Cannabis use disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 28, 2016
StartDiseasesCannabis use disorder

Cannabis, otherwise known as marijuana, is the most popular illicit substance used globally. Cannabis has psychoactive properties as a result of a substance called delta-9-tetrahydrocannabinol (THC). The amount of THC in cannabis has increased from an average of about one to five percent in the 1960s to about 10 to 15 percent today, and the potency of the drug has also increased. For most people, the habitual use of cannabis will likely be limited to the teenage years and the 20's. However, cannabis use disorder (or marijuana use disorder) is a disorder that involves unhealthy and harmful consequences of using the drug.

Contents

Definition & Facts

Previously, problems with marijuana use were classified as either cannabis dependence or cannabis abuse. As outlined by the fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM), these two conditions have now been replaced by the term cannabis use disorder. Contrary to popular opinion, cannabis has been found to be addictive (that is, cause dependence) as reflected by research indicating that withdrawal symptoms become evident within 24 hours after cessation of use.

Complicating what is most often a problem occurring in the teenage years is the increased risk that a person with cannabis use disorder may abuse other substances such as alcohol or may have mental health problems. Treatment and prevention programs are available to address cannabis abuse and dependency and take into consideration co-existing psychiatric disorders and substance use.

Symptoms & Complaints

The severity of the patient's cannabis use disorder is measured by how many of the symptoms are present. A wide range of symptoms exist and they include:

  • Habitually using more cannabis than was planned
  • Devoting a large portion of time to cannabis use
  • Difficulty reducing or ceasing use of cannabis
  • Feeling a frequent urge to use cannabis
  • Experiencing negative consequences at home, school and/or work as a result of cannabis use
  • A refusal to cease cannabis use despite negative effects on one's relationships or social life
  • Dropping other activities in order to spend more time using cannabis
  • Using cannabis in situations that are risky
  • Continuing cannabis use despite negative mental or physical consequences
  • Experiencing higher and higher tolerance for cannabis, and the occurrence of withdrawal symptoms when use of cannabis has been discontinued.

Unlike alcohol or other harsher illicit drugs, the effects of cannabis may manifest very slowly.

Causes 

As with many other drugs, cannabis promises the user with the reward of getting "high." Combined with a feeling of euphoria is the general perception that cannabis is relatively safe. These two factors often lead young adults to experiment with cannabis, though many of these users do not understand that cannabis may cause a number of harmful effects.

Many of the classic withdrawal symptoms, such as anxiety, irritability, stomach pain, and aggression occur when cannabis use is discontinued. In addition, long-term use of cannabis may cause changes in the brain, similar to other addictive drugs. The combination of the addictive nature of cannabis, its long-term effects, and the current trend of increased potency of the drug have contributed to an increase in cannabis use disorder.

Risk factors for cannabis use disorder include a family history of substance abuse, antisocial personality disorder, tobacco use, low socioeconomic status, an unstable or abusive family life, family members who use cannabis and poor academic performance. It is quite common for teenagers or young adults to experiment with using cannabis.

Diagnosis & Tests 

Diagnosis usually involves examining the patient for at least two of the symptoms of cannabis use disorder. A patient is considered mildly affected if he or she has two to three of the symptoms, moderately affected if four to five of the symptoms are present, and severely affected if six or more symptoms are evident.

Treatment & Therapy 

Because cannabis use disorder may co-exist alongside addictions to other substances or other psychiatric conditions, treatment for each individual case is unique. The most common approach to recovery is through various kinds of psychotherapy (talk therapy). Among the types of therapy that have shown promise are cognitive behavioral therapy, contingency management, and motivational enhancement therapy. A goal of treatment is for an individual suffering from cannabis use disorder to gain an understanding that the heavy use of cannabis has caused numerous undesirable consequences.

One particularly common symptom of withdrawal upon discontinuing one's ongoing cannabis use is insomnia. For this reason, a number of sleep medications are used to treat cannabis use disorder.

In addition, self-help programs and twelve-step programs (Marijuana Anonymous) may be very useful in increasing the chances for ongoing abstinence as well as enabling a patient to develop relationships with people who do not use cannabis. In all cases, treatment seeks to enable the individual to discontinue abusing the drug.

Prevention & Prophylaxis 

The strongest efforts at prevention of cannabis use disorder focus on teenagers and young adults. Among three major types of prevention programs, the first consists of universal prevention programs which often target teenagers before they have started to experiment with cannabis use. The effectiveness of these programs has been mixed. Universal prevention programs may be conducted at schools and reach an entire population.

The second type of prevention programs are those conducted which seek to identify populations vulnerable or at-risk of developing a cannabis use disorder. Screening and assessment programs conducted in school have also been used to identify students who show some indication that cannabis use may be a problem.

Indicated prevention programs target those populations which are already demonstrating symptoms of substance use or abuse. These attempt to prevent the vulnerable population from developing a full-blown disorder. It may be possible to identify these populations in a school setting by indications such as truancy, bad grades, and evidence of suicidal ideation.