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Treatment Implications Associated With Cannabis and Tobacco Co-use

  • Cannabis Addiction (B Sherman and A McRae-Clark, Section Editors)
  • Published:
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Abstract

Purpose of Review

The goal of this article is to summarize the treatment-focused literature on cannabis and tobacco co-use and the treatment implications of co-use. This review will focus on the following: (1) the impact of co-use on cessation outcomes, (2) compensatory use/substitution of the non-treated substance among co-users, and (3) treatment interventions to address co-use. This article will highlight the limitations to co-use captured in the literature and offer considerations and directives for co-use research and treatment moving forward.

Recent Findings

The degree to which co-use affects cessation for a single, targeted substance remains in question, as the literature is largely mixed. Cannabis treatment trials are better equipped to answer these questions given that they do not typically exclude tobacco users. While the relationship between tobacco use and poorer cannabis outcomes appears to have some evidence, the reverse relationship (cannabis use affecting tobacco outcomes) is not consistently supported.

Summary

The co-use of cannabis and tobacco and its impact on single substance cessation and/or compensatory substance use during cessation is generally overlooked in treatment trials, while interventions to address both substances are rare. Capturing co-use adds burden for researchers, clinicians, and participants, but is warranted given the prevalence of co-use and a rapidly changing cannabis and tobacco regulatory environment, which may further complicate co-occurring substance use. Co-users are a heterogeneous population; trials focused on co-users, in addition to better data capture and consistent terminology, will aid in an understanding of nuanced patterns of co-use critical to inform treatment interventions.

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Acknowledgments

We would like to thank Jenny Nankoua for her assistance in reviewing the co-use treatment literature.

Funding

Effort was supported by the National Institutes of Health grants (R37 CA237245, EAM). A National Institute for Health Research University College London Hospitals Biomedical Research Centre bridging fellowship supported CH. Canada First Research Excellence Fund awarded to the Healthy Brains for Healthy Lives initiative at McGill University supported RAR.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, MSC 861, 67 President Street, Charleston, SC, 29425-8610, USA

    Erin A. McClure

  2. Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA

    Erin A. McClure

  3. Department of Psychiatry, McGill University and The Douglas Mental Health Institute, Montreal, Canada

    Rachel A. Rabin

  4. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Dustin C. Lee

  5. Clinical Psychopharmacology Unit, Department of Clinical, Educational & Health Psychology, University College London, Faculty of Brain Sciences, University College London, London, UK

    Chandni Hindocha

  6. Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK

    Chandni Hindocha

  7. University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK

    Chandni Hindocha

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  1. Erin A. McClure
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Correspondence to Erin A. McClure.

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McClure, E.A., Rabin, R.A., Lee, D.C. et al. Treatment Implications Associated With Cannabis and Tobacco Co-use. Curr Addict Rep 7, 533–544 (2020). https://doi.org/10.1007/s40429-020-00334-8

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