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Cannabis-Related Disorders Follow-up

  • Author: Lawrence Genen, MD, MBA; Chief Editor: David Bienenfeld, MD  more...
 
Updated: Jun 23, 2014
 

Further Outpatient Care

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.

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Further Inpatient Care

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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Inpatient & Outpatient Medications

Overall, a dearth of empirical research has focused on the role of pharmacotherapy in the treatment of cannabis dependence. A double-blinded trial examining the role of nefazodone dosed at 300 mg twice daily and bupropion-SR dosed at 150 mg twice daily demonstrated that neither medication was effective at increasing abstinence or reducing withdrawal symptoms among patients seeking treatment for cannabis dependence.[32]

Currently, no medications have demonstrated effectiveness in the treatment of cannabis dependence or reduction of cannabis withdrawal symptoms. Time remains the best tincture for these patients.

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Deterrence/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 recent 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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Complications

Marijuana use may be complicated by comorbid substance use and medical problems as outlined.

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Prognosis

As with other substance abuse conditions, relapse is common in those meeting criteria for dependence, and treatment may be necessary for multiple episodes.

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Patient Education

See the list below:

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Contributor Information and Disclosures
Author

Lawrence Genen, MD, MBA Board Certified Psychiatrist; Diplomate, American Board of Psychiatry and Neurology; Founder, The Genen Group - A Multi-Specialty Psychiatry and Psychotherapy Practice

Disclosure: Nothing to disclose.

Coauthor(s)

William F Haning, III, MD, FASAM, DFAPA Professor of Psychiatry, Director of Graduate Affairs, Office of the Dean, Program Director, Addiction Psychiatry/Medicine, Department of Psychiatry, University of Hawaii, John A Burns School of Medicine; Principal Investigator and Co-Director, Pacific Addiction Research Center

William F Haning, III, MD, FASAM, DFAPA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Addiction Psychiatry, American Medical Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Military Surgeons of the US, Hawaii Medical Association

Disclosure: Nothing to disclose.

John Franzen, MD Resident Physician, Department of Psychiatry, University of Nebraska-Creighton University

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Additional Contributors

Barry I Liskow, MD Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Robert C Daly, MB, ChB, MPH, BCh; Can M Savasman, MD; Caroline Fisher, MD, PhD; and Lina Cassandra Vawter, MD to the development and writing of this article.

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Cannabis sativa.
The major psychoactive component of marijuana is tetrahydrocannabinol (THC).
 
 
 
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