Policy and practice briefingsResponding to problems associated with cannabis use
Issues
Cannabis use can result in, or exacerbate, a range of physical and mental health, social and economic problems. Problems are more likely to develop if use begins at a young age and develops into regular and long-term use. The primary objectives for health and social responses to address cannabis use and associated problems should therefore include:
- preventing use, or delaying its onset from adolescence until young adulthood;
- preventing the escalation of cannabis use from occasional to regular use;
- reducing harmful modes of use; and
- providing interventions, including treatment, for people whose cannabis use has become problematic
European picture
- Universal prevention is widespread but not always evidence-based. Selective prevention approaches are used in some European countries, most commonly with young offenders or with youth in care institutions, but little is known about their effectiveness. Indicated prevention approaches and brief interventions do not appear to be widely used.
- Many EU countries offer treatment for people with cannabis problems within generic drug treatment programmes, and cannabis-specific treatment is available in half of the countries. Most treatment is provided in community or outpatient settings and increasingly online.
Summary of the available evidence
Interventions to prevent or delay cannabis use
| Response option | Quality of evidence |
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Multicomponent interventions can reduce alcohol and cannabis use when delivered in schools using social influence approaches, correcting normative misperceptions and developing social competences and refusal skills. Programmes that only provide information about the risks of using drugs have not been found to be effective in preventing use. |
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Universal family interventions, such as Familias Unidas, Focus on Kids, Strengthening Families 10–14, may be effective in preventing cannabis use when delivered across multiple settings and domains. |
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Structured computer-based interventions may be effective in preventing cannabis use when delivered in schools or to family groups. |
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Motivational interviewing interventions targeting cannabis use may be effective when delivered in emergency departments or primary care settings. |
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It is unclear if school-based brief interventions can reduce substance use in young people although some information suggests they may possibly have some limited impact on cannabis use. |
Treating problematic cannabis use
| Response option | Quality of evidence |
|---|---|
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Behavioural interventions (e.g. cognitive behavioural therapy, motivational interviewing and contingency management) can reduce use and improve psychosocial functioning in adults and adolescents in the short term. |
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Multidimensional family therapy helps reduce use and keep patients in treatment, especially in high- severity young patients. |
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Web- and computer-based interventions may be effective in reducing cannabis use, at least in the short term, and are a cost-effective way of reaching a large number of cannabis users. |
Key
High quality evidence— one or more up-to-date systematic reviews that include high-quality primary studies with consistent results. The evidence supports the use of the intervention within the context in which it was evaluated.
Moderate quality evidence— one or more up-to-date reviews that include a number of primary studies of at least moderate quality with generally consistent results. The evidence suggests these interventions are likely to be useful in the context in which they have been evaluated but further evaluations are recommended.
Low quality evidence— where there are some high or moderate quality primary studies but no reviews available OR there are reviews giving inconsistent results. The evidence is currently limited, but what there is shows promise. This suggests these interventions may be worth considering, particularly in the context of extending services to address new or unmet needs, but should be evaluated.
Implications for policy and practice
Basics
- Core responses in this area include general prevention approaches aimed at discouraging use or delaying onset, brief interventions for those with minor problems and formal treatment for those with more serious problems.
Opportunities
- More attention should be paid to harm reduction approaches to cannabis use, particularly with respect to the patterns of use and co-use with tobacco.
- Greater use of e-health approaches.
- The new regulatory models for cannabis that are emerging globally can provide valuable information on the pros and cons of different options for regulation and their likely impact on responses to cannabis problems.
Gaps
- There is still a need to develop a better understanding of the nature of cannabis-related disorders and what constitutes the most effective and appropriate treatment options for different clients.
- A better understanding is needed of the types of treatment being received by the increasing numbers of people entering treatment for cannabis use in Europe, in order to ensure that provision is appropriate and efficient.
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