Cannabis cessation and neurocognitive recovery: Patterns, predictors, and clinical implications-a systematic review

Cannabis use disorder affects millions globally, with growing interest in neurocognitive recovery following cessation. The reversibility of cannabis-induced neuroadaptations remains critical for clinicians, given increasing cannabis potency and early initiation. This systematic review examines neurocognitive recovery patterns and biomarker changes following cannabis cessation, focusing on clinical implications and factors influencing recovery trajectories.

A comprehensive literature search was conducted using PubMed, EMBASE, PsycINFO, and Cochrane databases (2000-2025). Studies examining neurocognitive recovery following cannabis cessation were included, with abstinence periods ranging from acute (≥72 h) to extended (months to years). Primary outcomes included neuroimaging changes, cognitive performance, and biomarker recovery patterns. Study quality was assessed using Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. Narrative synthesis was employed due to heterogeneity.

Twenty-six studies met the inclusion criteria. Neuroimaging demonstrated CB1 receptor normalization within 4 weeks and cognitive improvements within the first week of cessation. Recovery patterns varied by age of onset and use intensity. Adolescent-onset users showed less complete recovery than adult-onset users; heavy users required extended recovery periods. Cognitive deficits in attention and executive function persisted beyond acute cessation.

Cannabis cessation produces substantial neurocognitive recovery, particularly within the first year. However, recovery requires extended clinical support, age-stratified approaches, and systematic cognitive monitoring. Current evidence challenges assumptions about permanent cannabis-related brain damage while highlighting vulnerabilities in adolescent populations.

These findings provide evidence-based guidance for treatment duration, realistic expectation-setting, and individualized prognosis determination in cannabis use disorder recovery.