Cannabis Use Disorder

The primary symptoms used to diagnose this disorder are related to an individual’s patterns of cannabis use and its impacts on their life. It may not be possible to define how much marijuana use is “too much.” Instead, diagnosis may come down to assessing whether a person’s cannabis use is difficult for them to control, getting in the way of their happiness, or causing significant personal consequences. Typically, an individual’s symptoms will be compared with the diagnostic criteria for cannabis use disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders. Notable symptoms listed in the DSM-V include:

• Using cannabis more often, or in higher amounts, than intended
• Continuing cannabis use despite a desire to quit
• Repeated unsuccessful attempts to cut down on usage
• Using cannabis in inappropriate or dangerous situations
• A significant proportion of time spent on cannabis use and related activities
• Strong urges or cravings for cannabis intoxication
• Neglecting responsibilities due to cannabis use
• Cannabis use getting in the way of social, recreational, or work-related activities
• Continued usage despite personal or professional consequences
• Continued usage despite medical problems linked to cannabis, such as a cough or lung pain 

Developing a tolerance for marijuana or its primary intoxicating ingredient (THC) could also be a warning sign of CUD. Tolerance means that an individual’s body has become less sensitive to a particular substance, so taking a dose of the same strength reduces the effect. This action may lead some users to begin using more and more of the substance to achieve the same level of intoxication.

Cannabis withdrawal

Another possible symptom of cannabis use disorder is the experience of withdrawal from the substance. Cannabis withdrawal was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, after being left out of the fourth edition. Withdrawal can happen when the body becomes accustomed to regular doses of cannabis, so when drug use temporarily ceases, the user experiences unpleasant physiological reactions. Though some people may believe cannabis use does not lead to a withdrawal syndrome, a 2020 meta-analysis found evidence that a significant portion of habitual users may experience withdrawal. Effects of cannabis withdrawal can include:

• Anxiety
• Disrupted sleep, including insomnia or vivid nightmares
• Irritability
• Chronic anger
• Lack of appetite
• Depressive symptoms
• Restlessness
• Trembling or shaking
• Muscle tension
• Headaches 
• Abdominal discomfort or pain
• Excessive sweating
• Chills
• Fever

Identifying the exact causes of cannabis use disorder can be difficult, as there’s not a widely accepted standard for distinguishing between problematic and non-problematic cannabis use. Some studies have found that using this substance is not a strong predictor of developing CUD. Social, psychological, and genetic risk factors may be more critical.

Some risk factors that have shown predictive value in long-term studies of cannabis users include:

• Use of other substances
• Mental health conditions, especially mood disorders like depression
• Favorable peer attitudes toward cannabis use
• Being a man 

Another potentially vital characteristic is age at the time of first cannabis use. Studies suggest that the younger a person is when they first begin consuming marijuana, the more likely they are to develop cannabis use disorder later in life. It’s unclear whether this connection is a cause-and-effect relationship, however. There could be another factor that makes a person more likely to try cannabis at a younger age and more likely to develop problematic use. 

The most common treatments for CUD are psychotherapies like cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET), though pharmacological options like gabapentin may also be used. These methods often aim to reduce the client’s use of cannabis and help them self-regulate their usage, as well as alleviate the effects of cannabis withdrawal.

Medication

There are currently no FDA-approved medications for treating cannabis use disorder. Researchers are continuing to search for effective pharmacological treatments. Some potential medications are aimed at reducing the symptoms of cannabis withdrawal, while others are intended to assist with abstinence and prevent relapse. Certain medications may also target other mental health conditions that can occur alongside CUD and increase its severity.

Early trials have shown potentially promising results from medicines like:

• Naltrexone, an anti-opioid drug that may reduce cannabis cravings in some users
• Bupropion, an antidepressant often used for cigarette smoking cessation
• N-acetylcysteine, a supplement that may decrease the body’s cravings for certain drugs
• Gabapentin, which decreases nervous system excitement and could ease withdrawal symptoms

Consult a medical doctor before starting, changing, or stopping medication for any health condition. 

Self-care

Individuals with CUD may also enhance their recovery with positive lifestyle changes and motivational strategies. Some people who successfully overcome problematic cannabis use recommend techniques like focusing on more constructive life activities and steering clear of known reasons for use. They also mention the importance of maintaining focus on their reasons for wanting to decrease cannabis use.

Self-care strategies that may help you decrease the urge to use cannabis and moderate withdrawal effects include:

• Cultivating new social relationships
• Taking up a constructive or creative hobby
• Engaging in regular exercise
• Meditation
• Seeking support from family and friends
• Attending Narcotics Anonymous, Marijuana Anonymous, or another support group 

There are various resources available for those seeking support in quitting or reducing cannabis use. Reaching out to a mental health professional who can provide therapy may be the most effective option. A primary care doctor can often refer individuals to a counselor trained in techniques like CBT and MET. 

Online therapy is also an increasingly popular option. Locating a therapist through an online platform like BetterHelp may be faster than going through the usual channels, and attending therapy remotely is often more convenient. Though this treatment may be newer, it has shown substantial effectiveness in randomized trials.

In addition, there are numerous governmental sources for further information on cannabis use disorder. The National Institute on Drug Abuse, a division of the National Institutes of Health, offers a comprehensive educational site on marijuana, as well as the Substance Abuse and Mental Health Services Administration (SAMHSA) 

Peer support groups may also be helpful in combating CUD. Marijuana Anonymous is a worldwide organization focused on helping people addicted to this substance. It offers a space where those struggling with cannabis use can talk freely about their difficulties without fear of being stigmatized or dismissed. The National Alliance on Mental Illness (NAMI), a non-profit organization aimed at addressing mental health challenges, also provides all-purpose peer support groups around the country.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

One major cause for concern among researchers and clinicians studying cannabis use disorder is the increasing availability and potency of marijuana due to legalization or decriminalization in various US states. Observers are concerned that with high-THC marijuana becoming more accessible to obtain, CUD rates will increase. The data on this question is far from conclusive, however. A 2021 review noted that there was some evidence for an increased risk of cannabis use disorder for adults — though not for adolescents — following medical or recreational legalization.

A 2023 study reported that after the legalization of recreational cannabis use, consumption of cannabis increased among adolescents and young adults, but fewer people sought treatment for cannabis use disorder. The authors suggested that there may be two factors at work: 

1. Increased social acceptability of marijuana may reduce some of the negative consequences that accompany the use of this substance, potentially decreasing CUD.
2. At the same time, increased perceptions that cannabis use is harmless may make people with CUD less likely to seek treatment.

Among those who do choose to pursue treatment for cannabis use disorder, more options may be available in the near future. A 2023 experimental trial of a medicine that blocks cannabinoid receptors demonstrated a significant reduction in marijuana use. This medication appears to function by reducing the perception of the positive effects of ingesting cannabis. However, more research may be necessary to replicate these findings.

22% to 33% of people who use cannabis may develop cannabis use disorder

Researchers estimate that 22% of all past cannabis users are at risk of developing cannabis use disorder (CUD) compared to 33% of young people who use the substance weekly or on a daily basis, who are more likely to develop the condition.¹

¹Addictive Behaviors Journal

Below are more statistics on cannabis use disorder: 

• According to a 2015 survey, roughly 4% of the world’s population were cannabis users, with considerably higher percentages among adolescents.
• The potency of recreationally available marijuana has been sharply increasing — the average TCH percentage as measured in 2017 was 17.1%, nearly twice the average in 2008.
• Studies indicate that more than 80% of people with cannabis use disorder eventually recover, most within three years or less.