Psychotherapy Remains the Best Treatment for Cannabis Dependence, With No Approved Medications | Research

The takeaway

A review of randomized trials found cognitive behavioral therapy combined with other approaches had moderate to large effects on cannabis dependence, while no pharmacotherapy has been approved and serotonergic antidepressants may actually worsen withdrawal.

Read this if you want to quit cannabis and are looking for evidence-based treatment approaches.

CBT showed moderate-to-large effects (d = 0.53-0.9) on cannabis dependence; no medication is approved.

What the researchers found

This evidence-based review of treatment options for cannabis dependence found psychotherapy to be the most effective approach, with all psychotherapeutic interventions supported at evidence level Ia (the highest).

Cognitive behavioral therapy (CBT) combined with other techniques showed moderate to large effects (Cohen's d = 0.53-0.9) on cannabis consumption, psychosocial functioning, and dependence severity. Systemic multidimensional family therapy was beneficial for younger adolescents with high use and psychiatric comorbidities. Motivational interviewing was effective for patients regardless of initial desire for abstinence.

For pharmacotherapy, gabapentin showed a weak effect (d = 0.26) on consumption and abstinence. Cannabinoid receptor antagonists alleviated withdrawal symptoms. Critically, serotonergic antidepressants were found to potentially worsen withdrawal and increase relapse likelihood.

Abstinence rates even with psychotherapy remained only moderate, highlighting the need for continued treatment development.

Why it matters

With cannabis use increasing globally and cannabis dependence now recognized as a clinical condition, practitioners need guidance on evidence-based treatments. This review provides a clear hierarchy: psychotherapy first, specific pharmacological adjuncts for withdrawal management, and a warning against using serotonergic antidepressants.

The numbers in context

CBT: effect size d = 0.53-0.9 (evidence level Ia). Gabapentin: d = 0.26 (evidence level Ib). Cannabinoid receptor antagonists for withdrawal: d = 0.223 and 0.481 (evidence level Ib). Serotonergic antidepressants: may worsen withdrawal.

How the study worked

Selective literature review of randomized controlled trials from PubMed and Cochrane databases, evaluating psychotherapeutic and pharmacological interventions for cannabis dependence. Evidence levels were assigned according to standard hierarchies.

What this study cannot tell us

Selective rather than systematic review methodology. The evidence base for cannabis dependence treatment is smaller than for other substances. Many studies have small sample sizes and limited follow-up periods. The review was published in German, potentially limiting its reach.

How to read the evidence

Strong evidence from a review of randomized controlled trials with clear evidence level assignments for each intervention.

When this study was published

Published in 2016. The cannabis dependence treatment landscape continues to evolve with ongoing clinical trials.

The bigger picture

Unlike opioid and alcohol dependence, which have FDA-approved pharmacotherapies, cannabis dependence lacks any approved medication. Psychotherapy is effective but produces only moderate abstinence rates. The field needs the kind of pharmacological innovation that transformed opioid and alcohol treatment.

Questions still open

Could combinations of psychotherapy and pharmacotherapy produce better outcomes than either alone? Will the serotonergic antidepressant finding be confirmed in larger studies? Are newer compounds being tested for cannabis dependence treatment?

Common questions

What is the best treatment for cannabis addiction?

Cognitive behavioral therapy (CBT) combined with motivational interviewing has the strongest evidence, with moderate to large effect sizes. No medication has been approved for cannabis dependence. Gabapentin showed a small effect, and cannabinoid-based medications may help with withdrawal symptoms.

Can antidepressants help with quitting cannabis?

This review found that serotonergic antidepressants (SSRIs) may actually worsen cannabis withdrawal and increase relapse risk. This is an important caution for clinicians who might prescribe them to manage mood symptoms during cannabis cessation.

Read the original research

Evidence-based Treatment Options in Cannabis Dependency.

Deutsches Arzteblatt international, 113(39), 653-659

View on PubMed ↗Publisher’s paper ↗

Citation

Walther, Lisa; Gantner, Andreas; Heinz, Andreas; Majić, Tomislav. (2016). Evidence-based Treatment Options in Cannabis Dependency.. Deutsches Arzteblatt international, 113(39), 653-659. https://doi.org/10.3238/arztebl.2016.0653