Tobacco and Cannabis Use Disorders: Similarities, Differences and Therapeutic Approaches.

Cannabis and tobacco are two of the most commonly used drugs worldwide. Both drugs can lead to a use disorder, characterized by compulsive use despite harm and mediated by neurobiological changes in reward and motivational circuitry. Co-use of cannabis and tobacco is common and influences disorder severity and outcomes. Both cannabis use disorder (CUD) and tobacco use disorder (TUD) share key features, such as dopaminergic reward system involvement, severity of withdrawal symptoms, and mental health comorbidities, yet they differ in neurobiological pathways, diagnostic profiles, and available pharmacotherapies. Diagnostic frameworks like the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and International Classification of Diseases 11 provide standardized criteria for assessment. Optimal management integrates pharmacological and psychosocial interventions, though approved medications exist for TUD and not yet for CUD. Understanding similarities, distinctions, and treatment strategies is critical for effective prevention and clinical care.