Assessing Current Demand and Therapeutic Strategies for the Treatment of Cannabis Use Disorder

Background and Purpose: The shifting landscape of cannabis use throughout the United States has created unique challenges in treating patients with cannabis use disorder (CUD), who often use legalization as justification for continued cannabis use. This analysis examines the extent to which substance use disorder (SUD) treatment providers use cannabis-specific screening tools, and adapt any therapies in treating patients with CUD.

Methods: Data were collected using phone interviews from 406 clinical directors of SUD treatment centers throughout the United States to examine treatment delivery for clients who use cannabis. Respondents were asked ordinal questions regarding use and qualitative data were thematically coded by three independent coders through iterative rounds.

Results: About 65% of centers indicated a low treatment demand for primary cannabis patients When asked if demand for treatment has increased, decreased, or remained the same over the past three years, just over half (54%) of respondents indicated that treatment demand has remained the same. Respondents were asked to identify cannabis-specific screening tools used at their center from a list of seven instruments including: Marijuana Dependence Scale (MDS); Cannabis Abuse Screening Test (CAST); Cannabis Use Disorder Identification Test (CUDIT); Comprehensive Marijuana Motives Questionnaire; Alcohol, Smoking and Substance Involvement Screening Test (ASSIST); Marijuana Problems Scale; and Marijuana Motives Measure (MMM). We largely found that centers did not use any of these tools, and instead used a combination of general validating screening and assessment tools (ASAM, DSM-V) or tools created by the center. In terms of specific therapies, Motivational Enhancement Therapy (MET) and Cognitive Behavioral Therapy (CBT) were the most utilized therapies for cannabis patients, with 95% of centers using MET or CBT. When asked about having a specific detox strategy for primary marijuana patients, 87% indicated having no specific detox strategy and that 89% indicated making no adaptations to manual-based therapies to treat cannabis patients. Thematic analysis identified CUD patients struggling with motivation to complete treatment, and specific adaptations to MET were made to address these issues.

Conclusions and Implications: Results indicate a gap in treatment centers utilizing specific tools to treat CUD patients. Patients seeking treatment for cannabis have a unique set of issues and often struggle with maintaining abstinence from cannabis during and following treatment. A potential barrier to effective treatment is the absence of a robust therapeutic and clinical strategy that targets the unique issues regarding treatment of patients with CUD. Demand for treatment remains low, even though reported rates of CUD are growing in the United States. Creating more specialized CUD treatment services that specifically address the challenges of treating CUD patients will help bridge this gap.