Other Cannabis-Induced Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) outlines specific criteria for a person’s symptoms to rise to the level of receiving a diagnosis of a cannabis-induced disorder, including the following. 

Symptoms required for diagnosis of cannabis intoxication delirium

Delirium³ is defined by the American Psychiatric Association as “a disturbed mental state in which attention cannot be sustained, the environment is misperceived, and the stream of thought is disordered.” For delirium to be associated with cannabis intoxication,⁴ the following four symptoms must be present:

• Recent use of cannabis, whether recreationally or medically
• A disturbance in attention, a person’s ability to focus, and their ability to shift their attention
• A disturbance in awareness, meaning a person is no longer able to perceive their environment correctly 
• At least one additional cognitive disturbance, which may involve an inability to recall memories, disorientation, or language loss

Symptoms required for diagnosis of cannabis-induced psychosis

For cannabis-induced psychotic disorder to be diagnosed, an individual must experience hallucinations or delusions during or after cannabis use or withdrawal. A hallucination is a sensory perception that the individual believes to be real, although it is not grounded in any aspect of reality, such as hearing voices. A delusion is a belief that the person firmly adheres to despite its irrationality, such as a belief that other people can read one’s thoughts.

Symptoms of cannabis-induced anxiety disorder 

For cannabis-induced anxiety disorder to be diagnosed, individuals must experience anxiety or panic attacks during or after cannabis use or withdrawal. Anxiety is a pervasive sense of worry about the future that typically is not tied to any specific future event. Panic attacks are episodes in which a patient experiences feelings of intense fear and panic accompanied by physical symptoms such as chest pain, difficulty breathing, and heart palpitations.

Cannabis-induced sleep disorder 

For cannabis-induced sleep disorder to be diagnosed, an individual must experience significant disturbances in sleep during or after cannabis use or withdrawal. To receive a diagnosis of any cannabis-induced disorder, a patient’s symptoms cannot be better explained by another mental health disorder, such as a psychotic disorder, an anxiety disorder, or a sleep disorder. 

The only definitive cause of cannabis-induced disorders is the recent use of cannabis. However, several risk factors can increase the chances that a cannabis user may experience one of these disorders.

Cannabis intoxication delirium

Risk factors for cannabis intoxication delirium include:

• More concentrated levels of delta 9-tetrahydrocannabinol (THC), the main psychoactive compound in cannabis
• Certain methods of cannabis intoxication (smoking cannabis will typically result in a faster onset of symptoms than ingesting it orally)
• Individual factors, such as tolerance level, sensitivity, and bodily absorption rate
• Use of other recreational substances such as alcohol and street drugs (both concurrent use and having a history of past use)
• Use of prescribed psychotropic medications, such as those used to treat anxiety disorders, depression, bipolar disorder, and schizophrenia

Cannabis-induced psychotic disorder

Cannabis can act as a stressor on the brain that can lead to the emergence of psychotic symptoms that may have remained latent otherwise. It is thought that THC’s long-acting properties may lead to a buildup of THC in the body and brain after prolonged cannabis use, which may eventually cause an acute psychotic episode. Evidence suggests that genetic factors might also predispose some people to experiencing cannabis-induced psychosis.

Cannabis-induced anxiety disorder

Evidence suggests that genetic factors might also predispose some people to experiencing cannabis-induced psychosis. In many cases, cannabis use starting at a younger age, typically adolescence, is associated with a greater risk of developing cannabis-induced anxiety disorder.

Cannabis-induced sleep disorder

Researchers have found that THC binds to receptors in the nervous system that are associated with sleep regulation. Their findings indicate that these receptors may demonstrate impaired functioning after long-term cannabis use, potentially due to desensitization. Genetics related to the development of cannabis use disorder may also be linked to the development of insomnia and other sleep disorders, indicating a brain link between cannabis use and sleep disturbance.

The goal of treatment for cannabis-induced disorders is often cessation of cannabis use, which leads to an absence of symptoms. Therefore, standard treatments for cannabis-induced disorders often overlap with treatments for cannabis use disorder (CUD), with some variations.  

Medication

For cannabis-induced psychotic disorder, antipsychotic medications may be effective at preventing future episodes. 

For cannabis-induced acute anxiety, benzodiazepines may be effective at treating cannabis-associated anxiety and panic attacks in the short term, but these medications also have high abuse potential.

For cannabis-induced hyperemesis (vomiting) syndrome, typical anti-nausea medicines do not usually work well. In these cases antipsychotic medications like haloperidol or olanzapine have been used with some success. 

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance.   

Self-care

For cannabis-induced anxiety disorder, techniques that may ground a person and center them in the present moment may alleviate some symptoms. These techniques include mindfulness, meditation, deep breathing, and yoga. Journaling can also be beneficial, as documenting one’s feelings on paper may make them less overwhelming. 

For cannabis-induced sleep disorders, practicing sleep hygiene can be valuable. Sleep hygiene involves going to bed at the same time every night, avoiding screens for at least two hours before bedtime, and developing a relaxing bedtime routine such as reading a book or having a warm cup of tea before bed. Avoiding additional substances like caffeine, alcohol, and sugar can also make a difference in getting better sleep.

For cannabis-induced psychosis, it may be helpful to know that a psychotic episode can be worsened and potentially caused by stress. The strategies listed above may reduce stress and mediate psychotic symptoms.

Cannabis-induced disorders can cause significant disruptions in functioning. High levels of anxiety or fear of a future psychotic episode may make the thought of seeking professional help seem overwhelming. In these situations, online therapy through a platform like BetterHelp may be a beneficial resource. With internet-based therapy through a legitimate online platform, clients can find cognitive-behavioral therapy and other techniques for reducing cannabis use and addressing cannabis-induced symptoms from the comfort and convenience of their own homes. 

If you are attempting to stop your cannabis use but are running into difficulties, several resources can connect you to additional support. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a comprehensive information page on cannabis use, and the US Department of Health and Human Services FindTreatment.gov page can connect individuals to addiction care providers. Marijuana Anonymous is a national network of peer support groups where people can build connections with other people who are interested in reducing their cannabis use.

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

Research has indicated the possible existence of a relationship between how the brain processes dopamine, one of the “feel good” neurotransmitters, and experiences of psychosis. One study found that long-term use of cannabis resulted in a reduced ability to synthesize dopamine, which presents differently than the dopamine-related impacts associated with other psychotic disorders, such as schizophrenia. This finding implies that different brain mechanisms may cause cannabis-induced psychosis than other forms of psychosis, which could influence future treatment options.

Cannabis use and its associated complications, including cannabis-induced disorders, occur at higher rates in younger populations, typically highest for people between the ages of 18 and 25. A study examined the effectiveness of a text therapy program in reducing cannabis use among younger adults. The researchers found that participants in the program decreased their cannabis use and reported fewer cannabis-related mental health concerns. Unique therapy options such as text therapy may be effective for younger populations, who make up most cannabis users.

Below are several statistics on cannabis-induced disorders:

• 25% to 30% of all emergency room visits involving cannabis are for cannabis-induced psychotic disorder. 
• One study found that out of a sample of patients seeking medical care for cannabis use, 17.3% experienced cannabis-induced anxiety, with almost 12% reporting panic attacks. 
• After recreational cannabis use was decriminalized in Canada, there was a 56% increase in young adults seeking medical care for cannabis intoxication delirium.
• Roughly 82% of people who experience a cannabis use disorder are able to stop using cannabis within five years after undergoing treatment.