Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings

Denis C, Lavie E, Fatseas M, Auriacombe M

Published Online:

July 16, 2008

Cannabis use disorder is the most commonly occurring illicit substance use disorder in the general population. Despite the large number of cannabis users who seek or may need treatment only a few randomised clinical trials exist that explore the most effective interventions. The six studies included in this review show that cannabis dependence is not easily treated by psychotherapies in outpatient settings. Cognitive-behavioral (CB) both in individual or group sessions, motivational enhancement in individual sessions have been demonstrated to be effective to reduce cannabis use. The most recent, best quality and largest controlled trial, found extended individual CBT to be more effective than brief individual motivational therapy. The two studies on contingency-management treatments concluded that this may enhance outcomes combined with CBT or motivational enhancement.

Abstract (click to read)

Background:

Cannabis use disorder is the most common illicit substance use disorder in general population. Despite that, only a minority seek assistance from a health professional, but the demand for treatment is now increasing internationally. Trials of treatment have been published but to our knowledge, there is no published systematic review .

Objectives:

To evaluate the efficacy of psychosocial interventions for cannabis abuse or dependence.

Search strategy:

We searched the Cochrane Central Register of Trials (CENTRAL) The Cochrane Library Issue 3, 2004; MEDLINE (January 1966 to August 2004), PsycInfo (1985 to October 2004), CINAHL (1982 to October 2004), Toxibase (until September 2004) and reference lists of articles. We also contacted researchers in the field.

Selection criteria:

All randomised controlled studies examining a psychotherapeutic intervention for cannabis dependence or abuse in comparison with a delayed-treatment control group or combinations of psychotherapeutic interventions.

Data collection and analysis:

Two authors independently assessed trial quality and extracted data

Main results:

Six trials involving 1297 people were included. Five studies took place in the United States, one in Australia. Studies were not pooled in meta-analysis because of heterogeneity. The six included studies suggested that counselling approaches might have beneficial effects for the treatment of cannabis dependence. Group and individual sessions of cognitive behavioral therapy (CBT) had both efficacy for the treatment of cannabis dependence and associated problems, CBT produced better outcomes than a brief intervention when CBT was delivered in individual sessions. Two studies suggested that adding voucher-based incentives may enhance treatment when used in combination with other effective psychotherapeutic interventions. Abstinence rates were relatively small overall but favoured the individual CBT 9-session (or more) condition. All included trials reported a statistically significant reductions in frequency of cannabis use and dependence symptoms. But other measures of problems related to cannabis use were not consistently different.

Authors' conclusions:

The included studies were too heterogenous and could not allow to draw up a clear conclusion. The studies comparing different therapeutic modalities raise important questions about the duration, intensity and type of treatment. The generalizability of findings is also unknown because the studies have been conducted in a limited number of localities with fairly homogenous samples of treatment seekers. However, the low abstinence rate indicated that cannabis dependence is not easily treated by psychotherapies in outpatient settings.

This record should be cited as:

Denis C, Lavie E, Fatseas M, Auriacombe M. Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005336. DOI: 10.1002/14651858.CD005336.pub2

Assessed as up to date:

April 21, 2006

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Primary Review Group:

Drugs and Alcohol Group

Health topics:

Tobacco, drugs, & alcohol dependence > Cannabis

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings

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