Remission/Recovery from Cannabis Use Disorders: Update
In my blog of January 29, 2016, I reviewed recent research on remission and recovery from cannabis use disorders in the United States. I outlined the dependency-producing properties of cannabis and the nature and prevalence of cannabis dependence (1.6% of the U.S. general population and 18% of people entering addiction treatment in the U.S.). At that time, data on remission/recovery from cannabis use disorders (CUD) revealed six key findings:
- Full remission from cannabis-related problems is possible and probable (67-90% rates in short-term and lifetime rates).
- CUD remission rates are similar for men and women, but women experience a more rapid onset and stabilization of remission than men.
- Remission takes time—an average of 32.5 months from CUD onset to one year of remission.
- CUD remission styles vary, with some people with CUDs achieving remission through deceleration of the frequency and intensity of cannabis use rather than through total abstinence.
- Abstinence styles of CUD remission are more likely to produce greater enhancements in global functioning than non-abstinent remission patterns.
- CUD remission can be fragile during its early stages but strengthens over time, suggesting the need for assertive and continuous management, particularly during the first months and years of remission.
A recently published study by John Kelly, Claire Greene, and Brandon Bergman offers significant new insights into recovery from cannabis use problems. Their U.S. population survey suggests that approximately 2.5 million Americans once experienced but no longer experience cannabis-related problems. In comparing recovery from cannabis-related problems to recovery from alcohol and other drug problems, Kelly and colleagues noted that people recovering from cannabis-related problems are more likely to report 1) earlier age of onset of drug use, 2) earlier experience of drug-related problems, 3) multiple drug use and related problems, 4) earlier age of achieved remission, 5) greater likelihood of achieving remission without the aid of formal treatment (with a recent trend towards use of outpatient treatment), and 5) lower rates of recent mutual aid group attendance.
Two implications of the Kelly study are noteworthy. First, the early age of CUD onset and potential for earlier problem resolution reinforces the need for the availability of three evidence-based, cannabis-focused interventions within local communities: youth-focused primary prevention programs, early intervention programs (e.g., student assistance programs), and youth-oriented treatment and recovery support resources (e.g., youth-focused recovery coaching, recovery support programs within educational settings).
Second, additional research needs to explore the lower representation of people experiencing CUDs in addiction treatment and recovery mutual aid groups. Hasin and colleagues found in a 2016 study that only 13.2% of people who experience a CUD ever participate in professional treatment or a recovery mutual aid group. While some would suggest this reflects the lower severity of problems related to CUDs, it also reflects treatment and recovery support models drawn from and focused primarily upon experiences linked to alcohol, opioid, and stimulant addiction that, as a result, attract and retain fewer people experiencing cannabis-related problems. This would suggest the need for treatment and recovery support methods and materials that specifically address the experiences and needs of people experiencing cannabis-related problems.
The increased legalization and licit commercialization of cannabis will predictably result in a portion—estimated at 30% of current users (Hasin et al, 2015) and 10% of lifetime cannabis users (CDC, 2018)—who develop life-impacting problems related to their use of this drug. If states move towards this change in drug policy, as it appears they are, and reap the financial rewards from cannabis legalization, then these same states should also bear a level of responsibility for the unintended casualties of this policy change. Put simply, a portion of all state revenues generated from cannabis sales should be devoted to funding of cannabis-focused prevention, early intervention, treatment, and recovery support services.
Hasin, D. S., Saha, T. D., Kerridge, B. T., Goldstein, R. B., Chou, S. P., Zhang, H., Jung, J., Pickering, R. P., Ruan, N. J., Smith, S. M., Huang, B., & Grant, B. F. (2015). Prevalence of marijuana use disorders in the United States between 2001 and 2002 and 2012–2013. JAMA Psychiatry, 72(12), 1235–1242.
Hasin, D. S., Kerridge, B. T., Saha, T. D., Huang, B., Pickering, R., Smith, S. M., Smith, S. M., Jung, J., Zhang, H., & Grant, B. F. (2016). Prevalence and correlates of DSM-5 cannabis use disorder, 2012–2013: Findings from the national epidemiologic survey on alcohol and related conditions-III. American Journal of Psychiatry, 173(6), 588–599.
Kelly, J. F., Greene, M. C., & Bergman, B. G. (2018). Is recovery from cannabis use problems different from alcohol and other drugs? Results from a national probability-based sample of the United States adult population. International Journal of Drug Policy, 53, 55-64.
Lopez-Quintero, C., Pérez de los Cobos, J., Hasin, D. S., Okuda, M., Wang, S., Grant, B.F., & Blanco, C. (2011) Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug & Alcohol Dependence, 115(1-2), p. 120-30.
Centers for Disease Control and Prevention. Marijuana and Public Health. Accessed August 3, 2018.