Literatus: CUD treatment updates

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Tuesday, July 15, 2014

“WHEN you can stop you don’t want to, and when you want to stop, you can’t,” described Luke Davies in Candy on how addiction feels like.

It may be surprising, or even unbelievable, but the overall addiction potential for cannabis has been found less than for caffeine, tobacco, alcohol, cocaine or heroin.

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), considers cannabis use disorder (CUD) as a condition requiring treatment.


As of 2012, no medication has proven effective for treating CUD. The US Food and Drug Administration approved no medication for it. Unlike opiate or alcohol dependence, it has far fewer treatment options.

The review of novel medications for CUD, the Balter, Cooper and Haney Review published in Current Addiction Reports (June 2014), noted treatments that had been confirmed ineffective. Norepinephrine, dopamine, and serotonin failed to decrease withdrawal symptoms contrary to expectations as antidepressant, anxiolytic and antipsychotic.

Multiple antidepressants, such as fluoxentine, venlafaxine, and buspirone, also failed to decrease cannabis use.

Atomoxetine showed no significant change in cannabis use. In fact, most patients even experience adverse events. Divalproex also failed in the same way.

Dronabinol, a synthetic tetrahydrocannabinol (THC), has mixed results in decreasing cannabis use and withdrawal symptoms. THC is the psychoactive substance naturally found in marijuana.

The more popularly used treatment, N-acetylcysteine and gabapentin, decreased cannabis use and craving in a clinical trial, the review went. But the results cannot be replicated thereafter.

Fortunately for those undergoing rehabilitation from DUC, four pharmaceuticals are showing promise. In laboratory studies, nabilone and lofexidine decreased cannabis withdrawal symptoms following a period of abstinence from cannabis use. Buspirone reduced cravings, irritability and depression; while entacapone (in a small study) managed to decrease cravings.

The researchers noted an agreement among experts that psychotherapy hold better promise. Psychological interventions include cognitive behavioral therapy, motivational enhancement therapy, contingency management, supportive-expressive psychotherapy, and related family and systems interventions. The 12-step method of the Marijuana Anonymous unfortunately showed only small reduction in general drug use.

They noted a more effective five-step program that we cannot cover here for lack of space.

Carl G. Jung advised: “Every form of addiction is bad, no matter whether the narcotic be alcohol, morphine or idealism.” Who dares add Facebook-ing?


Published in the Sun.Star Cebu newspaper on July 16, 2014.


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