Cannabis Dependence


Phillip W. Long, M.D.


Medical Treatment

Basic Principles

Usually adverse effects of marijuana intoxication do not lead to professional attention. There is no adequately documented case of a fatality in a human being. Pure marijuana abuse rarely requires inpatient or pharmacological treatment, and detoxification is not necessary.

Since marijuana may be one of many drugs abused, total abstinence from all psychoactive substances should be the goal of therapy.

Periodic urine testing should be used to monitor abstinence.

Cannabinoids can be detected in the urine up to 21 days after abstinence in chronic abusers due to fat redistribution; however, one to five days is the normal urine positive period. Thus, beginning drug monitoring needs to be interpreted accordingly.

Antianxiety Drugs

Antianxiety drugs are occasionally needed to treat severe cannabis-induced anxiety or panic.

If the patient was using cannabis for anxiety reduction, an antianxiety drug should be considered as substitution therapy.

Antipsychotic Drugs

Antipsychotic drugs are occasionally needed to treat protracted, cannabis-induced psychosis.

Antidepressant Drugs

If the patient was using cannabis for alleviation of depression, an antidepressant should be considered as substitution therapy.

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Psychosocial Treatment

Basic Principles

If a user is to remain drug-free, follow-up treatment, usually with psychiatric help and resort to community resources, is vital.

Life-style changes such as avoiding people, places, and things related to cannabis use should be encouraged.

Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognition of the negative consequences of cannabis abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of support plans.

Drug urine tests should be used to ensure compliance.

Educating patients about the amotivational syndrome and other complications of cannabis abuse may dissuade some from using cannabis. Often the patient does not realize the full extent of his amotivational syndrome until he stops using the drug and notices the improvement.


It is likely that some heavy cannabis users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy.

Psychotherapy is useful when it focuses on the reasons for the patient's drug abuse. The drug abuse itself - past, present, and future consequences - must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial.

In the adolescent, cannabis dependence often hides poor self-esteem, depression, severe family problems, and learning disorders. These issues must be addressed in therapy. Generally, a nonjudgmental, honest, steady, and firm approach is needed with adolescence.

Behavior Therapy

Behavior therapy teaches the cannabis drug user other ways to reduce anxiety. Relaxation training, assertiveness training, self-control skills, and new strategies to master the environment are emphasized.

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Internet Mental Health ( copyright 1995-2011 by Phillip W. Long, M.D.