Working with clients who self-medicate using cannabis: Mind the gap in knowledge

Clinicians often work with clients who report using cannabis to self-medicate their mental health symptoms. In an article entitled "Working With Clients Who Self-Medicate Using Cannabis: Ethical and Clinical Considerations for Psychologists, " Stuart-Maver (2020) argued that scientific evidence concerning the effect of cannabis use, as well as ethical considerations, call for an open-minded approach among clinicians who work with such clients. This commentary aims to bring to the readers' attention two gaps in knowledge that may be relevant to this matter. First, to date, research including a recent systematic meta-analysis of clinical trials has indicated that cannabinoids do not show clinical superiority in treating mental health symptoms compared to placebo. Notably, there is evidence that cannabis use may be associated with a significant increased risk for short-term adverse consequences, withdrawal, and addiction. Second, it is yet unclear to what extent cannabis use affects the therapeutic process and its outcome. Specifically, there is lack of evidence concerning the effect of cannabis use on therapeutic facilitators of change, such as emotional insight, change in maladaptive cognition, and formation of a client-therapist alliance. Establishing a nonjudgmental discourse concerning cannabis use is indeed a morally and ethically proper therapeutic stance. However, this commentary encourages therapists to communicate possible concerns associated with cannabis use to their clients.