Benyamina Amine, Lecacheux Marie, Blecha Lisa, Reynaud Michel, Lukasiewcz Michael
Centre d'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Paul Brousse, 94804 Villejuif Cedex, France.
Expert Rev Neurother. 2008 Mar;8(3):479-91. doi: 10.1586/14737175.8.3.479.
Cannabis has long been perceived as a drug causing questionable dependence. Only recently has a clinically recognized withdrawal syndrome been described, thus laying the foundations for specific treatment evaluations. Six different pharmacotherapies have been studied in cannabis withdrawal. Of these, only oral tetrahydrocannabinol, and perhaps mirtazapine, have shown some promise in the specific treatment of withdrawal symptoms. In cannabis dependence, rimonabant, and perhaps buspiron, have shown promising results. Clinical trials of oral tetrahydrocannabinol were less convincing. Cognitive and behavioral therapies and motivational enhancement therapies have proven their efficacy in several randomized controlled trials. Brief therapies have also been associated with good compliance and efficacy. Combinations with voucher incentives in certain populations have been associated with improved treatment compliance and reduced cannabis use. Only two studies have analyzed the cost-efficacy of psychotherapies. It would seem that brief combined cognitive and behavioral therapies, and motivational enhancement therapies are the most cost effective. For the moment, it is uncertain whether the additional treatment costs associated with voucher incentives are proportional to the accrued abstinence duration.
长期以来，大麻一直被视为一种会导致可疑成瘾性的毒品。直到最近才描述了一种临床上公认的戒断综合征，从而为具体的治疗评估奠定了基础。已经对六种不同的药物疗法进行了大麻戒断方面的研究。其中，只有口服四氢大麻酚，或许还有米氮平，在戒断症状的具体治疗中显示出了一些希望。在大麻成瘾方面，利莫那班，或许还有丁螺环酮，已显示出有前景的结果。口服四氢大麻酚的临床试验说服力较弱。认知行为疗法和动机增强疗法在多项随机对照试验中已证明了它们的疗效。简短疗法也与良好的依从性和疗效相关。在某些人群中与代金券激励措施相结合已与改善治疗依从性和减少大麻使用相关。只有两项研究分析了心理疗法的成本效益。似乎简短的认知行为联合疗法和动机增强疗法是最具成本效益的。目前，与代金券激励措施相关的额外治疗成本是否与累积的戒断持续时间成比例尚不确定。
