Evidence-based Treatment Options in Cannabis Dependency.

BACKGROUND: Now that the consumption of natural and synthetic cannabinoids is becoming more widespread, the specific treatment of cannabis-related disturbances is an increasingly important matter. There are many therapeutic options, and it is not always clear which ones are evidence-based and appropriate for use in a given clinical situation. METHODS: This review is based on reports of pertinent randomized and controlled trials (RCTs) that were retrieved by a selective search in the PubMed and Cochrane databases. RESULTS: Cognitive behavior therapy (CBT) combined with other techniques has been found to have a moderate to large effect (Cohen's d = 0.53-0.9) on the amount of cannabis consumed as well as on the level of psychosocial functioning or the dependence syndrome. Systemic multidimensional family therapy (MDFT) has been found beneficial for younger adolescents who consume large amounts of cannabis and have psychiatric comorbidities. Short-term interventions with motivational talk therapy have been found effective for patients with or without an initial desire to achieve cannabis abstinence. All of these psychotherapeutic interventions are effective at evidence level Ia. The administration of gabapentin had a weak effect (d = 0.26) on the quantity consumed and on abstinence (evidence level Ib). Withdrawal symptoms can be alleviated with cannabinoid-receptor antagonists (d = 0.223 and 0.481) (evidence level Ib). On the other hand, there is evidence that serotonergic antidepressants can worsen withdrawal manifestations and increase the likelihood of relapse. CONCLUSION: Psychotherapeutic techniques remain the foundation of treatment for cannabis dependence. No drug has yet been approved for the treatment of cannabis dependence because of the lack of scientific evidence. The rates of abstinence that are currently achieved, even with psychotherapy, are still only moderate. Further clinical studies are needed for the evaluation of combinations of various treatments that can meet the needs of individual patients.

Implementation fidelity of Multidimensional Family Therapy in an international trial.

Implementation fidelity, a critical aspect of clinical trials research that establishes adequate delivery of the treatment as prescribed in treatment manuals and protocols, is also essential to the successful implementation of effective programs into new practice settings. Although infrequently studied in the drug abuse field, stronger implementation fidelity has been linked to better outcomes in practice but appears to be more difficult to achieve with greater distance from model developers. In the INternational CAnnabis Need for Treatment (INCANT) multi-national randomized clinical trial, investigators tested the effectiveness of Multidimensional Family Therapy (MDFT) in comparison to individual psychotherapy (IP) in Brussels, Berlin, Paris, The Hague, and Geneva with 450 adolescents with a cannabis use disorder and their parents. This study reports on the implementation fidelity of MDFT across these five Western European sites in terms of treatment adherence, dose and program differentiation, and discusses possible implications for international implementation efforts.

[Multidimensional family therapy for adolescent clients with cannabis use disorders--Results and experience from the INCANT pilot study]. / Multidimensionale Familientherapie für cannabis- abhängige Jugendliche--Ergebnisse und Erfahrungen aus der "INCANT"-Pilotstudie.

The INCANT pilot study (International Cannabis Need of Treatment) is based on the Cannabis Action Research Plan from 2003, which followed up on the joint Cannabis Conference with the Ministries of Health from Belgium, France, Germany, the Netherlands, and Switzerland. It was decided to fund a pilot study into the efficacy of Multidimensional Family Therapy (MDFT) in the European context. MDFT has been tested in several U.S.-RCT-studies and is developed by H. Liddle and colleagues at the "Center for Treatment Research on Adolescent Drug Abuse" (CTRADA), University of Miami Medical School. Goal of the INCANT pilot study was to proof the feasibility of a multi-site randomized controlled trial with MDFT in Europe. The results of the INCANT study confirmed the need of treatment for those young clients in the five countries. The implementation of MDFT in the treatment centers seems to be feasible. The plan is now to start the trans-national multi-site trial (from 2006 to 2009) on behalf of the ministry of health of the five countries.