Research on the mechanisms of behavior change (MOBC) for the treatment of cannabis use disorder (CUD) has limitations due to an overemphasis on abstinence, rigid definitions, and a lack of consideration for demographic variation. Our objective was to address these limitations by investigating the following emerging MOBC properties: (1) the viability of craving and use reductions as MOBCs, (2) if immediate treatment outcomes facilitate longer-term behavioral changes, and (3) if the course of CUD treatment differs between men and women. Treatment-seeking individuals (n = 186; 70.1% male; 57.2% White) with CUD, aged 18-50 (M = 30.90, SD = 8.95), participated in a 12-week multi-site clinical trial with a 4-week follow-up. We collected weekly self-reports and biweekly creatinine-corrected cannabinoid urine concentrations. We employed moderated multigroup four-timepoint longitudinal path analyses to analyze treatment progression. We examined (H₁) if mid-treatment reductions in craving and cannabis use mediated the direct effect of CUD severity at the screening visit on immediate treatment outcomes (anxiety, depression, and cannabis-related problems), (H₂) if immediate treatment outcomes mediated the direct effect of mid-treatment MOBCs on a four-week follow-up outcome (quality-of-life challenges), and (H₃) if gender moderated these effects. We found that craving reduction may be a MOBC for the full and men samples. However, for women, depression functioned concurrently as an immediate outcome and a MOBC for follow-up quality-of-life challenges. Additionally, we observed gender differences in treatment progressions; for men, the MOBC was craving reduction, while for women, it was reducing cannabis use. These findings indicate that our understanding of CUD treatments may be more nuanced than the existing literature suggests.

由于过分强调禁欲、严格的定义以及缺乏对人口统计学差异的考虑，用于治疗大麻使用障碍（CUD）的行为改变机制（MOBC）的研究存在局限性。我们的目标是通过研究以下新兴的 MOBC 特性来解决这些局限性：（1）作为 MOBC 的渴望和使用减少的可行性，（2）立即治疗结果是否促进长期行为改变，以及（3）如果男性和女性的 CUD 治疗有所不同。寻求治疗的18-50 岁 CUD患者（ n = 186；70.1% 男性；57.2% 白人）（ M = 30.90，SD = 8.95）参加了一项为期 12 周的多中心临床试验，其中包括为期 4 周的临床试验跟进。我们收集每周的自我报告和每两周肌酐校正的大麻素尿浓度。我们采用有调节的多组四时间点纵向路径分析来分析治疗进展。我们检查了 (H ₁ ) 治疗中期渴望和大麻使用的减少是否介导了筛选访视时 CUD 严重程度对立即治疗结果（焦虑、抑郁和大麻相关问题）的直接影响，(H ₂ ) 如果立即治疗结果介导了治疗中期 MOBC 对 4 周随访结果（生活质量挑战）的直接影响，以及 (H ₃ ) 性别是否调节了这些影响。我们发现，对于完整样本和男性样本来说，渴望的减少可能是一个 MOBC。然而，对于女性来说，抑郁症既是直接后果，又是后续生活质量挑战的 MOBC。此外，我们观察到治疗进展中的性别差异；对于男性来说，MOBC 渴望减少大麻的使用，而对于女性来说，它正在减少大麻的使用。这些发现表明，我们对 CUD 治疗的理解可能比现有文献所暗示的更加细致。