Cannabis use disorder, or marijuana addiction, is when someone continues to use cannabis despite causing clinically significant impairment. [1] They become dependent on the drug and continue to use more as their tolerance increases. Marijuana use disorder is currently only treated through therapy.

What is cannabis use disorder?

Cannabis use disorder is when somebody is negatively affected by their continued use of cannabis without necessarily being addicted. People with this substance use disorder are usually dependent on the potentially addictive drug because of chemical changes in the brain and can experience withdrawal symptoms [2] such as:

  • Anxiety and depression
  • High irritability
  • Trouble sleeping and restlessness
  • Decreased appetite

Marijuana addiction is usually linked to an increase in dosage over time because of the tolerance you build up as you take it more often. It is estimated to affect up to 10% of regular marijuana users. [3]

Effects of cannabis use disorder

The effects of marijuana addiction can be short-term and long-term. [4]

Short-term effects include:

  • Difficulty remembering things
  • Changes in mood
  • Difficulty thinking
  • High dosages can cause hallucinations and psychosis

Long-term effects include:

  • Problems with brain development if used when young or during pregnancy
  • Difficulty breathing or coughing and irritability
  • Worsening of some mental disorders and illnesses

Symptoms and signs of cannabis use disorder

The symptoms of cannabis use disorder can be physical and behavioral. [5]

Physical symptoms

  • If you feel like you are craving cannabis regularly.
  • Your tolerance to cannabis and the desired effects builds up over time. You may need to increase your dose each time to have the desired effects.
  • You experience withdrawal symptoms if you stop taking cannabis, such as anxiety, trouble sleeping, and a decreased appetite. Cannabis withdrawal symptoms show up in half of people in treatment for the disorder. [2]

Behavioral symptoms

Behavioral symptoms negatively affect your daily life and may not always be as noticeable as physical symptoms. However, they can be just as harmful.

  • You continue using cannabis despite noticing the negative effects it is having on you.
  • It begins to cause social or relationship problems. This can include spending money on cannabis and missing out on social interactions because of your cravings.
  • Problems at work or school because of your cannabis use.
  • Spending excessive amounts of time using cannabis and not doing the activities that you usually enjoyed before the consumption started.
  • Taking cannabis in high-risk and high-stress situations as a way to calm your nerves or suppress withdrawal symptoms.

Long-term adverse effects

  • Marijuana use at a young age can alter brain development and lead to both mental and physical health complications in the future.
  • Chronic bronchitis is an inflammation of the airways that can cause shortness of breath and constant coughing.
  • Increased risk of other lung conditions and infections.
  • Higher likelihood of psychotic disorders such as schizophrenia or hallucinations, as well as psychiatric disorders such as depression and anxiety. [13]

Diagnosing cannabis use disorder

To be diagnosed with cannabis use disorder, you must show at least two of the following 11 symptoms over the last 12 months according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), criteria [1]

  • Continued use despite physical or psychological problems
  • Continued use despite social or relationship problems
  • Neglecting social roles
  • Showing withdrawal symptoms when trying to quit
  • Increasing tolerance to cannabis
  • Taking larger doses over time to feel the same effects
  • Repeated failed attempts to quit using cannabis
  • Spending a lot of your time using cannabis
  • Giving up normal activities or hobbies to take cannabis instead
  • Cravings for cannabis
  • Using cannabis hazardously, such as driving while under the influence

Your doctor may also assess how frequently you use cannabis to help with diagnosis [6]. This includes episodic, continuous, or unspecified usage.

There are three severity levels used in diagnosis to help decide what treatment is necessary [5]

  • Mild: Two or three symptoms shown
  • Moderate: Four or five symptoms shown
  • Severe: Six or more symptoms shown

Causes of cannabis use disorder

Cannabis use disorder is usually caused by someone taking an increasing amount of the drug as their brain and body become more tolerant to it. Certain risk factors may make you more susceptible to developing the disorder if you start to take cannabis. These include:

  • Being prone to addiction. This can either be genetic or environmental. [7]
  • If you start to use cannabis at a young age. [8]
  • If your group of friends regularly use cannabis around you. [8]
  • If you are addicted to cigarettes. [8]
  • If you have a pre-existing mental health condition such as depression or anxiety.

Prevention of cannabis use disorder

Preventing cannabis use disorder can be difficult as most do not notice the symptoms until it is too late. However, there are some ways of preventing you or your loved one from developing the disorder.

  • Do not begin taking cannabis or any other recreational or illicit drug if you know you are prone to addiction. Being prone to addiction can be genetic or environmental. If your parent or close relative has a serious addiction, it may be in your best interest to avoid potentially addictive substances.
  • If you take cannabis for medical or personal reasons, then keep it in a closed container in a hidden place to prevent your children or pets from accessing it accidentally. [9]

Treatment for cannabis use disorder

In the U.S., the average person seeking treatment will have been taking cannabis regularly for over ten years and have attempted to quit multiple times. [10]

There is no medication currently available to treat cannabis use disorder. However, medical professionals can successfully treat it through psychological and therapeutic interventions. [11]

  • Cognitive Behavioral Therapy: Where a therapist will help you deal with the thoughts and triggers that have led to your addiction to marijuana, allowing you to form alternative responses to triggers that would usually make you want to use cannabis.
  • Contingency Management: This form of therapy works using incentives (such as vouchers or prizes) to help you stay on track and contain withdrawal symptoms.
  • Other forms of therapy, such as group therapy and self-help groups, may be helpful to some as it allows for conversations with other people going through similar symptoms and discussing how they deal with them.

Helping someone with cannabis use disorder

General barriers to the treatment of cannabis use disorder can include a lack of interest in treatment, a lack of motivation, and not knowing about the treatments available to them. [12] Therefore, if you know anyone showing symptoms of cannabis use disorder, encouraging and helping them find the resources needed for treatment can be extremely helpful.

Cannabis addiction can vary in severity. Be prepared for your loved one to not recognize their problems at first and reject your offers for help. Be firm while supportive, as escalating the situation into a potential conflict may lead them to refuse treatment altogether. They must recognize their addiction and want to stop themselves, as therapeutic methods rely on patient cooperation.

Resources:

  1. American Psychiatric Association. (2022, March 18). Diagnostic and Statistical Manual of Mental Disorders, Text Revision Dsm-5-tr (5th ed.). Amer Psychiatric Pub Inc.
  2. Bahji, A., Stephenson, C., Tyo, R., Hawken, E. R., & Seitz, D. P. (2020, April 9). Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids. JAMA Network Open, 3(4), e202370. https://doi.org/10.1001/jamanetworkopen.2020.2370
  3. Connor, J. P. (2021, February 25). Cannabis use and cannabis use disorder. Nature. Retrieved September 29, 2022, from https://www.nature.com/articles/s41572-021-00247-4
  4. Cannabis (Marijuana) DrugFacts. (2022, March 22). National Institute on Drug Abuse. Retrieved September 29, 2022, from https://nida.nih.gov/publications/drugfacts/cannabis-marijuana
  5. Psychiatry Online. (n.d.). The American Journal of Psychiatry. Retrieved September 29, 2022, from https://ajp.psychiatryonline.org/
  6. ICD-11 for Mortality and Morbidity Statistics. (n.d.). Retrieved September 29, 2022, from https://icd.who.int/browse11/l-m/en
  7. Coffey, C., Carlin, J. B., Lynskey, M., Li, N., & Patton, G. C. (2003, April). Adolescent precursors of cannabis dependence: findings from the Victorian Adolescent Health Cohort Study. British Journal of Psychiatry, 182(4), 330–336. https://doi.org/10.1192/bjp.182.4.330
  8. Evidence-based Answers to Cannabis Questions: A Review of the Literature. (2006, October 2). Australian National Council on Drugs.
  9. Marijuana Use Disorder/Cannabis Use Disorder | Disease or Condition of the Week | CDC. (n.d.). Retrieved September 29, 2022, from https://www.cdc.gov/dotw/marijuana-use/index.html#:%7E:text=Prevention%20Tips%201%20Persons%20who%20are%20pregnant%20or,with%20other%20things%2C%20such%20as%20marijuana.%20More%20items
  10. Budney, A., Roffman, R., Stephens, R., & Walker, D. (2007, December). Marijuana Dependence and Its Treatment. Addiction Science &Amp; Clinical Practice, 4(1), 4–16. https://doi.org/10.1151/ascp07414
  11. Gates, P. J., Sabioni, P., Copeland, J., Le Foll, B., & Gowing, L. (2016, May 5). Psychosocial interventions for cannabis use disorder. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd005336.pub4
  12. Treloar, C., & Holt, M. (2006, January). Deficit models and divergent philosophies: Service providers’ perspectives on barriers and incentives to drug treatment. Drugs: Education, Prevention and Policy, 13(4), 367–382. https://doi.org/10.1080/09687630600761444
  13. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, R. B. (2014). Adverse Health Effects of Marijuana Use. The New England journal of medicine, 370(23), 2219. https://doi.org/10.1056/NEJMra1402309