Cannabis Use Disorder as a disorder of motivational dysregulation: a systematic review of clinical, neurocognitive, and treatment evidence

This systematic review evaluated whether CUD can be coherently reconceptualized as a disorder of motivational dysregulation by synthesizing clinical, neurocognitive, and treatment-related evidence published over the last 10 years. A systematic search was conducted in PubMed, Scopus, Embase, and CINAHL for studies published between January 2015 and January 2026, in accordance with PRISMA 2020 guidelines. Eligible studies included adults with CUD and examined motivational processes, decision-making, reward valuation, goal-directed behavior, or motivation-focused mechanisms of treatment. Quantitative, qualitative, and mixed-methods studies were included. Two independent reviewers conducted study selection, with disagreements resolved through consensus Risk of bias was assessed using standardized tools appropriate to study design, and findings were synthesized narratively. Convergent evidence indicated clinically salient motivational features such as persistent ambivalence, diminished intrinsic goal pursuit, and return to use driven by contextual and affective factors rather than consumption severity alone. Neurocognitive findings implicated alterations in reward prediction, effort-based decision-making, and executive control relevant to motivational regulation. Interventions explicitly targeting motivation demonstrated superior engagement and treatment outcomes compared with abstinence-centric or deterrence-based approaches. Overall, risk of bias was low in well-conducted randomized controlled trials, while observational and neurocognitive studies demonstrated moderate risk due to potential confounding and measurement variability. Case-series designs exhibited higher risk of bias. In conclusion the evidence from the past decade supports reframing CUD as a disorder of motivational dysregulation rather than consumption per se, with important implications for assessment, treatment design, and return to use prevention.