 ng/ml THC test. 4 fewer cannabis use days at 6 months. Biological (urine) and self-report outcomes both confirmed effects.
How They Did This
Two-arm RCT with 1,078 US young adults randomized to 4 weeks of PNC-txt (text-message motivational interviewing) or wait-list control, followed for 6 months. Urine drug tests and self-reported use were outcome measures. The Marijuana Ladder assessed stages of change, dichotomized as Cognitive (precontemplation/contemplation/preparation) vs. Behavioral (action/maintenance) stages.
Why This Research Matters
Cannabis use disorder treatment has historically struggled with engagement, especially among young adults. A text-message approach overcomes key barriers (stigma, scheduling, cost) and this study shows it works through a well-established clinical mechanism, the Stages of Change.
The Bigger Picture
This is one of the largest CUD treatment trials ever conducted and one of the first to validate text-based delivery with biological outcomes. The combination of biological confirmation (urine THC) with the behavioral mechanism (stages of change) strengthens the evidence considerably.
What This Study Doesn't Tell Us
Wait-list control means participants knew their group assignment. The mediation analysis is exploratory. Not all participants provided urine samples at all time points. The treatment effect operates through motivation change, so participants not ready to change may not benefit.
Questions This Raises
- ?Could this approach be scaled through healthcare apps or integrated into primary care?
- ?Would adding pharmacotherapy enhance the text-message treatment effects?
Trust & Context
- Key Stat:
- 50% lower odds of high THC levels at 6 months
- Evidence Grade:
- Large RCT with biological outcome confirmation and established mediator. Moderate-strong evidence, though wait-list control and mediation design introduce some limitations.
- Study Age:
- Published in 2025.
- Original Title:
- Young Adults Advancing Through the Stages of Change: A Mediational Analysis of Cannabis Use Disorder Treatment.
- Published In:
- Substance use & misuse, 60(10), 1523-1529 (2025)
- Authors:
- Mason, Michael J(3), Coatsworth, J Douglas(3), Russell, Michael A(2), Mennis, Jeremy, Riggs, Nathaniel R, Zaharakis, Nikola, Brown, Aaron
- Database ID:
- RTHC-07075
Evidence Hierarchy
Participants are randomly assigned to treatment or placebo groups to test cause and effect.
What do these levels mean? →Frequently Asked Questions
How does a text-message treatment work for cannabis?
PNC-txt delivers motivational interviewing content via text messages over 4 weeks. It helps users examine their reasons for use, build motivation to change, and develop strategies for reducing use, all through their phone.
Do you have to want to quit for this to work?
The treatment works by moving people through stages of readiness. You do not have to start in the "action" stage, but the treatment helps you get there. Those who reached action/maintenance showed the best outcomes.
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Cite This Study
https://rethinkthc.com/research/RTHC-07075APA
Mason, Michael J; Coatsworth, J Douglas; Russell, Michael A; Mennis, Jeremy; Riggs, Nathaniel R; Zaharakis, Nikola; Brown, Aaron. (2025). Young Adults Advancing Through the Stages of Change: A Mediational Analysis of Cannabis Use Disorder Treatment.. Substance use & misuse, 60(10), 1523-1529. https://doi.org/10.1080/10826084.2025.2505767
MLA
Mason, Michael J, et al. "Young Adults Advancing Through the Stages of Change: A Mediational Analysis of Cannabis Use Disorder Treatment.." Substance use & misuse, 2025. https://doi.org/10.1080/10826084.2025.2505767
RethinkTHC
RethinkTHC Research Database. "Young Adults Advancing Through the Stages of Change: A Media..." RTHC-07075. Retrieved from https://rethinkthc.com/research/mason-2025-young-adults-advancing-through
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.