Cognitive behavioral therapy did not significantly outperform other treatments for reducing cannabis use in a meta-analysis of 9 trials | Research

The takeaway

A meta-analysis of nine RCTs with 1,280 participants found CBT did not produce significant reductions in cannabis use frequency compared to contingency management, treatment as usual, or other psychosocial interventions at any time point.

Addiction therapists, clinical psychologists, treatment program designers, and people seeking help with cannabis use.

CBT: no significant advantage over other treatments at any time point

What the researchers found

CBT did not significantly reduce cannabis use frequency at short-term (effect=0.12, p=0.10), medium-term (effect=-0.03, p=0.75), or long-term (effect=0.01, p=0.91) follow-ups compared to control conditions. Daily consumption showed a significant medium-term effect (-0.50, p<.05) but insignificant effects at other time points.

Why it matters

CBT is often considered a first-line psychosocial treatment for cannabis use disorder. This meta-analysis challenges that assumption by showing it does not clearly outperform other approaches, suggesting the field needs to reconsider treatment recommendations.

The numbers in context

2,347 records screened, 9 RCTs included, 1,280 participants. Short-term: 0.12 (95% CI -0.02 to 0.26, p=0.10). Medium-term: -0.03 (95% CI -0.18 to 0.13, p=0.75). Long-term: 0.01 (95% CI -0.18 to 0.20, p=0.91). Daily consumption medium-term: -0.50 (p<.05).

How the study worked

Systematic review and meta-analysis of MEDLINE, PsycINFO, CINAHL, AMED, Cochrane Library, and clinical trial registries. Nine RCTs involving 1,280 participants were included. Quality assessed using Cochrane Risk of Bias tool.

What this study cannot tell us

Only nine RCTs available, with study heterogeneity, small sample sizes, and risk of bias. Comparison conditions varied (contingency management, TAU, other psychosocial). Unstandardized CBT content across studies. Cannot assess which CBT components might be effective.

How to read the evidence

Strong: systematic review with meta-analysis of RCTs, though limited by small number of included studies and heterogeneity.

When this study was published

Published 2026.

The bigger picture

The finding that CBT does not outperform other psychosocial treatments does not mean therapy is useless for cannabis use, but rather that no single approach has established superiority. This opens the door for integrative or personalized treatment strategies.

Questions still open

Would standardized CBT protocols perform better? Is CBT more effective when combined with contingency management or pharmacotherapy? Are there patient subgroups for whom CBT is particularly effective or ineffective?

Common questions

Does CBT help people stop using cannabis?

This meta-analysis found CBT did not significantly outperform other psychosocial treatments for reducing cannabis use frequency, suggesting it may not have a specific advantage over alternative approaches.

What treatments work for cannabis use disorder?

The finding that CBT performed similarly to contingency management and other approaches suggests multiple psychosocial treatments can be effective. The field is moving toward identifying which treatment works best for which individual.

Read the original research

Effectiveness of cognitive behavioral therapy for harmful cannabis use: a systematic review and meta-analysis.

Cognitive behaviour therapy, 1-21

View on PubMed ↗Publisher’s paper ↗

Citation

Ullah, Safat; Ullah, Asad; Ahmad, Fayaz; Latif, Abdul; Sohaib, Muhammad; Khan, Muhammad Firaz; Ahmad, Bilal; Yadegarfar, Ghasem; Farooq, Saeed; Naeem, Farooq; Paudyal, Priyamvada. (2026). Effectiveness of cognitive behavioral therapy for harmful cannabis use: a systematic review and meta-analysis.. Cognitive behaviour therapy, 1-21. https://doi.org/10.1080/16506073.2026.2613114