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Cannabis Dependence
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Book description

Cannabis dependence is controversial. Does it occur or is it a myth put forth by those who oppose legalisation? What are the signs of cannabis dependence? How many people are affected? What are the health and behavioural risks of becoming cannabis-dependent? What counselling approaches have been tested with adults and adolescents, and how effective are they? What are the arguments for legalisation, regulation or prohibition? Looking back and toward the future, what do we know and what do we need to learn? This state-of-the-science review sets out to answer all those questions, beginning with an historical examination and moving into diagnosis, classification, epidemiology, public health, policy, issues relating to regulation and prohibition, and evidence-based interventions.


Review of the hardback:'Overall, this book is useful as a pioneering guide to understanding cannabis dependence in order to inform and implement topical prevention strategies, interventions, and policies. It is very comprehensive, and, also aims to dispel certain common myths regarding cannabis. As a review of the fresh research it could also prove valuable as a potential springboard for other researchers wishing to explore this area further.'

Source: Journal of Mental Health

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  • 1 - Themes in the History of Cannabis Dependence
    pp 3-20
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    This chapter examines the history of cannabis dependence, particularly emphasizing key themes that have contributed to how cannabis dependence has been perceived by the general public, by the scientific community, and by policy-makers. Variations in cannabis plant species, preparations, and methods of administration result in a wide range of behavioral effects associated with the regular use of this drug. Vivid and evocative imagery, often conveyed in popular literature and the media, has been among the key contributors to the public's perceptions of cannabis, its dependence liability, and the consequences of becoming dependent. In the mid-1800s, a group of French writers and artists, referring to themselves as Le Club des Hachichins, met monthly in Paris, experimented with an eaten cannabis concoction, and mused about its effects on their creative imaginations. Formal boards of inquiry have been established periodically in order to summarize existing knowledge concerning cannabis.
  • 2 - The Diagnosis of Cannabis Dependence
    pp 21-36
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    This chapter considers the classification and diagnosis of cannabis dependence from several perspectives. It reviews the scientific evidence for the cannabis dependence syndrome, its etiology, course and natural history. The main elements of drug dependence are psychological symptoms, physiological signs and behavioral symptoms. Many patients with a history of drug dependence experience rapid reinstatement of the features of the syndrome following resumption of substance use after a period of abstinence. The chapter describes the classification of cannabis dependence within the two standard nomenclatures used both in the USA and worldwide. The first is the WHO International Classification of Diseases (ICD). The second is the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA). The purpose of diagnosis is to provide the clinician with a logical basis for planning treatment and estimating prognosis. Diagnosis also may serve a variety of administrative, statistical and scientific purposes.
  • 3 - Understanding the Pharmacology and Physiology of Cannabis Dependence
    pp 37-57
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    This chapter summarizes several important advances of the actions of cannabis and its interaction with an endogenous cannabinoid system. The subsequent discovery of cannabinoid binding sites and the cloning of two cannabinoid receptor subtypes provide definitive support for the existence of cannabinoid receptors. The existence of an endocannabinoid system in the central nervous system has gained general acceptance as a result of the discovery of both endogenous cannabinoids and cannabinoid receptors. More recently, chronic marijuana use has been associated with an increased risk of cannabis dependence. Studies of drug self-administration in animals have proved valuable in elucidating the mechanisms of action underlying drug-reinforced behavior as well as predicting the abuse liability of new drugs. Evidence is also beginning to emerge suggesting that opioid receptors may play a modulatory role on cannabinoid dependence.
  • 4 - The Epidemiology of Cannabis Dependence
    pp 58-105
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    This chapter describes selected features of cannabis epidemiology, with a focus upon recent evidence from field studies of cannabis dependence. Recent epidemiological evidence from the USA speaks to the question of how many individuals might need clinical services early in the cannabis dependence process. Among the 14 million current users, roughly 1.6-2.3 million users qualified as a recently active Diagnostic and Statistical Manual, (DSM-IV) cannabis dependence case according to the National Survey field assessment methods and DSM-IV diagnostic algorithm. Research on early-onset drug use and later increased risk of drug problems has encompassed investigations into early-onset cannabis use as a suspected determinant of later increased risk of cannabis dependence. Differences between cannabis users and non-users also complicate other inquiries into the health and social consequences of cannabis involvement. To date, epidemiology's contribution to research on prevention, intervention, amelioration, and control of cannabis dependence has been indirect.
  • 5 - The Adverse Health and Psychological Consequences of Cannabis Dependence
    pp 106-128
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    This chapter summarizes the most probable adverse health effects that cannabis-dependent persons are at increased risk of experiencing. A major difficulty in appraising the adverse health effects of chronic cannabis use is a dearth of good epidemiological evidence on the long-term health consequences of cannabis use. Cannabis exerts its most prominent effects on the central nervous system where it acts on an endogenous cannabinoid system that is involved in regulating mood, emotion, memory, attention, and other cognitive functions. The findings from both human and animal research suggest that prolonged use of cannabis alters the functioning of the brain's cannabinoid system but that this does not translate to serious impairment. The most consistent physiological effect of cannabis in humans and animals is to increase heart rate. This change parallels the experienced "high" and is related to amount of tetrahydrocannabinol (THC) in the blood.
  • 6 - Cognitive-Behavioral and Motivational Enhancement Treatments for Cannabis Dependence
    pp 131-153
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    Cognitive-behavioral (CBT) and motivational enhancement treatments (MET) are two of the most researched and most empirically supported approaches to the treatment of alcohol and drug use disorders. MET is based on motivational interviewing (MI), an empathic, reflective therapeutic style designed to resolve ambivalence and develop self-motivation for change. CBT targets the functional role that drug use plays in the individual's life. Clients learn to identify the antecedent feelings, thoughts, and situations that precipitate use, and then are helped to generate and master alternate responses. Both group and individual CBT interventions have been found to be efficacious with cannabis-dependent adults, as well as with other drug-dependent populations. For the most part, MET and CBT treatments have been adapted and applied to cannabis-dependent adults in the same way they have been used with alcohol and other drug problems.
  • 7 - Contingency-Management Interventions for Cannabis Dependence
    pp 154-176
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    Contingency management (CM) interventions represent one treatment approach that has great potential to effectively motivate and facilitate change in this challenging clinical population. CM interventions are based on extensive basic-science and clinical-research evidence demonstrating that drug use and abuse are heavily influenced by learning and conditioning and are quite sensitive to systematically applied environmental consequences. Behavioral-analytic theory and the empirical literature on behavior change in general suggests that the efficacy of CM interventions is influenced by the schedule used to deliver consequences the magnitude of the consequence, the choice of the target behavior, the selection of the type of consequence, and the monitoring of the target behavior. The chapter uses examples from cannabis CM program to describe these basic principles and illustrate their application. Almost half of those seeking treatment for marijuana abuse have criminal justice involvement and are referred to treatment by the legal system.
  • 8 - The Marijuana Check-Up
    pp 177-203
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    This chapter describes the Marijuana Check-Up (MCU), a low-cost and low-demand intervention designed to attract adult marijuana users who are experiencing some negative consequences but who are not necessarily committed to change. The Drinkers' Check-Up (DCU) provided a model for the MCU, but adapting it for marijuana users required considerations on how to promote or market it, the nature of the assessment data and its presentation in the personal feedback report (PFR), and therapeutic issues unique to marijuana. The chapter reviews these issues and describes the decisions made in constructing the initial version of the MCU. Therapists were trained to use motivational interviewing techniques as the PFR was reviewed with the client. Offering a MCU raises several clinical issues that are relatively specific to marijuana-focused interventions and a potential ethical dilemma related to "check-up" studies in general.
  • 9 - Guided Self-Change: A Brief Motivational Intervention for Cannabis Abuse
    pp 204-224
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    This chapter describes the guided self-change (GSC) treatment as applied to cannabis users. The brief motivational nature of this intervention may be particularly appropriate for cannabis users who approach treatment with less severe problems and ambivalence about reducing use, and who may be reluctant to accept a goal of complete abstinence from marijuana use. Important influence on the development of the GSC treatment was the purported efficacy of brief treatments for alcohol problems, especially less severe problems. In order to evaluate the efficacy of the GSC approach with cannabis users, the chapter uses data from a randomized controlled trial comparing an individual and group format of GSC treatment. The fact that the majority of cannabis abusers in the GSC trial chose a reduced use goal suggests that a harm reduction approach might be a good way to involve cannabis abusers in treatment.
  • 10 - Supportive–Expressive Psychotherapy for Cannabis Dependence
    pp 225-244
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    The goal of supportive-expressive (SE) psychotherapy is to help the client achieve mastery over their difficulties, gain self-understanding, and practice self-control over habitual drug use and related problems. The theory behind the SE approach emphasizes the formative influence of life experiences on the development of personality and on the genesis of problems, including habitual cannabis use. Cannabis users' most frequently reported psychological problems concerned feelings of insecurity, low self-image, extreme introversion, depression, and relationship problems. This chapter illustrates some of the SE psychotherapy processes, and how they lead to positive change. As interpersonal, social, intimacy, and work difficulties are often reported by cannabis users, SE dynamic psychotherapy approach may be particularly salient as it focuses not only on drug use, but also on the relationship between use and interpersonal problems. To date, evidence in the psychotherapy field suggests that longer treatment leads to better outcomes.
  • 11 - The Cannabis Youth Treatment Study: The Treatment Models and Preliminary Findings
    pp 247-274
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    This chapter outlines the clinical approaches tested and preliminary findings from the Cannabis Youth Treatment (CYT) study. The purpose of CYT was to test the clinical and cost-effectiveness of a variety of interventions targeted at reducing or eliminating marijuana use and associated problems in adolescents. Family support network (FSN) was designed as an adjunct to the 12-week motivational enhancement therapy/cognitive behavioral therapy-12 (MET/CBT12). FSN is based on the belief that a single treatment modality, possibly regardless of duration, is neither intensive nor comprehensive enough to reduce a persistent and multifaceted problem such as adolescent substance use disorders. Adolescent community reinforcement approach (ACRA) therapists help adolescents recognize that their drug use is incompatible with other short- or long-term reinforcers. The theoretical bases of multidimensional family therapy (MDFT) reside in several areas. Individual, family, social, and environmental risk and protective factors are considered as contributing to or buffering against substance use.
  • 12 - The Teen Cannabis Check-Up: Exploring Strategies for Reaching Young Cannabis Users
    pp 275-296
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    This chapter describes a motivational enhancement therapy (MET) intervention tailored to reach young people who use cannabis. MET intervention also motivates young people to voluntarily participate in a confidential assessment and evaluation of the impact of cannabis on their lives, and offer support to those who wish to quit or reduce use. A general trend toward increased cannabis use for much of the 1990s was particularly marked among teenagers, possibly due to its ready availability and declining perceptions of risk. Developmental tasks of adolescence include increasing psychological autonomy, expanding social roles, development of the capacity for intimacy, and the formation of value systems and life goals. The Teen Cannabis Check-Up is a two-session assessment and feedback intervention developed to reach cannabis users who are neither self-initiating change nor seeking treatment. The chapter describes the variations of cannabis check-up interventions tailored for adolescents and common issues in implementing the check-up approach.
  • 13 - Engaging Young Probation-Referred Marijuana-Abusing Individuals in Treatment
    pp 297-312
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    This chapter describes the rationale for and results from a preliminary study of the efficacy of strategies to engage probation-referred marijuana-abusing young adults in substance abuse treatment. Frequent marijuana use in young adults is associated with greater delinquency and involvement with the legal system, and early involvement with the legal system is a predictor of further problematic substance use and legal involvement. One factor that may be related to the paucity of efficacy data on motivational enhancement therapy (MET) with drug abusers is the complexity of the issues around implementing this approach with comparatively severe, treatment-seeking drug users. A notable recent finding in the drug abuse field is the effectiveness of the contingency management (CM) approach. In MET, the therapeutic stance is one in which empathy is expressed, resistance and argumentation are avoided, and self-efficacy is supported.
  • 14 - The Policy Implications of Cannabis Dependence
    pp 315-340
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    This chapter summarizes the key features of cannabis dependence, and briefly discusses why dependence requires a policy response. It then explores the various ways in which the public health system may respond to cannabis dependence. A major development in responding to alcohol dependence and alcohol-related health problems has been the adoption of a public health perspective on alcohol use. The prohibition on the recreational use, cultivation, and sale of cannabis is primarily aimed at preventing young people from using cannabis. Public education campaigns can be used to inform drinkers about the risks of alcohol use. Adolescents are a priority group for research into treatment of cannabis dependence. The existence of cannabis dependence is a contested issued in the cannabis policy debate in the USA. The existence of cannabis dependence complicates the political task of those who want to decriminalize or legalize cannabis use.
  • 15 - The Nature, Consequences and Treatment of Cannabis Dependence: Implications for Future Research and Policy
    pp 343-356
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    The phenomenon of cannabis dependence has been a topic of interest and varying levels of concern for well over 100 years. Cannabis's acute effects on attention, reaction time, and motor coordination predict impairment of driving and increased risk for accidents. The frequent coincidence of cannabis and alcohol use, a known contributor to motor vehicle accidents, has made it difficult to directly identify a causal link for cannabis. More recent research has found cannabis to independently increase risk for accidents. The reductions in cannabis use resulting from treatment were often substantial and accompanied by equally large decrements in self-reported problems. Systematic evaluation of treatment for adolescent cannabis users is in its early stages. Education about the risks of cannabis dependence should be part of any policy because it may deter initiation or escalation of use that could lead to dependence.


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