CBT for cannabis use disorder: how cognitive behavioural therapy can help
23rd September 2024 / Written by Harbor London
In clinical circles, there exists a general consensus that cognitive behavioural therapy (CBT) is one of the most effective treatments for cannabis use disorder (CUD); indeed, one report 1 found that “[since] it is accepted that cannabis use is a learned behaviour, [then] achievement of abstinence is also a learning process.”
In UK adults aged 16-59 years old, cannabis is the most widely-used illicit drug, with 7.6% of the demographic reporting cannabis use in 2023 2. Although cannabis is often perceived as a ‘less harmful’ substance in comparison to other drugs, long-term use can become problematic and develop into dependency; affecting both mental and physical health. One condition that often presents is CUD.
In the following article, we’ll explore cannabis use disorder, and the various ways CBT can help those struggling with the condition to overcome it.
Learn more about how CBT can help individuals with CUD.
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What is cannabis use disorder?
CUD is characterised by a continuous and problematic pattern of cannabis use that negatively affects an individual’s everyday functioning and/or causes distress. A 2016 WHO report 3 concluded that the prevalence of CUD is high enough to warrant its classification as a public health problem (at least, in higher-income nations), and that its prevalence appears to have increased significantly since 2000.
According to The Diagnostic and Statistical Manual of Mental Disorders 4 (DSM-V), CUD is defined as “the presence of clinically significant impairment or distress in 12 months, manifested by at least 2 of the following:
- Cannabis is taken in larger amounts or used over a longer period than intended
- Persistent desire to cut down with unsuccessful attempts
- Excessive time spent acquiring cannabis, using cannabis, or recovering from its effects
- Cravings for cannabis use
- Recurrent use resulting in neglect of social obligations
- Continued use despite social or interpersonal problems
- Important social, occupational, or recreational activities foregone to be able to use cannabis
- Continued use despite physical harm
- Continued use despite physical or psychological problems associated with cannabis use
- [Increased] tolerance
- Withdrawal symptoms when not using cannabis.”
Typically, CUD develops as a consequence of prolonged or excessive use of cannabis, where users find it increasingly difficult to control their consumption – despite experiencing negative consequences in various aspects of their lives. Anecdotal evidence often points to damage to the working memory, as well as the exacerbation of comorbid conditions 5 (such as anxiety, depression, and psychosis), which invariably lead to a negative impact on work, relationships, and everyday functioning.
In this field, the number of clinical studies are growing rapidly; that said, even today, most researchers agree 6 that “heavy and dependent cannabis use is consistently associated with a high prevalence of comorbid psychiatric disorders and learning and memory impairments.”
Increasingly, further evidence is coming to light suggesting a probable impact of cannabis use disorder on mental health. For instance, one report 7 found an “increased risk of psychotic and nonpsychotic bipolar disorder and unipolar depression”, “schizophrenia, anxiety disorders, and personality disorders”.
Interestingly, the study also suggests that the link between CUD and mental health disorders goes both ways – in that individuals who already experienced a relevant condition (such as depression, schizophrenia, or BPD) were more likely to develop CUD than those who did not.
An introduction to cognitive behavioural therapy (CBT)
In short, cognitive behavioural therapy (CBT) is a type of talking therapy that focuses on the relationship between thoughts, feelings, and behaviours.
Developed in the 1960s by psychiatrist Aaron Beck, CBT 8 is based on the theory that our thoughts significantly influence our emotions and behaviours, and by altering these thought patterns, we can change our behaviours and emotional responses.
CBT is a structured, goal-oriented therapy that is typically shorter-term, rendering it a more accessible option for many. It involves identifying and challenging negative thought patterns and replacing them with healthier, more constructive ways of thinking.
“CBT is based on the theory that the way individuals perceive a situation is more closely connected to their reaction than the situation itself. Individuals’ perceptions are often distorted and unhelpful, particularly when they are distressed.
Cognitive Behavior Therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioural changes.” 8 |
That aspect of behavioural intervention is a key note. CBT encourages individuals to engage in activities that promote wellbeing and reduce reliance on harmful behaviours – which may include substance use.
For those experiencing the challenges associated with cannabis use disorders, CBT offers a practical, effective therapeutic approach. It can dramatically enhance the addiction rehabilitation process by helping clients obtain and maintain more control over their behaviours.
How CBT for cannabis use disorder works
CBT can be particularly effective in treating cannabis use disorder 9 since its effectiveness lies in addressing the underlying cognitive and behavioural patterns that can often drive the use of the substance.
By focusing on both cognition, as well as behaviour, individuals can develop the skills and strategies needed to manage impulses, avoid triggers and, ultimately, reduce or eliminate their cannabis use.
Understanding thought patterns
A foundational element of CBT lies in helping individuals recognise and understand the thought patterns that drive their cannabis use. For instance, clinicians might find that clients dealing with CUD have ingrained beliefs or automatic thoughts that justify cannabis misuse: ‘marijuana helps me decompress and relax.’ ‘I can’t handle stress without smoking.’
Over time and left unchecked, these thoughts can become deeply entrenched; leading to a cycle of dependence. CBT works by identifying these cognitive distortions (unhelpful thought styles) 10 and challenging their validity.
On the topic of CBT’s effectiveness in dealing with CUD, research 1 concludes that “cognitive restructuring includes modifying unrealistic expectancies, changing maladaptive beliefs about effects of cannabis and enhancing motivations toward sobriety.”
Cognitive behavioural interventions
In addition to addressing unhelpful thought patterns, CBT also incorporates cognitive behavioural interventions 11 that are crucial for overcoming cannabis use disorder. These strategies can help individuals harness the power that inner speech (or self-talk) can have on behaviour.
Guven’s seminal research on the topic, Cognitive Behavioral Therapy in Cannabis Use Disorder 1 – which we’ve cited on several occasions here – summarises: “[in CBT for CUD], behavioural methods focus on interrupting the compulsive cannabis use, and rewarding successful attempts [at healthier behaviours].”
For example, a client may work with a therapist to identify the triggers that lead to cannabis misuse – such as social situations involving alcohol, stress, or boredom.
Once these triggers are recognised, CBT can help that individual develop strategies to avoid them, or to cope with them in healthier, more productive ways. This might include investing time in learning relaxation techniques, reading, developing a new exercise routine, or finding new hobbies and interests that provide a sense of fulfilment.
Key CBT techniques for managing cannabis use
Several of the techniques used in CBT can be particularly effective in managing cannabis use disorder by helping individuals change their thinking patterns, modify their behaviours, and build a strong foundation for long-term recovery.
Cognitive restructuring
Cognitive restructuring 12, also known as cognitive reframing, is a CBT technique that involves identifying and challenging negative or distorted thought patterns. For individuals with cannabis use disorder, cognitive restructuring can be particularly powerful in breaking down the beliefs that perpetuate substance use.
During this process, a therapist might work with a client to examine their thoughts about cannabis use, such as, ‘I need cannabis to have fun,’ or, ‘I can’t cope without it.’ They’d then help the individual evaluate the accuracy of these thoughts by finding evidence for and against this belief, which opens the door to considering alternative perspectives.
Indeed, one report 13 found that cognitive restructuring (alongside “self-monitoring, […] cost-benefit analysis, role playing, and modelling”) is a powerful method of encouraging an individual to “pursue alternative prosocial behaviours.”
By breaking down cognitive distortions, individuals begin to see cannabis use in a new light, developing a stronger desire for change. Cognitive restructuring empowers those dealing with CUD to take control of their unhelpful thoughts, minimising the power that cannabis holds over their life and increasing confidence in their ability to quit.
Behavioural activation
Behavioural activation 14 is another salient CBT technique used to help treat cannabis use disorder. Grounds for this are well-founded: a meta-analysis substantiated the “promising” and “positive” effects of behavioural activation in treatment of substance use disorders, including cannabis.
In the context of CUD, behavioural activation (or BA) focuses on increasing time spent doing positive, rewarding activities; activities that have no link to an individual’s cannabis use. The goal is to help the individual find new sources of pleasure and fulfilment that do not involve cannabis, thereby reducing their reliance on the drug.
For example, therapists might encourage a client to participate in activities that they used to enjoy before their cannabis use became problematic: exercise, hobbies, or spending time with loved ones, for instance. By reintroducing these positive activities into their life, individuals create a more balanced and satisfying lifestyle that is conducive to their recovery.
In addition, behavioural activation helps to break the cycle of negative emotions and substance use.
Often, people with CUD may turn to cannabis to help them cope with feelings of depression, anxiety, or boredom (Feingold, 2021) 16. By engaging in rewarding, more fulfilling activities, they improve their mood and overall wellbeing, thereby reducing the urge to use cannabis as a crutch.
Combining CBT with other treatments for cannabis use disorder
Even deployed as a standalone treatment, CBT can prove an incredibly powerful method of treating CUD, along with a variety of other substance use disorders and mental health conditions.
Combining CBT with other treatments can compound and enhance its effectiveness, providing a more comprehensive, whole-person approach to overcoming cannabis use disorder.
Medication-assisted treatment
Although there are currently no medications specifically approved for the treatment of cannabis use disorder, some individuals may benefit from medication-assisted treatment (MAT) 17. This treatment style uses medication alongside psychological and social support to address co-occurring conditions, such as anxiety or depression, which can complicate CUD recovery.
Though the report is primarily aimed at US clinicians, it may be useful to take note of findings from the Psychiatric Times 18: “No FDA-approved medications are available for CUD, but some studies show potential […] in mitigating withdrawal and maintaining abstinence.”
The report goes on to state that “behavioural interventions are the current mainstay of evidence-based treatment.”
Support groups
Outside of therapeutic interventions, many support groups and organisations provide valuable assistance for individuals struggling with cannabis use disorder in the UK, including:
- Marijuana Anonymous 19 is a fellowship that shares experiences, problems and advice with others recovering from cannabis addiction.
- FRANK 20 offers a helpline and chat service, directing individuals to local support groups and treatment options.
- Narcotics Anonymous (UKNA) 21 is an organisation run by recovering drug addicts offering support groups and a hotline to help individuals avoid drug misuse.
- Turning Point 22 can help individuals find a nearby support group.
CBT and CUD: the bottom line
Ultimately, CBT often represents a highly effective treatment for cannabis use disorder, as testified by the studies and research we’ve cited in this article – offering individuals the tools to understand and change the thoughts and behaviours that perpetuate their cannabis use.
In particular, by focusing on and committing to cognitive restructuring and behavioural activation, CBT empowers people to break free from the cycle of drug addiction and dependency, and regain control over their lives.
When combined with other treatments – such as medication-assisted therapy, or whole-person lifestyle interventions (eg., nutrition, exercise, and mindfulness) – CBT can form the foundation for a comprehensive, curated approach to recovery; helping individuals build healthier, sustainable habits for enduring sobriety.
Speak to our team today to learn more about CUD treatments available at Harbor London.
References
- https://www.sciencedirect.com/science/article/abs/pii/B9780128007563001277#:~:text=Cognitive%20Behavioral%20Therapy%20(CBT)%20is,is%20also%20a%20learning%20process.
- https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2023
- https://scholar.google.com/scholar_lookup?title=The+Health+and+social+effects+of+nonmedical+cannabis+use&publication_year=2016&
- https://www.ncbi.nlm.nih.gov/books/NBK538131/#:~:text=The%20Diagnostic%20and%20Statistical%20Manual%20of%20Mental%20Disorders%2C%20DSM%E2%80%935,a%20longer%20period%20than%20intended
- https://www.cambridge.org/core/journals/psychological-medicine/article/abs/psychosocial-and-pharmacological-treatments-for-cannabis-use-disorder-and-mental-health-comorbidities-a-narrative-review/42DC4AC75716B6AB115FE1EBA0D1F9C1
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027478/
- https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2804862
- https://beckinstitute.org/about/understanding-cbt/
- https://www.researchgate.net/publication/312410843_Chapter_109_Cognitive_Behavioral_Therapy_in_Cannabis_Use_Disorder
- https://www.psychologytools.com/articles/unhelpful-thinking-styles-cognitive-distortions-in-cbt/
- https://www.sciencedirect.com/topics/psychology/cognitive-behavioral-intervention/
- https://onlinelibrary.wiley.com/doi/pdf/10.1002/9781118528563.wbcbt02
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880536/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461437/
- https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-018-0173-2
- https://pubmed.ncbi.nlm.nih.gov/33332004/
- https://publichealthscotland.scot/our-areas-of-work/health-harming-commodities/substance-use/treatment/medication-assisted-treatment-mat-standards/overview/
- https://www.psychiatrictimes.com/view/current-treatments-for-cannabis-use-disorder
- https://www.ma-uk.org/
- https://www.talktofrank.com/get-help/find-support-near-you
- https://ukna.org/
- https://www.turning-point.co.uk/support-we-offer/drugs-and-alcohol