Differential Mechanisms of Behavior Change in Cannabis Use Disorder Treatments: Functional Improvements and Clinical Implications

Research on the mechanisms of behavior change (MOBC) for the treatment of cannabis use disorder (CUD) has limitations due to an overemphasis on abstinence, rigid definitions, and a lack of consideration for demographic variation. Our objective was to address these limitations by investigating the following emerging MOBC properties: (1) the viability of craving and use reductions as MOBCs, (2) if immediate treatment outcomes facilitate longer-term behavioral changes, and (3) if the course of CUD treatment differs between men and women. Treatment-seeking individuals ( n = 186; 70.1% male; 57.2% White) with CUD, aged 18-50 ( M = 30.90, SD = 8.95), participated in a 12-week multi-site clinical trial with a 4-week follow-up. We collected weekly self-reports and biweekly creatinine-corrected cannabinoid urine concentrations. We employed moderated multigroup four-timepoint longitudinal path analyses to analyze treatment progression. We examined (H 1 ) if mid-treatment reductions in craving and cannabis use mediated the direct effect of CUD severity at the screening visit on immediate treatment outcomes (anxiety, depression, and cannabis-related problems), (H 2 ) if immediate treatment outcomes mediated the direct effect of mid-treatment MOBCs on a four-week follow-up outcome (quality-of-life challenges), and (H 3 ) if gender moderated these effects. We found that craving reduction may be a MOBC for the full and men samples. However, for women, depression functioned concurrently as an immediate outcome and a MOBC for follow-up quality-of-life challenges. Additionally, we observed gender differences in treatment progressions; for men, the MOBC was craving reduction, while for women, it was reducing cannabis use. These findings indicate that our understanding of CUD treatments may be more nuanced than the existing literature suggests.