Marijuana is the most widely used substance of abuse in the world. It has less dependence potential than other major substances of abuse; however, its abuse can be associated with social, cognitive, and other problems, including an increased risk of other substance use. Unfortunately, research into the treatment of marijuana dependence has been limited. This chapter covers what is known about the neurobiology and treatment of marijuana use disorder.

One complication of long-term, heavy, frequent use is the “amotivational syndrome,” which is characterized by the emergence of decreased drive and ambition. Heavy marijuana use is also associated with other socially and occupationally impairing symptoms, including a shortened attention span, poor judgment, easy distractibility, impaired communication skills, introversion, and diminished effectiveness in interpersonal situations. Personal habits may deteriorate, and there may be a loss of insight and even feelings of depersonalization.

There is currently no pharmacotherapy specifically recommended for either marijuana withdrawal or the maintenance of abstinence following marijuana cessation. Bupropion, divalproex, and naltrexone have all been studied in human trials of marijuana withdrawal, but all the trials have had negative results. Dronabinol, a synthetic formulation of THC, has been preliminarily studied for marijuana withdrawal, but current results are not sufficient to recommend its use. Instead, marijuana dependence and any associated withdrawal is usually treated with psychosocial therapies, as shown in Table 7.1. Withdrawal symptoms typically resolve within 1–2 weeks.