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Psychosocial and pharmacological treatments for cannabis use disorder and mental health comorbidities: A narrative review

Research output: Contribution to journalReview articlepeer-review

Rachel Lees, Lindsey A. Hines, Deepak Cyril D'Souza, George Stothart, Marta DI Forti, Eva Hoch, Tom P. Freeman

Original languageEnglish
Pages (from-to)353-364
Number of pages12
JournalPsychological Medicine
Volume51
Issue number3
DOIs
PublishedFeb 2021

Bibliographical note

Funding Information: Financial support. RL is funded by an MRC DTP studentship. DCD receives research funding administered through Yale University from the National Institute of Drug Abuse, National Institute of Mental Health, National Center for Advancement of Translational Sciences, Brain and Behavior Foundation, Takeda, Roche, the Heffter Research Institute and the Wallace Foundation. EH reports grants from the Federal Ministry of Health, Federal Ministry of Education and Research, European Monitoring Centre of Drugs and Drug Addiction, during the conduct of the study. TPF was funded by a Senior Academic Fellowship from the Society for the Study of Addiction. LAH is funded by the Wellcome Trust (209158/Z/17/Z). The funders had no role in the development or writing of this manuscript or in the decision to submit it for publication. Publisher Copyright: Copyright © The Author(s) 2021. Published by Cambridge University Press. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.

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