Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK.
Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
Psychol Med. 2021 Feb;51(3):353-364. doi: 10.1017/S0033291720005449. Epub 2021 Feb 4.
Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.
大麻是全球使用最广泛的非法药物，据估计，多达 30%的大麻使用者会出现大麻使用障碍（CUD）。全球几乎每个地区对治疗 CUD 的需求都在增加，而大麻的使用与精神障碍高度共病，持续使用会降低治疗依从性并增加复发风险。在这篇叙述性综述中，我们概述了针对 CUD 的心理社会和药理学治疗策略的证据，包括单独治疗和与精神病、焦虑或抑郁共病时的治疗策略。认知行为疗法、动机增强疗法和强化管理等心理社会治疗目前是治疗 CUD 的最有效策略，但与精神病共病时效果有限。针对内源性大麻素系统的药物治疗有可能减少大麻戒断和 CUD 中的大麻使用。焦虑、抑郁和精神病等精神共病会阻碍有效的治疗，应在治疗提供和临床决策中加以解决，以减轻全球 CUD 负担。抗精神病药物可能会减少 CUD 患者的大麻使用和大麻渴望以及精神病症状。针对 CUD 共病的焦虑和抑郁的靶向治疗是可行的。
