A Brief Cannabis Cessation Protocol to Increase Patient Motivation

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SPECIAL REPORT: ADVANCES IN PSYCHIATRY

Cannabis is the most widely used illicit drug. Approximately 19.5% of users develop cannabis use disorder (CUD), which, as of 2021, equates to approximately 16.3 million individuals. Unfortunately, few of those seeking treatment for CUD can achieve a substantial reduction or abstain from cannabis use. Furthermore, cannabis withdrawal syndrome impacts approximately half of those who use it regularly.

In “Motivational Enhancement and Cannabis Use: Implementing a Brief Cannabis Cessation Protocol,” one of the initial sessions of the 2024 APA Annual Meeting, the presenters sought to help attendees identify barriers to improvement, engagement, and change in CUD, as well as share their brief cannabis cessation protocol to increase patient motivation for change.

“Our hope is that we can give everyone here concrete tools to use when they treat patients with CUD,” said copresenter Aimee Chiligiris, PsyD, an instructor in clinical psychology (in psychiatry) at Columbia University Medical Center in New York, New York.

The presenters reviewed the numerous current pharmacotherapy options under investigation for this disorder, some meant to specifically target withdrawal symptoms.

“There are no FDA-approved medications for CUD, and there have been a couple of challenges in looking at medications to treat [patients with] CUD,” said Elizabeth A. Evans, MD, an assistant professor of psychiatry at Columbia University Medical Center. “Additionally, the marijuana today is not the marijuana of 10 or 20 years ago. There’s much higher potency.”

Agents under investigation include bupropion, nefazodone, atomoxetine, venlafaxine ER, mirtazapine, buspirone, escitalopram, cannabidiol, N-acetylcysteine, lithium, quetiapine, oxytocin, fatty-acid amyl hydroxylase inhibitor, naltrexone, dronabinol, dronabinol/lofexidine, nabilone, and nabiximols.

Pharmacotherapy works best when used with motivational interviewing. The presenters suggested using 2 motivational interviewing models: PACE and OARS.

P: Partnership

A: Acceptance

C: Collaboration

E: Evocation

O: Open-ended questions

A: Affirmations

R: Reflections

S: Summary statements

“We seek to understand the person’s perspectives and experiences. Change is hard and it takes courage. We must respect a person’s right to make informed choices about changing—or not changing—their behavior,” Chiligiris said.

The cannabis cessation protocol steps can be found in Table 1.

Table 1. The 6 Steps of the Cannabis Cessation Protocol

“We are continuing to collect data to understand how this protocol impacts folks that receive it,” explained Samantha Lookatch, PhD, an assistant professor in medical psychology (in psychiatry) at Columbia University Medical Center, the final copresenter.

“Our preliminary findings do show that there is an increased length of treatment for individuals who have received this protocol. The longer people are in treatment, the more likely they are to reap benefits of it.”

The purposes of their cannabis cessation protocol can be found in Table 2.

Table 2. Purposes of the Cannabis Cessation Protocol

“We want them to feel comfortable that they can come in and know they are going to be heard,” Lookatch said. “They are going to be validated in the difficult work they must do to minimize further abuse and recommit to their goals for change.”