Low treatment completion rates hinder recovery for teens with cannabis use disorder

Cannabis use disorder in adolescents in the United States remains a growing threat despite declines in cannabis use. Many adolescents begin using cannabis before high school during crucial stages of brain development, which may pose short- and long-term risks for cognitive, academic and social challenges.

Although behavioral therapies show promise, there is still limited understanding of what truly drives recovery in teens. With treatment often sought only after serious problems emerge, identifying who succeeds – and why – is essential to developing more effective and targeted interventions.

Researchers at Florida Atlantic University's Charles E. Schmidt College of Medicine conducted a study to better understand how U.S. adolescents respond to treatment for cannabis use disorder. They analyzed data collected from more than 40,000 adolescents ages 12 to 17 who received treatment between 2018 and 2021. They investigated treatment completion rates and explored possible obstacles that hinder recovery.

Results of the study, published in the peer-reviewed journal Pediatric Reports, show that treatment completion rates remain low, ranging from 34.2% in 2018 to 33.8% in 2021. The most common reasons for not completing treatment in all years were dropping out, transferring to another facility and being terminated by the facility.

Nearly 60% of the adolescents started using cannabis between ages 12 and 14. More than one-third reported co-occurring mental health and substance use disorders. Adolescents who began using cannabis at age 11 or younger had a significantly lower treatment completion rate of 12.9%.

"While gender differences in treatment completion were relatively small, boys were somewhat less likely to complete treatment than girls," said Panagiota "Yiota" Kitsantas, Ph.D., corresponding author, former chair of the FAU Department of Population Health and currently an affiliate professor in the Schmidt College of Medicine. "These patterns pose new challenges for treatment models."

Hispanic and Native Hawaiian/Pacific Islander/Asian Pacific Islander adolescents were more likely to complete treatment. In contrast, Black and white non-Hispanic adolescents were less likely to complete treatment. Adolescents with co-occurring mental health and substance use disorders (30.3%) and the use of substances other than cannabis at admission (31.9%) were less likely to complete treatment.

Most adolescents lived in dependent settings (60%). Adolescents in dependent living arrangements had significantly higher completion rates (64.4%) compared to those in independent living (35.3%) or homeless situations (0.2%). In addition, 9.2% had a history of arrests in the past 30 days. These individuals had significantly lower treatment completion rates.

Adolescents who stayed in treatment for four to six months had higher completion rates (37.8%), while those with stays longer than 12 months showed no marked difference. Adolescents staying for less than one month had the lowest completion rates (9.3% for completed treatment versus 33.6% for not completed). Most adolescents spent two to six months in treatment.

The primary referral sources were the judicial system (38.5%), individual/self-referral (20.3%), and other health care providers (14.8%), while ambulatory, non-intensive outpatient was the most common treatment setting (72.1%).

These low rates of completion of treatment among U.S. adolescents with cannabis use disorder may portend increasing short- and long-term consequences."

Charles H. Hennekens, M.D., FACPM, co-author and the first Sir Richard Doll Professor of Medicine and Preventive Medicine and interim chair of population health, Schmidt College of Medicine

These data offer vital insights into the challenges and opportunities in addressing cannabis use disorder among youth, aiming to improve care and outcomes for this susceptible population.

"Research like this is essential because it gives us a clearer picture of who is falling through the cracks, and why," said Lewis S. Nelson, M.D., dean and chief of health affairs of the Schmidt College of Medicine. "Adolescents are not just small adults; their brains, behaviors and environments demand approaches grounded in evidence and tailored to their unique needs. If we want to curb the long-term consequences of cannabis use, we must invest in data-driven strategies that improve access, retention and outcomes – especially for the most vulnerable youth."

Study co-authors are Helena Miranda, FAU medical student; Jhon Ostanin, medical student, Florida International University; Simon Shugar; FAU medical student; Maria Carmenza Mejia, M.D, professor; and Lea Sacca, Ph.D., assistant professor, both in the Department of Population Health, Schmidt College of Medicine; and Mitchell L. Doucette, Ph.D., senior director of research, Leafwell.