Substance use disorder is a complex condition marked by uncontrolled use of a substance despite the harmful consequences it causes. The most common substances people abuse are alcohol, cocaine, opioids, heroin, amphetamines, but also cannabis.
The generally accepted idea is that cannabis is safe and harmless. Many marijuana users believe they can’t develop dependence or addiction. The reality is different. This post explains what is cannabis use disorder and everything you need to know about it.
The Legal Status of Cannabis In The United States
In the United States, cannabis is classified as a Schedule I drug. The Drug Enforcement Administration (DEA) describes Schedule I as a drug, substance, or chemical with no currently accepted medical use and a high potential for abuse. Besides marijuana, this class of drugs also includes heroin, ecstasy, LSD, among others.
The use and possession of marijuana are illegal under federal law for any purpose in the U.S. due to the Controlled Substances Act of 1970, which classified cannabis as a Schedule I drug. Despite the illegal status of cannabis on the federal level, most U.S. states have legalized the plant for adult or medicinal use.
In 35 states of the U.S., the medicinal use of marijuana (with a doctor’s recommendation) is legal. Cannabis use is also legal in the District of Columbia and four out of five permanently inhabited U.S. territories. Other 13 states implemented laws to limit THC content.
Recreational cannabis use is legal in 14 states, the Northern Mariana Islands, District of Columbia, and Guam. The use of marijuana is decriminalized in other 13 states and U.S. Virgin Islands. Additionally, commercial distribution of marijuana is permitted in all places where marijuana is legalized except the District of Columbia.
What is Cannabis Use Disorder?
Cannabis use disorder (CUD), also known as marijuana use disorder, is a diagnosis that indicates problematic marijuana use, i.e., when a person continues to use cannabis despite consequences they experience. This problem was first defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Before that, problematic marijuana use was separated into two different disorders: dependence and addiction.
The term cannabis use disorder involves the possibility that marijuana can impact a person negatively without necessarily developing an addiction. However, it also recognizes that cannabis use can lead to tolerance, dependence, and addiction, both of which are more common than people believe.
Even though a general belief is that a person can’t be addicted to marijuana, the reality is they can (which is why it is classified as a Schedule I drug). Problematic use of marijuana is indicated by the onset of withdrawal symptoms when a person stops using it. As dependence and other factors escalate to cannabis use disorder (and, in the most severe form, addiction), a person can’t stop using the drug despite its interference with many aspects of their life.
The previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) didn’t include cannabis withdrawal due to lack of evidence. But, since then, the reliability and validity of cannabis withdrawal have been observed in studies of different formats (preclinical, clinical, and epidemiological). Evidence shows one-third of regular marijuana users in the general population reported withdrawal symptoms between 50% and 95% of heavy users reported withdrawal symptoms, as well.
How Many People Have Cannabis Use Disorder?
Cannabis is the most frequently used psychotropic drug in the U.S., according to the National Institute on Drug Abuse. Over 11.8 million young adults admitted to marijuana use in the last 12 months of 2018. Most cannabis users were males.
The Drug and Alcohol Dependence journal published a study that analyzed the prevalence of CUD in the adult U.S. population. For this purpose, the researchers analyzed data from 759,500 persons aged 18 or older who participated in the 2002-2017 U.S. National Surveys on Drug Use and Health (NSDUH).
During this period, the prevalence of CUD among adults remained stable at 1.4% to 1.5%. That being said, cannabis use jumped from 10.4% to 15.3%. Daily or near-daily use went from 1.9% to 4.2%. Mild DSM-5 CUD decreased from 1.4% to 1.9%. Past-year prevalence of CUD from DSM-IV manual dropped from 14.8% to 9.3%.
The same report showed that DSM-5 moderate and severe CUD cases decreased 4.3% to 3.1% and 2.4% to 1.3%, respectively. Scientists observed an increased prevalence of cannabis tolerance. Scientists also concluded DSM-5 single dimension CUD measure is more sensitive to diagnosis prevalence changes than DSM-IV diagnoses (dependence and abuse categories separately).
The use of marijuana is particularly prevalent in the young population, according to the above-mentioned report by National Institute on Drug Abuse. Many adolescents admit to using cannabis. What’s more interesting, a major rise in marijuana use among younger school grades was observed in 2019. The rise of cannabis use among adolescents results from a false perception where teens believe the drug has no risks and dangers.
In 2019, about 11.8% of 8th graders used cannabis in the past year, and 6.6% were current users (reported cannabis use in the past month). When it comes to 10th graders, the past-year use was reported by about 28.8% of students, whereas past-month use by 18.4%.
Around 35.7% of 12th graders reported marijuana use in the past year, while 22.3% admitted to using cannabis in the past month. Of these, 6.4% reported daily use. Medical emergencies involving marijuana also increased.
A report from the December 2019 issue of the Drug and Alcohol Dependence focused on the prevalence of cannabis use disorder in adolescents and adults. Scientists used 2002-2016 NSDUH data of 22,651 persons using cannabis for 300+ days in the past year.
During this period, the prevalence of CUD among people who reported daily cannabis use decreased by 26.8% in teenagers, 29.7% in young adults ages 18 to 25, and 37.5% in adults ages 26 and older. It’s important to mention the research focused on criteria from the DSM-IV manual.
According to the CDC, about one in 10 marijuana users will become addicted to the drug. The likelihood of developing addiction increases with the early age of onset of cannabis use. One in six people who start using marijuana younger than 18 becomes addicted.
How Does Cannabis Use Disorder Develop?
It would be impossible to discuss the development of cannabis use disorder without addressing the short- and long-term effects of this plant on the brain. So, that’s exactly what we are going to do before taking you through symptoms of cannabis use disorder.
A common misconception about marijuana is that it doesn’t yield negative effects on the user, but the reality is different. For that reason, it’s important to know what happens to the brain when a person uses marijuana in order to understand cannabis use disorder.
How Does Cannabis Produce A “High” Effect?
The primary psychoactive compound of marijuana, delta 9-tetrahydrocannabinol (THC), is responsible for the cognitive and addictive potential of this plant. In other words, THC is the culprit behind the “high” effect a person experiences when smoking cannabis. The structure of THC is similar to the brain chemical anandamide. This similarity allows the body and brain to recognize THC, which leads to altered normal brain communication.
Endogenous cannabinoids like anandamide function as neurotransmitters in a way they send chemical messages between neurons throughout the nervous system. They act on brain areas that play a role in pleasure, memory, concentration, attention, thinking, movement, coordination, sensory, and time perception. Since it’s similar to anandamide, THC can attach to cannabinoid receptors on neurons in these brain areas and activate them. THC can alter the functioning of the hippocampus and orbitofrontal cortex, brain areas that allow you to form memories or shift your attentional focus.
That’s why marijuana use, especially chronic, can impair thinking and interfere with a person’s ability to learn and perform complex tasks. Additionally, THC disrupts the functioning of the cerebellum and basal ganglia, which regulate balance, coordination, reaction time, and posture. This explains why persons who use marijuana may not be able to drive safely or experience problems when playing sports and engaging in other physical activities.
The Journal of Addiction Medicine published a review of studies exploring acute, residual, and long-term effects of cannabis use on executive functions, and results show the use of marijuana can have a significant impact on your brain and how you use it.
Acute or Immediate Effects of Marijuana (Occurring Within 0-6 Hours After Cannabis Use)
Upon smoking cannabis, the concentration of THC in the blood is detectable almost instantly. Considering the fact THC is fat-soluble, this psychoactive cannabinoid is easy to store in the body and released into your blood circulation.
The half-life of THC is long, and it’s all due to its fat-solubility. For that reason, the compound can be easily detected in a person’s urine. In fact, THC can stay in the system from one day to over a month after ingestion.
A marijuana user experiences the psychoactive effects of cannabis almost instantly after they smoke. Additionally, about 30 minutes after ingestion, a person achieves peak levels of intoxication, and they may last for several hours. Immediate effects of cannabis on cognition are demonstrated in the table below.
| Attention/concentration | Risk-taking and decision-making | Inhibition and impulsivity | Working memory | Verbal fluency (ability to generate letters or words in a specific amount of time) |
|---|---|---|---|---|
| Evidence on acute effects of cannabis on attention and concentration is mixed. Some studies showed acute intoxication could improve attention, while others observed impairments in attention and concentration. However, abstinence after marijuana use may cause information processing deficits. Slowed information processing could encourage a person to continue using marijuana in an effort to improve their information processing skills. This is especially the case with chronic use. | Chronic use of cannabis is also associated with risk-taking behaviors and longer planning times. The review confirmed the immediate effects of marijuana use include evident impairments in areas of planning and decision-making, especially in accuracy, response speed, and latency. | Acute marijuana use leads to more impulsive behavior and decreased inhibition. | Consumption of cannabis harms working memory. Working memory is the cognitive ability to hold and manipulate information and recall it after a short delay. In fact, acute intoxication with cannabis can cause significant impairments of working memory, especially with higher doses. | Cannabis use may not have an acute or immediate impact on verbal fluency. |
Acute or immediate effects of marijuana use on concentration and attention tend to be more pronounced in less experienced users than persons with a tolerance to cannabis. This only shows a person can build up a tolerance with chronic use, which may lead to dependence and the subject of our article – cannabis use disorder.
Residual Effects of Cannabis (7-20 Hours After Use)
Effects of cannabis use go beyond short-term changes in cognition. A marijuana user can experience certain effects for several weeks. Take a look at the table below to learn more.
| Attention/concentration | Risk-taking and decision-making | Inhibition and impulsivity | Working memory | Verbal fluency (ability to generate letters or words in a specific amount of time) |
|---|---|---|---|---|
| Cannabis use can affect attention and concentration for days or weeks after the last use. Evidence is still mixed on this subject. | Cannabis users have greater risk-taking tendencies and significant deficits in decision-making capacities than their counterparts who don’t use marijuana | Heavy marijuana use increases errors of inhibition and preservation after at least 12 hours of abstinence compared to light use. The gravity of deficits correlates with years of cannabis use. Evidence is still mixed on this subject. | Cannabis use may not have residual effects on working memory. Further studies are required to know more. | Some studies confirm cannabis has residual effects on verbal fluency, but the evidence is still largely mixed. |
Recently abstinent marijuana users often face problems in different aspects of their cognitive functioning. Their attention skills, concentration, impulsivity and inhibition, and other executive functions may or may not suffer as THC, and its metabolites are eliminated from their body and brain. Mixed evidence on this subject is largely due to studies with small sample sizes.
Long-Term Effects of Marijuana (3 Weeks and Beyond After Last Use)
A vast majority of studies focus on the short-term effects or potential benefits of cannabis. Only a handful of scientists have explored the long-term impact of cannabis use on the brain and cognitive functions. The table below demonstrates the long-term influence of marijuana on a person’s cognitive skills.
| Attention/concentration | Risk-taking and decision-making | Inhibition and impulsivity | Working memory | Verbal fluency (ability to generate letters or words in a specific amount of time) |
|---|---|---|---|---|
| Some studies have observed long-term attention and concentration impairments in heavy users. | Cannabis use is associated with significant impairment in risk-taking and decision-making in the long-term. | Studies focusing on different scales found different results in terms of the long-term impact of cannabis on inhibition and impulsivity. | Only one study explored the long-term influence of cannabis use on working memory and didn’t find deficits. The sample was small, though. | Early-onset cannabis users may experience significant impairments in verbal fluency. |
A lot more research is necessary to uncover the long-term effects of cannabis use. Age of onset of cannabis use, years of use, and the dosage could influence the likelihood and severity of long-term effects.
The table below summarizes the acute, residual, and long-term effects of cannabis on cognitive abilities.
| Cognitive function | Acute effects | Residual effects | Long-term effects |
|---|---|---|---|
| Attention and concentration | Impaired in less experienced users Normal in chronic users |
Evidence mixed, studies point to deficits. | Impaired in some users, normal in others |
| Decision-making and risk-taking | Impaired | Impaired | Impaired |
| Inhibition and impulsivity | Impaired | Impaired with heavy use | Mixed evidence |
| Working memory | Impaired | Normal | Normal |
| Verbal fluency | Normal | Mixed evidence | Impaired in persons with early-onset |
Besides the above-mentioned review, it’s also useful to mention a paper from the Current Opinion in Psychology which found that cannabis intoxication impairs learning and memory in a dose-dependent manner. Adolescent cannabis users may experience delayed recall and episodic memory impairments.
The National Institute on Drug Abuse explains marijuana exposure during development can cause long-term or possibly permanent adverse changes in the brain. Imaging studies of marijuana’s impact on the brain structure have shown cannabis use in adolescence may alter connectivity and reduce the volume of brain regions involved in executive functions such as memory, learning, and impulse control.
Additionally, marijuana use can cause functional impairment in cognitive abilities, but the severity of deficits depends on the age when a person has started using the substance, dosage, and how long they’ve been using it.
The Path to CUD
Acting through cannabinoid receptors, THC activates the reward system in the brain. The Reward system includes regions responsible for healthy pleasurable behaviors such as eating and sex. Like other substances that people misuse, THC can stimulate neurons in the reward system to release excessive levels of dopamine.
The flood of dopamine contributes to the pleasurable “high” effect that people link to marijuana use. Eventually, a person needs more and more marijuana, i.e., THC, to experience the same effect. That happens because they become tolerant of the substance. With time, this leads to dependence and subsequent addiction, which falls into cannabis use disorder.
What Are The Symptoms of Cannabis Use Disorder?
Not every cannabis use will result in CUD. The presence of at least two of the following symptoms within 12 months indicates cannabis use disorder:
- Hazardous use, i.e., taking more than intended and in high-risk situations.
- Social or interpersonal problems due to cannabis use
- Neglected or decreased performance at work or school due to cannabis use
- Building tolerance and eventually having to increase marijuana dosage to achieve the same effects
- Using larger amounts of cannabis for a longer period than intended
- Unsuccessful repeated attempts to quit marijuana or control use despite persistent desire to do so
- Spending a lot of time on marijuana use, whether to obtain the drug or to recover from its effects
- Physical or psychological problems associated with marijuana use
- Giving up or reducing social, recreational, and occupational activities to use marijuana
- Cravings to use marijuana
- Continuing using cannabis despite knowledge of having persistent or recurrent physical/psychological problems caused or worsened by cannabis
- Withdrawal is indicated by either characteristic withdrawal syndrome for cannabis or taking cannabis to relieve or avoid symptoms that occur with the cessation of use.
Who Gets Cannabis Use Disorder?
Everyone can develop CUD, but some people are at a higher risk than others. The most common risk factors that make a person more likely to develop CUD include:
- Genetics – like other forms of substance abuse, cannabis use disorder has a genetic component, too. Studies involving twins raised in different families found they have higher rates of an addiction co-occurring. This means if one twin develops cannabis addiction, the other twin is also more likely to do so. Evidence confirms heritable factors of dependence or addiction to cannabis account for 30% to 80% of the total variance of CUD risk. Genes encoding cannabinoid receptors are considered the main culprits here, but a lot more research is necessary to learn more about the genetic component of CUD.
- Lifestyle – having responsibilities such as work and other commitments may make a person less likely to develop CUD, while those without responsibilities could become dependent or addicted to cannabis. People who don’t develop addiction have more options and choices that keep them fulfilled and allow them to experience satisfaction, pleasure, motivation, or cope with problems in their lives. Lack of responsibilities and options may deprive a person of satisfaction, pleasure, motivation and impair their coping mechanisms. A lot more research is necessary on this subject, though
- Environment – a person’s environment has a lot to do with the risk of developing cannabis use disorder. For instance, some people have a strong support system and rich social life, whereas others do not. The latter could have a higher risk of developing CUD. Additionally, spending a lot of time with other heavy marijuana users can also pave the way for marijuana use, tolerance, dependence, and addiction.
- Emotional health and mental health and wellbeing – many people start using marijuana to manage anxiety or depression, but after a while, whenever they try to quit cannabis use, their anxiety or depression worsens. This creates a vicious cycle where a person uses the drug to manage a condition, but symptoms of that problem intensify later on as they want to stop using it.
How is Cannabis Use Disorder Diagnosed?
If you, or someone you know, have symptoms of CUD, the first step to do is to contact a marijuana rehab center for men in Texas (or encourage the affected person to do so) and schedule an appointment. Evaluation of symptoms is necessary to determine whether a patient really has cannabis use disorder. As mentioned above, cannabis use disorder occurs when a person has at least two symptoms from diagnostic criteria over 12 months.
Once the problem is diagnosed, it is necessary to determine the severity. Not all cases of CUD are the same. They can be:
- Mild (two to three symptoms)
- Moderate (four to five symptoms)
- Severe (six or more symptoms)
About four million Americans meet the criteria for diagnosing CUD.
It’s also important to mention, CUD is recognized in the 11th revision of the International Classification of Diseases (ICD-11). This manual adds more subdivisions, including time intervals of a pattern of use and dependence. The time interval of a pattern of use can indicate episodic, continuous, or unspecified cannabis use. Dependence describes current, full remission, sustained partial remission, or unspecified.
Cannabis Use Disorder Withdrawal Symptoms
Problematic cannabis use, dependence, and addiction that fall into CUD are indicated by withdrawal symptoms that occur when a person stops using the drug. Many people keep using cannabis, despite its consequences, only because they want to alleviate the withdrawal symptoms they experience.
However, in the treatment program for CUD in the marijuana rehab center for women in Dallas-Fort Worth, a patient quits marijuana use in the first stage of recovery – detox. During detox, withdrawal symptoms tend to occur.
The most common symptoms of marijuana withdrawal include:
- Chills
- Cravings for cannabis
- Depression and/or anxiety
- Feelings of restlessness and general malaise
- Headache
- Irritability, feelings of anger, and/or aggressiveness
- Loss of focus
- Mood changes
- Reduced appetite
- Sleep difficulties such as insomnia, disturbing dreams, nightmares
- Stomach problems
- Sweating (including cold sweats)
Cannabis withdrawal symptoms range in intensity from mild to severe. The severity of withdrawal symptoms depends on how long you use marijuana and how much you take. The longer you use cannabis, the more likely you are to experience withdrawal symptoms. They can be more severe for heavy users.
Every person goes through withdrawal differently. But in most cases, the timeline looks like this:
- Withdrawal symptoms tend to begin up to a week after cessation of use.
- Symptoms peak within ten days of cessation of cannabis use
- After the peak, symptoms start declining steadily over the next 10 to 20 days.
Keep in mind it’s possible to experience some problems such as mood swings, cravings, and lack of motivation for weeks or even months after the last cannabis use. Cannabis withdrawal symptoms are not life-threatening, but some persons may experience impaired judgment, a higher risk of accidents, and suicidal thoughts.
How is Cannabis Use Disorder Treated?
Cannabis use disorder is a serious problem, like any other substance use disorder. However, it’s important to keep in mind CUD is manageable. A person can achieve successful recovery in a marijuana detox center in North Texas.
The exact course of the treatment may depend on the severity of CUD and whether a patient has other comorbidities, including mental health problems such as anxiety and depression. In most cases, the treatment of CUD involves therapies that help patients overcome their substance use disorder. Various approaches serve this purpose, including:
- Cognitive-behavioral therapy (CBT) – teaches patients strategies to identify and correct behaviors that lead to substance abuse. CBT works because cannabis use disorder is considered to be a learned behavior, and achievement of abstinence is a learning process
- Contingency management (CM) – monitors target behaviors and rewards positive behavior changes. In most cases, contingency management is combined with other therapy approaches. It is not the sole therapy option for a patient with CUD.
- Motivational enhancement therapy (MET) – designed specifically to mobilize a person’s internal motivations for change. MET seeks to enhance motivation to change by providing nonjudgmental feedback, exploring and resolving ambivalence, and collaborative goal-setting.
Psychotherapeutic treatments for cannabis use disorder yield positive results. The best results are achieved when CBT, CM, and MET are combined, i.e., when treatment of CUD doesn’t focus on a single approach. It’s much better when a patient gets to take part in different therapy settings. Each therapy approach has its own strengths.
At this point, there is no specific medication protocol for the treatment of cannabis use disorder. Scientists explain there is an urgent need for more research to identify effective pharmacologic treatments for CUD.
A patient with anxiety or depression but who also has CUD may need to take medications to alleviate symptoms of their mental health problem. Sleep medications, antiepileptic drugs, anti-anxiety drugs may help with the treatment of CUD, but a lot more research is necessary to find out.
Conclusion
Cannabis use disorder is not uncommon, but it is largely misunderstood. The generally accepted belief is that marijuana is harmless and can’t induce addiction. Wrong! Cannabis is an addictive drug that can induce tolerance, dependence, and addiction. The main focus of this post was cannabis use disorder, its symptoms, causes, risk factors, and treatment options. Like any other substance use disorder, CUD is a serious problem, but the good thing is that it’s manageable.
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