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09-05-2024

Mechanisms of Behavior Change for Functional Improvements in Cannabis Use Disorder Treatments: Current Science and Future Outlook

Authors: Bryant M. Stone, Brian J. Sherman

Published in: Current Addiction Reports | Issue 4/2024

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Abstract

Purpose of Review

The rising prevalence of cannabis use disorder (CUD) has prompted an urgent need for effective behavioral treatments to reduce the global public health burden. However, the chances of achieving lifetime abstinence or symptom remission remain low. To address this limitation, we delineated the current research on mechanisms of behavior change (MOBC) for functional impairments in CUD treatments, including new developments, preliminary evidence, and theoretical considerations for unstudied MOBCs.

Recent Findings

MOBC studies were sparse, and intervention studies produced modest, inconsistent improvements to functional impairment. Three well-studied MOBCs appear in the literature: a) contingency-incentivized prolonged abstinence, which produced the largest effects; b) motivational enhancement, which is the most popular and disseminated; and c) coping skills, which produced the most consistent effects. Preliminary work supported cannabis use reductions and behavioral economics as MOBCs, and theoretical considerations support the potential of reducing cue-induced cravings and promoting positive constructs to improve functioning.

Summary

MOBCs for functional impairment in CUD treatments is an emerging area of research. Hypotheses are abundant, but direct evidence is sparse; several significant questions remain. Evidence-based preventive measures, harm reduction strategies, and CUD treatments may become more pertinent in the immediate future, so this area of study is crucial to address the public health consequences of CUD.
Footnotes
1
Improvements in functional impairment may also indirectly result in improvements in symptoms surrounding cannabis use, though, the remission of use problems is not necessary for functional improvements in CUD treatments as shown in these recent studies [1113].
 
2
Decreasing cannabis consumption doesn't always translate to the complete remission of symptoms related to its excessive and prolonged use. For individuals who consume cannabis in exceptionally high quantities, a decrease in usage can lead to functional betterment, although it might not result in the remission of their excessive and prolonged use symptom.
 
3
Mechanism studies for CUD treatment are sparse and limited compared to intervention studies and randomized control trials. We reviewed the evidence for MOBCs for functional impairment and their accompanying treatments to provide a more comprehensive literature review. We noted inconsistent evidence when MOBC deviated from their predominant treatment.
 
4
Note that researchers mention self-efficacy frequently as a potential MOBC for functional improvements for CUD. We omitted a discussion of self-efficacy because of very limited studies, poor characterization (i.e., it may be a part of motivational enhancement, a coping skill, or an outcome), and questionable utility as a MOBC. Although a noteworthy consideration for future research, the promise and trajectory of self-efficacy as a MOBC remains limited.
 
5
Rewards refers to positive emotions and pleasurable sensations from behaviors such as feeling happy while eating or excitement after skydiving, mostly associated with dopamine (wanting) and serotonin (liking; [101]).
 
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Metadata
Title
Mechanisms of Behavior Change for Functional Improvements in Cannabis Use Disorder Treatments: Current Science and Future Outlook
Authors
Bryant M. Stone
Brian J. Sherman
Publication date
09-05-2024
Publisher
Springer International Publishing
Published in
Current Addiction Reports / Issue 4/2024
Electronic ISSN: 2196-2952
DOI
https://doi.org/10.1007/s40429-024-00578-8

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