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Abstract

Purpose: This research investigates whether the efficacy of a digital cannabis use disorder (CUD) treatment for young adults (age 18–25) differs by exposure to cannabis retailers in the residential neighborhood and activity space (significant places visited throughout daily life).

Methods: This is a secondary analysis of data from a randomized clinical trial of the digital substance use disorder treatment Peer Network Counseling-txt (PNC-txt) for reducing cannabis use among young adults with CUD ( n = 425). We hypothesize that the indirect effect of treatment on reducing cannabis use via the mediating mechanism readiness-to-change is moderated by exposure to cannabis retailers, due to the stronger effect of readiness-to-change on reducing cannabis use at lower levels of exposure.

Results: The indirect effect of PNC-txt on reducing cannabis use is significantly moderated by activity space exposure to cannabis retailers (β=0.104, 95 % CI: 0.010, 0.197), where the treatment effect is more than three times as strong at low, as compared to high, levels of exposure. We did not find significant moderating effects by residential exposure (β=0.059, 95 % CI: −0.020, 0.137).

Conclusions: Findings indicate that greater exposure to cannabis retailers in a young adult’s activity space is associated with reduced CUD treatment efficacy. This is likely due to easier access to cannabis, more tolerant cannabis attitudes, and environmental cues which can trigger craving among those with CUD. Regulations regarding locations and density of cannabis retailers may contribute to better CUD treatment outcomes.

Document Type

Article

Publication Date

2026

Notes/Citation Information

0376-8716/© 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.drugalcdep.2026.113096

Funding Information

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number 5R01DA044206 (PIs M.J. Mason and J.D. Coatsworth) and by the National Science Foundation under Award Number 2445784 (PI J. Mennis). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or National Science Foundation.

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