Cannabis Use Disorder

What is cannabis use disorder?

Cannabis (marijuana) use disorder is a mental health condition in which you have a problematic pattern of cannabis/marijuana use that causes distress and/or impairs your life. It’s a type of substance use disorder (SUD).

Cannabis refers to all products that come from the Cannabis sativa plant. This includes its dried flowers, leaves, stems and seeds. The plant contains over 500 chemical substances. Cannabidiol (CBD) is one of these chemicals.

Marijuana is parts of or products from the Cannabis sativa plant that contain substantial amounts of tetrahydrocannabinol (THC) — the chemical that makes you feel “high.” Marijuana is cannabis, but not all cannabis is marijuana. Cannabis use disorder (CUD) mainly involves THC-containing substances (marijuana).

CUD exists on a spectrum and may be mild, moderate or severe. It typically involves an overpowering desire to use cannabis, increased tolerance to the cannabis and/or withdrawal symptoms when you stop taking it.

CUD can significantly impact your health, relationships and overall quality of life. It’s crucial to seek help as soon as you develop signs of it.

What’s the difference between marijuana use disorder and marijuana addiction?

Marijuana (cannabis) use disorder can be mild, moderate or severe. Marijuana addiction is the most severe form of the disorder. It involves continued marijuana use despite negative consequences. Addiction to marijuana happens when the reward system in your brain takes over and amplifies compulsive marijuana-seeking.

How common is cannabis use disorder?

CUD is relatively common. In 2021, researchers estimated that 5.8% of people (or about 16.3 million people) 12 years and older in the United States had a cannabis use disorder in the past 12 months.

What are the symptoms of cannabis use disorder?

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the signs of cannabis use disorder include:

• Taking cannabis in larger amounts and for a longer amount of time than you intended.
• Having a strong desire or urge to use cannabis.
• Having unsuccessful efforts to cut down on or control cannabis use.
• Spending a lot of time getting or using cannabis or recovering from its effects.
• Having issues fulfilling responsibilities at work, school or home due to cannabis use.
• Continuing to use cannabis even when it causes problems in relationships.
• Giving up social, occupational or recreational activities because of cannabis use.
• Using cannabis again and again, even when it puts you in danger (like when driving a vehicle).
• Continuing cannabis use despite an ongoing physical or psychological problem that cannabis is likely causing or making worse.
• Developing tolerance (need for increased amounts of cannabis to get the same effect).
• Experiencing cannabis withdrawal symptoms, which you can relieve by taking more of it.

Seeking medical care as soon as you have signs of cannabis use disorder is essential.

Other symptoms and behaviors of cannabis use disorder may include:

• Confusion.
• Memory issues.
• Difficulty learning.
• Hallucinations.
• Delusions.
• Withdrawing from friends and family.
• Sudden changes in mood and behavior.
• Hostility or denial when someone confronts you about cannabis use.
• Not caring about your physical appearance as much as you used to.
• Secretive behavior to hide cannabis use.

What causes cannabis use disorder?

The progression to cannabis use disorder often follows this pattern:

• Experimental use.
• Occasional use.
• Heavy use.
• Substance use disorder.

This progression is complex, and several factors contribute to the development of substance use disorder, including:

• THC’s effect on your brain chemistry.
• Genetics.
• Mental health conditions.
• Access and exposure to cannabis.

Brain chemistry

THC affects your brain, especially the reward center of your brain.

People are biologically motivated to seek rewards. Often, these rewards come from healthy behaviors. When you spend time with a loved one or eat a delicious meal, your body releases a chemical called dopamine, which makes you feel pleasure. It becomes a cycle; you seek out these experiences because they reward you with good feelings.

Substances like marijuana send massive surges of dopamine through your brain, too. But instead of feeling motivated to do the things you need to survive (eat, work and spend time with loved ones), such massive dopamine levels can lead to damaging changes that affect your thoughts, feelings and behavior.

This can create an unhealthy drive to seek more pleasure from marijuana and less from healthy experiences.

Over time, marijuana (THC) can change your brain chemistry, and you become desensitized to its effects. You then need more to produce the same effect.

Genetics

Studies show that genetic factors are responsible for 40% to 60% of the vulnerability to any substance use disorder. If you have a first-degree relative (biological sibling or parent) with SUD, you’re more likely to develop it.

Scientists have found that a change in the CHRNA2 gene on chromosome 8 is associated with CUD.

Mental health conditions

About half of people who experience a mental health condition will also experience a substance use disorder (like CUD) and vice versa. This is known as a dual diagnosis.

SUDs and other mental health conditions happen because of overlapping factors like:

• Genetic vulnerabilities.
• Issues with similar areas of your brain.
• Environmental influences.

Research shows that mental health conditions may contribute to SUD, and SUD can contribute to the development of mental health conditions.

Some people may use cannabis in an effort to manage symptoms of existing mental health conditions (self-medication). This can contribute to CUD.

Access and exposure

Access to cannabis is a particularly significant environmental risk factor. Factors that increase the extent of exposure and the opportunity for cannabis use include:

• Use of cannabis by a member of your household.
• Use of cannabis by your peers.
• Having a medical marijuana certificate (in states where it’s legal).

What are the risk factors for cannabis use disorder?

Certain factors may increase your risk of developing CUD, including:

• Age: People who begin using cannabis before the age of 18 are four to seven times more likely to develop CUD than adults.
• The potency of marijuana: Using higher-potency marijuana (high levels of THC) may increase your risk for CUD. In addition, some methods of using marijuana (like dabbing and vaping concentrates) may deliver very high levels of THC to your body.
• Frequency of use: In one study, 17% of people who used cannabis weekly and 18.8% of people who used cannabis daily met the criteria for cannabis dependence.
• Depression: Having depression may increase your risk of developing CUD.
• Sex: People assigned male at birth (AMAB) are more likely to develop CUD than people assigned female at birth (AFAB).
• Other substance use: Using or misusing other substances (like alcohol, nicotine or hallucinogens, for example) may increase your risk of CUD.

Risk factors for CUD in adolescents, specifically, include:

• Parental substance use.
• Poor school performance.
• Antisocial and oppositional behaviors.
• Alcohol and/or nicotine use.
• Childhood sexual abuse.

What are the complications of cannabis use disorder?

CUD can negatively affect your mental, physical and social health. Physical complications of cannabis use disorder can include:

• Cannabis-induced psychosis.
• Cannabis-induced anxiety disorder.
• Cannabis-induced sleep disorder.
• Cannabis hyperemesis syndrome.
• Chronic bronchitis if you smoke or vape marijuana.
• Fertility issues.

Adolescents with CUD are more likely to experience the following complications:

• Severe CUD (marijuana addiction).
• Altered brain development.
• Cognitive impairment.
• Poor educational outcomes.
• Increased likelihood of dropping out of school.
• Lower IQ.

How is cannabis use disorder diagnosed?

A single test can’t diagnose cannabis use disorder. Instead, healthcare providers rely on a thorough evaluation of your medical history and behaviors surrounding cannabis use. They may also order drug tests.

A provider will also ask about your mental health history, as it’s common to have CUD and a mental health condition.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you must have at least two signs in the symptoms section for over 12 months to be diagnosed with cannabis use disorder.

It’s important to remember that CUD exists on a spectrum of severity:

• Mild CUD: Two to three signs.
• Moderate CUD: Four or five signs.
• Severe CUD: Six or more signs.

How is cannabis use disorder treated?

Effective treatments are available for cannabis use disorder. Treatment depends on the severity of the disorder and is highly individualized — you may need different types of treatment at different times.

Treatment for CUD often requires continuing care to be effective, as CUD is a chronic condition with the potential for both recovery and relapse.

As people with CUD often have co-occurring mental health conditions, treating them together rather than separately is generally better.

The two main forms of CUD treatment include:

• Detoxification.
• Cognitive and behavioral therapies.

There are also several different types of treatment settings, including:

• Outpatient counseling.
• Intensive outpatient treatment.
• Inpatient treatment.
• Long-term therapeutic communities, such as sober living communities.

Detoxification

In detoxification, you stop taking cannabis, allowing it to leave your body. Depending on the severity of the CUD, a healthcare provider may recommend tapering it off to lessen the effects of withdrawal. It’s the first major step of treatment for CUD. You can go through detoxification in both inpatient and outpatient settings.

Scientists are currently studying medication for the detoxification of cannabis.

Cognitive and behavioral therapies

Psychotherapy (talk therapy) can help treat CUD and any other co-occurring mental health conditions. Therapy also teaches healthy coping mechanisms.

Healthcare providers may recommend cognitive and behavioral therapies alone or in combination with medications.

Some examples of effective therapies for adults with CUD include the following:

• Cognitive behavioral therapy (CBT): CBT is a structured, goal-oriented type of psychotherapy. A mental health professional helps you look closely at your thoughts and emotions during CBT. You can unlearn negative thoughts and behaviors through CBT and learn to adopt healthier thinking patterns and habits. For CUD, CBT also involves encouraging motivation to change and education about treatment and preventing relapse.
• Dialectical behavior therapy (DBT): DBT is especially effective for people who have difficulty managing and regulating their emotions. DBT has proven to be effective in treating and managing various mental health conditions, including CUD.
• Assertive community treatment (ACT): ACT provides mental health services in a community setting rather than a residential or hospital setting. ACT is highly individualized. Your treatment plan will focus on your strengths, needs and goals for the future.
• Therapeutic communities (TCs): A TC is a long-term residential treatment that focuses on helping people with CUD develop new and healthier values and behaviors related to substance use and other co-occurring mental health conditions.
• Contingency management (CM): CM encourages healthy behaviors by offering rewards for desired behaviors. Most commonly, the treatment provides something of monetary value to people with CUD to incentivize them not to use cannabis. For instance, upon a negative drug test result, you earn a chance to receive a prize or gift card.

Participating in self-help programs, like Marijuana Anonymous, can also play a significant role in CUD treatment.

How can I prevent cannabis use disorder?

The risk of substance use, including cannabis use, increases greatly during times of stress and change. For an adult, a divorce, loss of a job or death of a loved one may increase the risk of substance use. For a teenager, moving, family divorce or changing schools can increase their risk.

It’s important to turn to healthy coping mechanisms during these times of change, such as exercising, meditating or learning a new hobby. Consider seeing a mental health professional if you’re having issues managing your stress.

What can I expect if I have cannabis use disorder?

The prognosis (outlook) for cannabis use disorder varies based on several factors, including:

• The type and severity of the CUD.
• The degree of dependence and withdrawal.
• The level of commitment to abstinence.
• Treatment time frame.
• Genetics.
• How you cope during stressful situations.

Substance use disorder, including cannabis use disorder, is a lifelong disease. But you can recover from it and lead a full life. Getting help is essential to recovery. Different tools work for different people, but ongoing therapy and self-help groups help many.

CUD is a relapsing disease. If you’re in recovery, you have a high chance of using substances again. Recurrence can happen even years after you last used cannabis.

Because of the possibility of relapse, you need ongoing treatment. Your healthcare provider should review your treatment plan with you and adapt it based on your changing needs.