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Abstract
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Barrier #1: Getting people with CUD into treatment
People with CUD often do not perceive cannabis use as harmful, may perceive or experience health-related benefits from use, and do not associate experienced harms (e.g., worsening mental health symptoms) with cannabis use (Magnan and Ladd, 2019). Addiction is often characterized by ambivalence about change. Given the recent sociopolitical emphasis on the potential benefits of cannabis (which could impact ambivalence), CUD treatment should be as accessible as possible and address perceived ...
Research recommendations: Enhance identification of patients with CUD and improve care uptake
We must re-imagine models of CUD care to shift the onus of connecting to care from the patient to the health system. Thus, research needs to build on recommendations for screening (U.S. Preventive Services Task Force Recommendations, 2020), diagnosis, and care connection. Although, Screening, Brief Intervention, and Referral to Treatment (SBIRT) is recommended, “RT”, in particular, has limited effectiveness because referral typically means providing contact information for treatment programs ...
Barrier #2: Care for CUD is historically limited to specialty clinics - where people don’t want to go
There is limited evidence on efficacy of medication for CUD, although there are some efficacious psychotherapies including cognitive behavioral therapy, motivational enhancement, and abstinence-based contingency management. CUD treatments are predominantly available through specialty addiction clinics, which may be unappealing to patients due to stigma and/or lack of self-identification as having an addiction. We speculate this may be more profound for those with CUD given the perceived ...
Research recommendations: Diversify locations and models of care
CUD care should be appealing and accessible. Although the COVID-19 pandemic saw unprecedented telehealth uptake, telehealth is not a panacea to the problem of access. Research is needed to optimize telehealth approaches particularly because telehealth can potentially address stigma-related barriers to care, allowing patients to be treated in their preferred locations, rather than presenting to a clinic (Chakrabarti, 2015), and also alleviates other barriers (e.g., transportation, childcare) ...
Barrier #3: Available addiction-focused care is mismatched with many patients’ experiences of CUD
Given the low perceived harms and high acceptability of cannabis, approaches to CUD treatment that promote abstinence as the only acceptable goal may not be a good fit. Existing SUD/CUD treatments may not appeal to patients with CUD due to many treatment professionals’ focus on abstinence, which is seldom an initial goal of those with CUD (Paquette et al., 2022, Rosenberg et al., 2020 Jul, Rosenberg and Davis, 2014). Individuals report benefits of and/or reasonable motives for use (e.g., coping ...
Research recommendations: Align CUD care with outcomes that patients care about
Treatments rooted in a harm reduction approach, which can include reduced use and/or enhancing health-promoting behaviors (e.g., physical activity, values-aligned activities) are likely more appealing to those in earlier stages of problem recognition and readiness to change. For example, some evidence supports physical activity interventions to reduce consumption, perhaps because exercise blunts craving (Brellenthin and Koltyn, 2016). We recently led a pilot wherein motivational enhancement ...
Call to action
As scientist-practitioners, we argue that to address the considerable challenge of providing care to reduce the growing disease burden of CUD we need to: (a) prioritize getting people with CUD connected to and engaged in care, (b) provide low-threshold evidence-based models of care outside of stigmatizing SUD clinics, and (c) create and deploy treatments that are appealing, regardless of stage of change, and inclusive of harm reduction goals aligned with principles of holistic recovery (Carlon ...
Language: en |