What is Cannabis Use Disorder?
Cannabis Use Disorder (CUD) is classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), falling under the category of substance and addictive disorders.
Cannabis is often disregarded as an addictive drug despite, according to the National Institutes of Health (NIH), being the most used illicit substance. This is likely due to the fact that marijuana, aka cannabis, can be used for medicinal reasons in some states, has milder withdrawal symptoms than other drugs, and has high social acceptance.
Cannabis is consumed through smoking devices and hand rolled cigarettes, such as joints and blunts, or gummies which contain the Delta-9 THC compound that gets people a high.
Over time, with skyrocketing THC concentrations in cannabis products, the possibility of addiction has become even greater.
In fact, according to the Centers for Disease Control and Prevention 3 in 10 people who use cannabis are estimated to have Cannabis Use Disorder.
The Psychology Behind Cannabis Use Disorder
The use of cannabis positively affects the reward centers of your brain which often causes dependence on the drug, leading to withdrawal symptoms when one tries to quit.
Cannabis is primarily smoked. When substances are smoked, they reach the brain and are absorbed by the lungs faster. This quick influence on the brain causes pleasure, which is unfortunately [can be] a main factor of the abuse potential.
Important Factors
Wanting to manage depression and lower stress are major factors contributing to cannabis use amongst users.
Adolescents are most vulnerable to addiction to cannabis, even if they are using low levels. College students and young adults reported their reasons for using cannabis as mostly to fit in socially, followed by a desire to experiment, and also for pleasure. Use of cannabis at a younger age predisposes people to addiction.
Early cannabis use increases the risk of addiction.
Cannabis is the most used drug amongst pregnant mothers who admitted to using drugs. The reasons stated for use were to manage depression, anxiety, and stress, pain, nausea, and for recreation.
Symptoms and Signs
When used, common symptoms include euphoria, anxiety, feeling giggly, increased appetite, inattentiveness and forgetfulness, restlessness, tachycardia or an extremely high heart rate, bloodshot eyes, and dry mouth. Less common and most serious effects include psychotic episodes, delusions, hallucinations, and derealization according to the NIH. Continuous use typically causes a depressed mood, loss of interest, isolation, apathy, and lack of motivation. This lowered mood can cause thoughts of suicide.
Adverse intoxication of cannabis, also known as “greening out” are triggered by consuming high doses of THC. The symptoms of greening out include throwing up, feeling nauseous, paranoia, dizziness, sweating, shaking, panic attacks, and feelings of impending doom.
According to the NIH, studies point to the fact that regular or heavy cannabis use increases the risk of developing schizophrenia or experiencing psychotic episodes. Vulnerable populations include those with a family history of bipolar disorder and/or schizophrenia due to a genetic predisposition.
Chronic use is likely to cause a decreased sense of satisfaction with one’s life and cause respiratory issues. It impairs the neurology of the brain, alters brain development, causes cognitive impairment, and can exacerbate mental health. Cannabis decreases attention span and is linked to poor educational outcomes due to a higher likelihood of individuals who use cannabis dropping out of school. Cannabis use can lead to a reduced attention span and is associated with negative educational outcomes, including an increased probability of individuals discontinuing their schooling.
Other disorders related to cannabis are Cannabis-Induced Psychotic Disorder, Cannabis-Induced Anxiety Disorder, and Cannabis-Induced Sleep Disorder.
Cannabis Use Disorder Exists on a Spectrum.
The criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) consider 3 severities of TUD: mild, moderate, and severe. If a medical professional notes that you meet 2-3 symptoms, that characterizes mild TUD. Moderate TUD is characterized by the presence of 4-5 symptoms. Severe TUD is characterized by the presence of 6 or more symptoms.
CUD, Cannabis Use Disorder, is characterized by the presence of clinically significant impairment or distress in 12 months.
CUD includes tolerance and withdrawal. TUD is manifested by two or more of the following symptoms, occurring within the past 12-months:
- Cannabis is taken in larger amounts or used over a longer period than intended
- Persistent desire to cut down with unsuccessful attempts
- Excessive time spent acquiring cannabis, using cannabis, or recovering from its effects
- Cravings for cannabis use
- Recurrent use resulting in neglect of social obligations
- Continued use despite social or interpersonal problems
- Important social, occupational, or recreational activities foregone to be able to use cannabis
- Continued use despite physical harm
- Continued use despite physical or psychological problems associated with cannabis use
- Tolerance
- Withdrawal symptoms when not using cannabis [4]
Cannabis withdrawal accompanies cessation of cannabis use that has been heavy and prolonged (ie, usually daily or almost daily use over at least a few months). Three or more of the following signs and symptoms develop within 1 week after cessation of heavy, prolonged use:
- Irritability, anger, or aggression
- Nervousness or anxiety
- Sleep difficulty (ie, insomnia, disturbing dreams)
- Decreased appetite or weight loss
- Restlessness
- Depressed mood
At least one of the following physical symptoms are causing significant discomfort:
- Abdominal pain, shakiness or tremors, sweating, fever, chills, or a headache.
- The signs or symptoms are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.
The Path to Recovery
Luckily, getting access to counseling or psychiatric services can help identify mental illnesses that may be comorbid, or occurring at the same time as CUD, often exacerbating the issue. Counseling will help individuals modify their habits and develop healthy coping skills. There is also Marijuana Anonymous, which is similar to Narcotics Anonymous where those suffering from CUD come together to talk about their struggles and encourage each other’s recovery. Gradual decrease of cannabis is often preferred to quitting “cold-turkey”, also known as quitting abruptly. This helps lower the relapse rate due to withdrawal symptoms being easier to manage. Usually, getting high does not require medical help. However, there is treatment for adverse symptoms such as tachycardia and panic attacks in which a licensed professional can prescribe banzodiazepines or other anxiety reducing medications to make the quitting process easier. It is also important to note that there is no direct medication to treat CUD. The chance of prolonged cannabis use depends on individuals. Those who are impulsive, avoid boredom and unpleasant events, or use cannabis to self medicate for mental health issues have a high likelihood of long-term cannabis use.
