The use of cannabinoids for recreational and therapeutic purposes has been described for centuries [44]. Cannabis accounts for the third most commonly used substance worldwide, only after alcohol and tobacco [45]. Considering that around 1 in 10 of regular users of cannabis will develop moderate to severe forms of CUD over time, the need for more effective treatments for this condition is pressing [45]. Moreover, the increasing prevalence of cannabis use, CUD, and its complications over the past decade are not negligible, and treatments to date remain insufficient. As of now, there are no FDA-approved medications for this condition, and the off-label use of psychotropic medications has only demonstrated modest to no benefits, particularly for relapse prevention and abstinence [46]. At best, a few psychotropic medications, including cannabinoid agonists, have shown the potential to alleviate cannabis withdrawal symptoms, particularly insomnia, anorexia, and anxiety/restlessness, whereas most placebo-controlled trials for CUD testing a wide range of psychotropic agents have failed to demonstrate benefits for relapse prevention and sustained abstinence [46]. Unfortunately, side effects from these off-label treatments are not insignificant, often limiting compliance and/or resulting in a return to use of cannabis. Moreover, the use of these medications for specific age groups, such as adolescents and older adults, remains unclear, since most studies tend to exclude these specific cohorts from trials. Behavioral and psychosocial interventions remain the main stay treatment for CUD. However, limited access to these evidence-based interventions, engagement, and retention in treatment are often suboptimal, impacting clinical outcomes and overall prognosis.

Notably, although some studies have explored correlates of treatment outcomes, the paucity of data on age-specific treatments for CUD in the existing literature remains. Of note, data suggest that SUDs in older adults remain underestimated and largely untreated, in part because this population has traditionally accounted for only a small fraction of the problem [47,48,49]. The implications of underdiagnosing and undertreating older adults with SUD, including CUD, are particularly concerning, since these individuals are more vulnerable to adverse outcomes associated with drug use [50].

Despite an increasing need for older adult substance use services, facilities with programs designed for older persons remain relatively scarce [51]. In a study of 13,749 responding facilities in the US, only 17.7% had specific programs for older adults [51]. Of note, evidence demonstrates that treatments for SUDs are cost-effective and tend to have similar rates of recurrence/relapse compared to other chronic illnesses in the older adult population [52]. Moreover, evidence has also shown that older individuals tend to have greater adherence to treatment and clinical outcomes, including days of use and abstinence rates regardless of level of care, compared to younger counterparts [53]. Unfortunately, screening, diagnosis, and treatment of SUDs in older individuals remain suboptimal [54,55]. Expanding substance use services, particularly in primary care settings, would likely be considerably impactful, since primary care providers may play an important role in early detection and delivery of brief interventions, particularly for this particular age group [56,57].

This study underscores the imperative of tailoring cannabis use disorder (CUD) treatment according to age, as developmental stages significantly influence the underlying mechanisms of problematic use and the most effective strategies for behavior change. During adolescence, cannabis use often begins as a social activity driven by peer influence and novelty-seeking behaviors [58]. Still-developing cognitive control networks make it difficult for teens to resist immediate rewards and social pressures. Interventions should provide external reinforcement through rewards or environmental modifications to facilitate positive choices. Approaches boosting internal motivation like motivational interviewing also show promise by activating teens’ emerging self-reflective capacities and goal-setting abilities. As supported by the Stanger et al. randomized trial, interventions incorporating external reinforcement such as contingency management with rewards for abstinence can compensate and scaffold improved decision-making during this critical neurodevelopmental window. Specifically, adding a rewards program reliant on frequent drug testing to standard motivational and cognitive behavioral therapy (MET/CBT) prolonged adolescent cannabis abstinence durations over 12 months more successfully than MET/CBT alone [16].

Additionally, even brief counseling approaches exploring internal motivations and self-efficacy show efficacy for this population. The Mason et al. brief motivational interview session focused on eliciting adolescents’ personal reasons for and confidence in abstaining [18]. By emphasizing emergent introspection and metacognitive capacities, this individualized approach nearly tripled cannabis abstinence rates subsequently. This promising efficacy of brief, norms-based feedback on adolescent and youth cannabis outcomes warrants dedicated investigation into real-world implementation systems that could support almost universal reach across educational, workplace, and clinical settings. All youth could be screened for escalating cannabis use and select individuals offered these minimally demanding but high-impact interventions grounded in where their use diverges from peer averages. Preventing and reversing escalation early in critical neurodevelopmental phases can avert years of morbidity and functioning loss—making optimization and dissemination of these interventions an urgent priority with young populations.

Furthermore, for adolescents, involving parents in standard clinic-based treatment significantly improved abstinence outcomes (Stanger 2015), highlighting the vital role of family engagement when targeting youth substance issues [16]. The same emphasis on the role of family engagement was demonstrated in Rigter’s study in young adult age groups, which showed that interventions involving family members significantly impact treatment outcomes [26]. These findings highlight the significance of incorporating family-based interventions into substance use treatment programs for both adolescents and young adults. By recognizing and harnessing the influence of family dynamics, clinicians can enhance treatment effectiveness and promote sustainable recovery outcomes across these age groups.

Although young adults have greater self-regulation capacities, honing emotional and impulse control skills remains a key developmental task. Interventions should enable value exploration to strengthen evolving self-identity [59]. Similar to adolescents, it seems that building distress tolerance and protective peer communities as well as motivational enhancement and coping skill training serves as a fundamental basis for cannabis use interventions in younger adults. For example, a distress tolerance program focused on emotional exposure significantly reduced cannabis use days among young adults prone to distress intolerance (Macatee et al., 2021) [32].

Additionally, the utilization of computerized or mobile programs harnessing technology holds significant appeal for young adults, offering convenient platforms to bolster motivation and facilitate self-monitoring. By integrating young adults’ peer networks, these interventions provide essential accountability and support. For instance, Mason et al. implemented a 4-week automated text messaging program (PNC-txt) aimed at fostering motivation and nurturing positive peer relationships, resulting in notable increases in abstinence rates and reductions in cravings over a 3-month period [23]. Similarly, Riggs et al. demonstrated the effectiveness of a computerized eCHECKUP program, which provided personalized feedback on individual cannabis use patterns alongside tips for reducing use. This intervention yielded significant declines in use frequency and severity [28]. Hence, holistic interventions blending technology-based supports, distress prevention skill building, and positive peer influence optimization demonstrates high promise for reducing cannabis misuse among young adults.

In later life, older adults may face higher challenges, such as chronic pain, sleep disturbances, and mental health issues, that may contribute to relapse into entrenched cannabis use. Unlike other age groups, where studies of pharmacological interventions are limited, there seems to be a notable inclination towards medication-based interventions for older adults, perhaps owing to age-related pharmacokinetic changes and medical comorbidities. For example, Lintzeris et al. found that the cannabinoid medicine nabiximols combined with counseling conferred significantly higher abstinence rates and fewer usage days compared to placebo plus counseling. This underscores the potential utility of pharmaceuticals to help stabilize acute cessation in older individuals by alleviating withdrawal and cravings [36]. Hence, for older adults, an integrative approach blending medication relief from protracted withdrawal with counseling focused on building psychological resilience and social supports appears most effective. Additionally, extended monitoring and booster sessions prove vital for preventing slips from evolving into full relapse across aging. Walker et al. demonstrated that incorporating brief maintenance check-up sessions into standard psychosocial care improved short-term abstinence rates [34].

Furthermore, there appears to be disproportionately less research conducted in older adult populations compared to adolescents and young adults. Only 6 of the 24 studies majorly focused specifically on those aged 26–65 years old. This may be because cannabis use peaks in young adulthood, so there is greater perceived need to target those age groups. However, with increasing rates of older adults using cannabis regularly, more studies on effective treatments tailored to that population are warranted [42].

Additionally, evidence suggests potential gender differences in treatment response that may inform further personalization of interventions. Walukevich-Dienst et al. evaluated an online personalized feedback program aimed at reducing problems related to cannabis use among college students. Although no overall effects on use frequency were found, gender-specific analyses revealed that women receiving the personalized feedback intervention reported significantly fewer cannabis-related problems at one-month follow-up compared to female controls. However, no differences between intervention and control groups were observed for men. This indicates that web-based personalized normative and risk feedback may confer greater benefits for female versus male young adults regarding problematic use indicators. These preliminary findings highlight the need to better understand variables moderating treatment response—such as biological sex, psychosocial characteristics, and mechanisms maintaining use—that can enable further individualization of interventions by gender and other individual factors [29].

In summary, effective treatment for cannabis use disorder (CUD) necessitates an individualized approach that considers the diverse age groups affected, tailoring interventions to address specific developmental challenges and opportunities across the lifespan. Customized interventions, whether leveraging contingent rewards for adolescents, technological platforms for young adults, or pharmacological adjuncts for older individuals, have shown promise in enhancing outcomes. However, the optimal combination and sequencing of age-specific treatments remain uncertain, highlighting the need for further comparative effectiveness research to elucidate the most efficacious approaches. Nonetheless, adopting a personalized, lifespan developmental perspective holds potential to improve upon the modest treatment outcomes observed thus far.