Page 55 - CASA Bulletin of Anesthiology 2021, Vol 8, No. 6 (1)

Vol. 8, No. 6, 2021

role of anticonvulsants in treating CUD. N-acetylcysteine (NAC) is another agent of interest
given its role in regulating glutamate release and preliminary favorable results treating cocaine
and cigarette craving. NAC yielded positive primary cessation outcome in cannabis-dependent,
adolescents and young adults (age 18-21) in both open-labeled pilot study and double-blind,
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randomized control trial. The same group replicated the study in adults (age 18-50) but could
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not reproduce the positive result, suggesting a possible age effect in treatment.
44
While the search for pharmacological agents for CWS treatment remains ongoing,
psychotherapy studies have established several evidence-based models and promising techniques
in CWS/CUD treatment. Cognitive behavioral therapy (CBT), motivational enhancement therapy
(MET) and contingency management (CM) are studied the most and have all shown benefits in
cannabis use outcome (decreased frequency and quantity of use during treatment). And the
combination of the 3 modalities has the highest efficacy. 45 - 46 However, abstinence rate remained
modest and declined after treatment. Moreover, the increasing number of cannabis users, both
recreational and medicinal, ensures that the volume of people developing CUD and/or
experiencing CWS exceeds the capacity of substance abuse specialty services. Further
investigation on brief intervention, computer/telephone-based intervention and social media may
improve the accessibility of psychotherapy. Psychotherapy should also be incorporated with
pharmacological therapy to improve the efficacy of CWS treatment.

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