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

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. 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. 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.