Cannabinoids, especially cannabis, are the most widely used illicit psychoactive substances in the United States. Individuals with cannabis use disorder may use cannabis throughout the day over a period of months or years, and thus may spend many hours a day under the influence. Even though medical uses of cannabis remain controversial, use for medical circumstances should be considered when a diagnosis is being made.

Cannabis Use Disorder Defined

Cannabis use disorder is a condition characterized by the harmful consequences of repeated cannabis use, a pattern of compulsive cannabis use, and (sometimes) physiological dependence on cannabis (i.e., tolerance and/or symptoms of withdrawal). Over time, this plant material has accumulated many names (e.g., weed, mary jane, pot, grass, herb, skunk, and ganja). A concentrated extraction of the cannabis plant that is also commonly used is hashish. Cannabis is most commonly smoked via a variety of methods: pipes, water pipes (hookahs or bongs), cigarettes (joints or reefers), or, in the paper from hollowed-out cigars (blunts). Cannabis is sometimes also ingested orally, typically by being mixed into food. Recently, devices have been developed in which cannabis can be vaporized. Cannabis users can develop tolerance to this drug so that it can be difficult to detect when they are intoxicated. Signs of cannabis use include red eyes, chronic cough, cannabis odor on clothing, yellowing of fingertips (from smoking joints), burning of incense (to hide odor), and exaggerated craving and impulse for specific foods. This disorder is only diagnosed when cannabis use becomes persistent and causes significant academic, occupational or social impairment.

Cannabis Use Disorder Causes:

The onset of cannabis use disorder can occur at any time during or following adolescence, but onset is most commonly during adolescence or young adulthood. Individuals are not all automatically or equally vulnerable to developing cannabis use disorder or other substance-related disorders. Some individuals have a genetic predisposition developing problematic use if they’re exposed to drugs.

Cannabis Use Disorder Symptoms:

  1. Cannabis is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
  3. A great deal of time is spent in activities necessary to obtain the cannabis, use the cannabis, or recover from its effects.
  4. Craving, or a strong desire or urge to use cannabis.
  5. Recurrent cannabis use, resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
  7. Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
  8. Recurrent cannabis use in situations in which it is physically hazardous.
  9. Continued cannabis use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.
  10. Tolerance, as defined by either of the following:
    • A. A need for markedly increased amounts of cannabis to achieve intoxication or desired effect.
    • B. Markedly diminished effect with continued use of the same amount of cannabis.
  11. Withdrawal, as manifested by either of the following:
    • A. The characteristic withdrawal syndrome for cannabis.
    • B. Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

If you are taking cannabinoids, under appropriate medical supervision, an individual does not meet this criterion. Cannabis use disorder can include periods of cannabis intoxication and symptoms of withdrawal.

Cannabis Intoxication:

Cannabis Intoxication causes significant psychological and social impairment. Signs of Cannabis intoxication are:

A. Recent use of cannabis.
B. Clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, the sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use.
C. Two (or more) of the following signs or symptoms developing within 2 hours of cannabis use:

  1. Conjunctival injection.
  2. Increased appetite.
  3. Dry mouth.
  4. Tachycardia.

D. The signs or symptoms are not attributable to another medical conditioning are not better explained by another mental disorder, including intoxication with another substance.

Cannabis withdrawal:

Cannabis withdrawal occurs after the cessation of (or reduction in) heavy and prolonged cannabis use. The symptoms of cannabis withdrawal include:

  1. Irritability, anger, or aggression.
  2. Nervousness or anxiety.
  3. Sleep difficulty (e.g., insomnia, disturbing dreams).
  4. Decreased appetite or weight loss.
  5. Restlessness.
  6. Depressed mood.
  7. At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache.

How to Approach a Loved One:

There is not a perfect way to approach a loved one that you assume or know is struggling with a cannabis use disorder. Many people with cannabis use disorder do not seek treatment, mainly because they don’t think it is a problem. Approaching loved ones to tell them that they do have a problem can be difficult. An intervention from loved ones can help some people recognize and accept that they need help. If you’re concerned about someone who may have a cannabis use disorder, ask a professional experienced in drug addiction treatment for advice on how to approach that person. You can not force someone to seek professional care, but you can always offer your support and encouragement.

Types of Cannabis Use Disorder Treatment:

There is no FDA-approved pharmacological treatment for cannabis dependence. Lifestyle changes are important in deciding to stop using cannabis. Reflecting on why you choose to use cannabis and the effects you seek from cannabis may help in your decision to stop using cannabis. Ensuring that your family and friends are aware that you no longer want to use cannabis and develop a support system of friends and family who can support your decision is important. If you have people in your life that continue to take cannabis that does not support your choice to stop using, it may impact your decision and ability to stop. Engaging in other healthy habits like good sleep habits, regular physical activity, meditation, and yoga can be used to replace your cannabis use.

Resources:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.

Cannabis Use Disorder. (2018.). Retrieved from:
https://www.mentalhealth.com/home/dx/cannabisdependence.html

Hartney, E., & Gans, S. (n.d.). What Are Some Criteria for Substance Use Disorders? Retrieved from:
https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926

National Institute on Drug Abuse. (2018). Marijuana as Medicine. Retrieved from:
https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine