A Protocol to Assist With Cannabis Use Disorder

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CONFERENCE REPORTER

Cannabis is the most widely used illicit drug. Approximately 19.5% of users develop a cannabis use disorder (CUD), which, as of 2021, equates to about 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 about half of those who use regularly.

Presenters of, “Motivational Enhancement and Cannabis Use: Implementing a Brief Cannabis Cessation Protocol,” one of the starting sessions of the 2024 American Psychiatric Association Annual Meeting, 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.

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 CUD,” said Elizabeth A. Evans, MD, an assistant professor of Psychiatry at the 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 the following: bupropion, nefazodone, atomoxetine, venlafaxine ER, mirtazapine, buspirone, escitalopram, cannabidiol, N-acetylcysteine, lithium, quetiapine, oxyctocin, fatty-acid amyl hydroxylase inhibitor, naltrexone, dronabinol, dronabinol + lofexidine, nabilone, and nabixmols.

Pharmacotherapy works best when used with motivational interviewing. The presenters suggested using 2 possible 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,” said Chiligiris.

The cannabis cessation protocol steps include:

1. Elicit a patient’s motivations for change in cannabis use.
2. Enhance a patient’s motivation by identifying the benefits and harms of unchanged behavior.
3. Determine what barriers to success the patient faces, and cultivate their efficacy with a skill review or psychoeducation.
4. Consider the potential withdrawal symptoms a patients will endure and how best to cope with these concerns.
5. Identify supportive individuals in the patient’s life.
6. Create a brief plan in case the patient restarts cannabis use.

“We are continuing to collect data to understand how this protocol impacts folks that receive it,” said Sam Lookatch, an assistant professor in Medical Psychology (in Psychiatry) at Columbia University Medical Center, the third and 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 purpose of their cannabis cessation protocol is to:

• Deepen the patient’s understanding and motivation for cessation.
• Increase their awareness of coping skills.
• Enhance their belief in their ability to successfully stop cannabis use.

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

Check out all our 2024 APA Annual Meeting coverage here.