Redefining success in cannabis use disorder treatment with Toby Atkin

Redefining success in cannabis use disorder treatment with Toby Atkin

What drives someone to seek a life without rigid all‑or‑nothing goals around cannabis use? This conversation on Addiction Audio looks at that question through a research lens, with a clear eye on real people’s lives. Hosted by Dr Elle Wadsworth, the episode features psychiatrist and research fellow Dr Tobias (Toby) Atkin from Columbia University.

He talks through his opinion and debate piece on how success in cannabis use disorder treatment is usually judged by abstinence – even though, as he puts it, “for most people with cannabis use abstinence is not the goal.” Many patients, he explains, want to use less, shift use to later in the day, or reduce its impact on work, parenting and relationships.

The discussion is especially useful for clinicians, researchers and students, but anyone curious about treatment options for cannabis use disorder will find plenty to think about. Toby breaks down the current evidence for psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management, while stressing how resource‑heavy they are and how many people still struggle to reach abstinence or meaningful reduction. From there, the focus moves to why abstinence-based outcomes may be holding back treatment development.

Toby explains the problems with relying on urine THC metabolites – which stay positive for weeks – and why self-report measures, despite their flaws, may be more practical. You’ll hear a clear explanation of his proposed tiered outcome framework, where frequency of use (such as days used in the past month or time of day) acts as the central measure, supported by quantity, potency, abstinence measures and health and functioning indicators like sleep and mood.

Throughout, Toby keeps linking research questions back to patient goals and daily life. If you’re interested in cannabis, harm reduction, or how treatment research could better match what people actually want, this one might spark some fresh questions for your own practice or recovery journey.