TOPLINE: 

A network meta-analysis (NMA) showed that dialectical behavioral therapy/acceptance and commitment therapy (DBT/ACT) and cognitive behavioral therapy with motivation enhancement therapy (MET-CBT) combined with contingency management (CM) reduced the frequency of cannabis use in people with cannabis use disorder (CUD).

METHODOLOGY:

• Researchers conducted an NMA of 57 randomised controlled trials (RCTs) examining psychosocial interventions (21 RCTs; 3157 participants) and pharmacotherapies (36 RCTs; 3120 participants) for CUD in people aged 16 years or older, with outcomes including the level of cannabis use, abstinence, adverse events, and treatment completion.
• Psychosocial interventions were categorized by theoretical approach and therapeutic technique (eg, MET-CBT, DBT/ACT, or CM).
• Pharmacotherapies were grouped by clinical use and mechanism of action (eg, selective serotonin reuptake inhibitors, mixed-action antidepressants, or delta-9-tetrahydrocannabinol preparations).
• Researchers analysed between‑study heterogeneity and the certainty of evidence. They reported results relative to predefined thresholds for minimum clinically meaningful differences — an odds ratio [OR] of ≤ 0.8 or ≥ 1.25 and a standardised mean difference [SMD] of ± 0.2 — using 95% credible intervals (CrIs).
• Most RCTs took place in outpatient settings. Participants were predominantly men (average, 80%; range, 56%-100%) and young individuals (mean age, 30 years; range, 16-48 years), with baseline cannabis use averaging 78% of days.

TAKEAWAY:

• Both DBT/ACT and MET-CBT with CM, based on abstinence, reduced the frequency of cannabis use compared with a nonspecific comparator, with mean differences of -0.18 and -0.15, respectively; however, the certainty of evidence ranged from low to very low.
• Cannabidiol (OR, 2.91; 95% CrI, 0.45-27.98), N-acetylcysteine (OR, 1.30; 95% CrI, 0.55-3.74), and varenicline (OR, 4.85; 95% CrI, 0.65-48.26) showed effects consistent with increased point abstinence compared with placebo; however, the certainty of evidence was very low, and the CrIs were wide.
• Cannabidiol was associated with adverse events (OR, 1.58; 95% CrI, 0.26-8.98); additionally, very low‑certainty evidence suggested mixed‑action antidepressants, benzodiazepines, bupropion, and buspirone had more adverse events than placebo, without clear evidence of benefit.
• Compared with a nonspecific comparator, DBT/ACT and CM improved treatment completion, whereas MET-CBT (with or without affect management) reduced completion. N-acetylcysteine (OR, 1.29) and delta-9-tetrahydrocannabinol preparations (OR, 1.32) increased completion relative to placebo. However, all findings were based on evidence with certainty ranging from low to very low, with wide CrIs.

IN PRACTICE:

"There is some evidence that several psychosocial and pharmacological interventions for CUD may facilitate abstinence and help reduce cannabis use, although the therapeutic benefits are uncertain and some pharmacotherapies may cause adverse events," the authors wrote. 

"Given the limited evidence of their efficacy, pharmacotherapies should still be considered experimental in treating CUD. With the low-to-very low certainty of evidence, the reported findings should be interpreted cautiously, especially in clinical practice," they added.

SOURCE:

The study was led by Monika Halicka, University of Bristol, Bristol, England. It was published online on April 2 in Addiction.

LIMITATIONS:

The certainty of evidence ranged from low to very low across all studies due to imprecision, heterogeneity, and relatively small sample sizes. In some studies, several interventions were evaluated in only a single trial. Wide 95% Crls often spanned both benefit and harm, reflecting uncertainty about the true therapeutic effects. Risk for bias in study results was common, particularly from missing outcome data. No direct comparisons between psychosocial and pharmacologic interventions were available, limiting conclusions about their relative effects. The findings may not be fully generalisable to people with major psychiatric comorbidities or multisubstance dependence, and the evidence is mostly from young, predominantly male individuals.

DISCLOSURES:

This NMA was funded by the Evidence Synthesis Programme of the National Institute for Health and Care Research. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.