Cannabis-Related Disorders Treatment & Management

Updated: May 03, 2022
  • Author: Lawrence Genen, MD, MBA; Chief Editor: David Bienenfeld, MD  more...
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Treatment

Medical Care

Acute intoxication of cannabis usually resolves unremarkably within 4–6 hours and is best managed by the following measures:

  • Frequent reassurance and maintenance of a nonthreatening environment

  • Minimal stimuli

  • Use of a specifically assigned nurse to calm the patient

  • Judicious use of benzodiazepines when significant anxiety is present

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Consultations

People who use marijuana and are suffering from biological, psychological, or social impairment from marijuana use should be evaluated and, if necessary, treated by a psychiatrist.

The treatment of marijuana abuse follows the general principals of substance abuse, with particular attention to psychological and social aspects. Marijuana may be one of many drugs abused, and total abstinence from all psychoactive substances (with the exception of caffeine) is the treatment goal. Interventions may include psychiatric evaluation, occupational and family assessment, and implementation of a comprehensive treatment plan.

Psychological issues (eg, denial, minimization, rationalization) must be confronted. Often, cessation of drug use and subsequent cognitive improvement result in self-motivation and changes in the occupational and social well-being of the patient. Lifestyle changes, such as avoiding drug-related situations, may be encouraged.

Identify and address low self-esteem, mood disorders, family problems, and other stresses.

One-to-one therapy, group therapy, and even hospitalization may be necessary components of the treatment plan. (Patients with uncomplicated marijuana use in the absence of other psychiatric or medical problems are rarely hospitalized.)

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Prevention

School-based programs and peer-led groups may be useful in primary prevention of marijuana abuse.

Voucher-based reinforcement of marijuana abstinence among individuals with serious mental illness has proven effective.

Much has been made about marijuana as a “gateway drug.” Under this theory, one would expect a sequential initiation of drug use progressing from licit substances such as alcohol and tobacco to cannabis and moving on to other illicit substances. However, a study conducted across diverse countries and cohorts showed significant violations of this sequential gateway hypothesis and instead has demonstrated “that the strength of associations between substance use progression may be driven by background prevalence rather than being wholly explained by causal mechanisms.” [33]

Gateway violations, such as use of illicit substances prior to cannabis use, were highest in countries with the lowest rates of prevalence of cannabis use, with similar findings of gateway violations associated with alcohol and tobacco in countries with low prevalence rates of use for alcohol and tobacco. Further, the risk for later development of drug dependence may be more affected by the extent of prior use of any drug and the age of onset at which that use began. The implications of this information for drug abuse prevention would imply that prevention efforts may be most effective not simply by targeting drugs perceived to exist earlier in the “gateway” chain, but by efforts designed to prevent all drug use. [33]

As with all efforts to prevent drug abuse, straight-forward education on the risks associated with cannabis may be most effective. Given the increasing ease of access to marijuana, its increasing prevalence of use, and changing societal views, which seem to reflect its increasing acceptance, the scare tactics of old, which attempted to illustrate "reefer madness” may be perceived as out of touch, inaccurate, and therefore ineffective.

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Long-Term Monitoring

Follow-up care should be comprehensive and involve specialist services such as those provided by drug treatment units.

Treatment includes behavior therapy (aimed at reducing the chances of reexposure and establishing coping mechanisms to resist further use); family, group, and individual therapy; and periodic testing of urine to monitor abstinence.

Narcotics Anonymous (NA) is a self-help group organized on principles similar to Alcoholics Anonymous and is useful in helping addicts maintain abstinence.

Adolescent drug programs usually focus on promoting communication skills and age-appropriate behaviors.

Inpatient hospitalization for the treatment of cannabis abuse or dependence is not recommended. Additionally, inpatient treatment is not recommended for cannabis withdrawal syndrome (CWS), as CWS is only expected to occur in a subgroup of users, even among heavy, chronic users. [28]

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