Psychological aspects of cannabis use disorder: a review of the theory and implications for psychotherapy

Cannabis is the most widely used drug in the world, with 3.8% annual estimated global prevalence. Among regular cannabis users, between 20%-50% may develop cannabis use disorder (CUD), a mental disorder characterized by physical and psychological dependence as well as functional impairments caused by cannabis use. Prior research has identified several demographic, neurological and clinical risk factors for transition from cannabis use to CUD, early age of cannabis use onset, novelty seeking and co-occurring psychiatric disorders. However, little has been written on the psychological factors underlying the onset of CUD. In this presentation, we review current data on the psychological trajectories of pathological cannabis use, focusing on empirical data as well as theoretical-psychodynamic writing.

Evidence point that CUD may be attributed to compulsive attempts to regulate and 'self-medicate' affective distress and to establish and maintain balanced internal and external organization. We suggest that these regulatory functioning may be temporarily effective for cannabis users, yet on the long run they may result in delayed and impaired natural coping mechanisms. Based on these considerations, We propose clinical guidelines for working with individuals suffering from CUD, integrating reflective and non-judgmental approach, aimed at enhancing insight to the harms caused by extensive cannabis use, with action-focused interventions aimed at reducing cannabis-associated harms and acquiring alternative coping strategies.