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

Published online by Cambridge University Press:  04 February 2021

Rachel Lees Open the ORCID record for Rachel Lees [Opens in a new window] ,
Lindsey A. Hines ,
Deepak Cyril D'Souza ,
George Stothart ,
Marta Di Forti ,
Eva Hoch  and
Tom P. Freeman
Rachel Lees*
Affiliation:
Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
Lindsey A. Hines
Affiliation:
Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
Deepak Cyril D'Souza
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
George Stothart
Affiliation:
Department of Psychology, University of Bath, Bath, UK
Marta Di Forti
Affiliation:
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Eva Hoch
Affiliation:
Cannabinoid Research and Treatment Group, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
Tom P. Freeman
Affiliation:
Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
*
Author for correspondence: Rachel Lees, E-mail: rhl32@bath.ac.uk
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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.

Keywords

Anxietycannabis use disordercannabisdepressiondual diagnosispsychosisTHCtreatment
Type
Review Article
Information
Psychological Medicine , Volume 51 , Issue 3 , February 2021 , pp. 353 - 364
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Copyright
Copyright © The Author(s) 2021. Published by Cambridge University Press

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