cannabis use disorder

Cannabis use is sometimes comorbid for other mental health problems, such as mood and anxiety disorders, and discontinuing cannabis use is difficult for some users.{{cite journal | vauthors = Danovitch I, Gorelick DA | title = State of the art treatments for cannabis dependence | journal = The Psychiatric Clinics of North America | volume = 35 | issue = 2 | pages = 309–26 | date = June 2012 | pmid = 22640758 | pmc = 3371269 | doi = 10.1016/j.psc.2012.03.003 | type = Review }} Psychiatric comorbidities are often present in dependent cannabis users including a range of personality disorders.{{cite journal | vauthors = Dervaux A, Laqueille X | title = [Cannabis: Use and dependence] | language = fr | journal = Presse Médicale | volume = 41 | issue = 12 Pt 1 | pages = 1233–40 | date = December 2012 | pmid = 23040955 | doi = 10.1016/j.lpm.2012.07.016 }}

Based on annual survey data, some high school seniors who report smoking daily (nearly 7%, according to one study) may function at a lower rate in school than students that do not.{{cite web|last1=E.B.|first1=Robertson|title=Information on Cannabis Addiction|url=https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/references|website=National Institute on Drug Abuse|access-date=7 May 2018|archive-date=7 May 2018|archive-url=https://web.archive.org/web/20180507221704/https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/references|url-status=dead}} The sedating and anxiolytic properties of tetrahydrocannabinol (THC) in some users might make the use of cannabis an attempt to self-medicate personality or psychiatric disorders. A 2017 study that had 42 healthy individuals partake in two sessions, one with psychosocial stress (Trier Social Stress Test, TSST) and the other with a non-stressful task. 13 subjects were given 0mg of THC, 14 were given 7.5mg of THC, and 15 were given 12.5mg of THC, all administered through an oral capsule. The participants who ingested the 7.5mg capsules experienced some distress after completing the stressful task, and found it threatening and challenging. However those who took the 12.5mg found it to increase negative mood before, during, and after the tasks, and found their performance to be affected. While low-doses of THC may offer some stress-relief, higher doses can cause increased negative moods.{{Cite journal |last=Childs |first=Emma |last2=Lutz |first2=Joseph A. |last3=de Wit |first3=Harriet |date=2017-08-01 |title=Dose-related effects of delta-9-THC on emotional responses to acute psychosocial stress |url=https://pubmed.ncbi.nlm.nih.gov/28599212 |journal=Drug and Alcohol Dependence |volume=177 |pages=136–144 |doi=10.1016/j.drugalcdep.2017.03.030 |issn=1879-0046 |pmc=6349031 |pmid=28599212}}

Prolonged cannabis use produces both pharmacokinetic changes (how the drug is absorbed, distributed, metabolized, and excreted) and pharmacodynamic changes (how the drug interacts with target cells) to the body. These changes require the user to consume higher doses of the drug to achieve a common desirable effect (known as a higher tolerance), reinforcing the body's metabolic systems for eliminating the drug more efficiently and further down-regulating cannabinoid receptors in the brain.{{cite journal | vauthors = Hirvonen J, Goodwin RS, Li CT, Terry GE, Zoghbi SS, Morse C, Pike VW, Volkow ND, Huestis MA, Innis RB | display-authors = 6 | title = Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers | journal = Molecular Psychiatry | volume = 17 | issue = 6 | pages = 642–9 | date = June 2012 | pmid = 21747398 | pmc = 3223558 | doi = 10.1038/mp.2011.82}}

Cannabis users have shown decreased reactivity to dopamine, suggesting a possible link to a dampening of the reward system of the brain and an increase in negative emotion and addiction severity.{{cite journal | vauthors = Madras BK | title = Dopamine challenge reveals neuroadaptive changes in marijuana abusers | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 111 | issue = 33 | pages = 11915–6 | date = August 2014 | pmid = 25114244 | pmc = 4143049 | doi = 10.1073/pnas.1412314111 | bibcode = 2014PNAS..11111915M | doi-access = free}}

Cannabis users can develop tolerance to the effects of THC. Tolerance to the behavioral and psychological effects of THC has been demonstrated in adolescent humans and animals.{{cite journal | vauthors = González S, Cebeira M, Fernández-Ruiz J | title = Cannabinoid tolerance and dependence: a review of studies in laboratory animals | journal = Pharmacology, Biochemistry, and Behavior | volume = 81 | issue = 2 | pages = 300–18 | date = June 2005 | pmid = 15919107 | doi = 10.1016/j.pbb.2005.01.028 | s2cid = 23328509 }}{{cite journal | vauthors = Maldonado R, Berrendero F, Ozaita A, Robledo P | title = Neurochemical basis of cannabis addiction | journal = Neuroscience | volume = 181 | pages = 1–17 | date = May 2011 | pmid = 21334423 | doi = 10.1016/j.neuroscience.2011.02.035 | s2cid = 6660057}} The mechanisms that create this tolerance to THC are thought to involve changes in cannabinoid receptor function.

One study has shown that between 2001–2002 and 2012–2013, the use of cannabis in the US doubled.{{Cite web|url=https://www.nih.gov/news-events/news-releases/marijuana-use-disorder-common-often-untreated|title=Marijuana use disorder is common and often untreated|date=2016-03-04|website=National Institutes of Health (NIH)|access-date=2019-04-03}}

Cannabis dependence develops in about 9% of users, significantly less than that of heroin, cocaine, alcohol, and prescribed anxiolytics,{{cite journal | vauthors = Wilkie G, Sakr B, Rizack T | title = Medical Marijuana Use in Oncology: A Review | journal = JAMA Oncology | volume = 2 | issue = 5 | pages = 670–675 | date = May 2016 | pmid = 26986677 | doi = 10.1001/jamaoncol.2016.0155 | doi-access = free }} but slightly higher than that for psilocybin, mescaline, or LSD. Of those who use cannabis daily, 10–20% develop dependence.

Cannabis withdrawal symptoms occur in half of people being treated for cannabis use disorder.{{cite journal |last1=Bahji |first1=Anees |last2=Stephenson |first2=Callum |last3=Tyo |first3=Richard |last4=Hawken |first4=Emily R. |last5=Seitz |first5=Dallas P. |title=Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids |journal=JAMA Network Open |date=9 April 2020 |volume=3 |issue=4 |pages=e202370 |doi=10.1001/jamanetworkopen.2020.2370|pmid=32271390 |pmc=7146100 |doi-access=free }} Symptoms may include dysphoria, anxiety, irritability, depression, restlessness, disturbed sleep, gastrointestinal symptoms, and decreased appetite. It is often paired with rhythmic movement disorder. Most symptoms begin during the first week of abstinence and resolve after a few weeks. About 12% of heavy cannabis users showed cannabis withdrawal symptoms as defined by the DSM-5, and this was associated with significant disability as well as mood, anxiety, and personality disorders.{{cite journal | vauthors = Livne O, Shmulewitz D, Lev-Ran S, Hasin DS | title = DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults | journal = Drug and Alcohol Dependence | volume = 195 | pages = 170–177 | date = February 2019 | pmid = 30361043 | pmc = 6359953 | doi = 10.1016/j.drugalcdep.2018.09.005 }} Furthermore, a study on 49 dependent cannabis users over a two week period of abstinence proved most prominently symptoms of nightmares and anger issues.{{cite journal |last1=Allsop |first1=David |title=The Cannabis Withdrawal Scale development: Patterns and predictors of cannabis withdrawal and distress |url=https://www.sciencedirect.com/science/article/pii/S0376871611002663#section-cited-by |journal=Drug and Alcohol Dependence |date=2011 |volume=119 |issue=1–2 |pages=123–129 |doi=10.1016/j.drugalcdep.2011.06.003 |pmid=21724338 |access-date=March 12, 2024}}

Cannabis addiction is often due to prolonged and increasing use of the drug. Increasing the strength of the cannabis taken and increasing use of more effective methods of delivery often increase the progression of cannabis dependency. Approximately 17.0% of weekly and 19.0% of daily cannabis smokers can be classified as cannabis dependent.{{cite journal |last1=Cougle |first1=Jesse R. |last2=Hakes |first2=Jahn K. |last3=Macatee |first3=Richard J. |last4=Zvolensky |first4=Michael J. |last5=Chavarria |first5=Jesus |title=Probability and Correlates of Dependence Among Regular Users of Alcohol, Nicotine, Cannabis, and Cocaine: Concurrent and Prospective Analyses of the National Epidemiologic Survey on Alcohol and Related Conditions |journal=The Journal of Clinical Psychiatry |date=27 April 2016 |volume=77 |issue=4 |pages=e444–e450 |doi=10.4088/JCP.14m09469|pmid=27137428 }} In addition to cannabis use, it has been shown that co-use of cannabis and tobacco can result in an elevated risk of cannabis use disorder.{{cite journal |last1=Connor |first1=Jason P. |last2=Stjepanović |first2=Daniel |last3=Le Foll |first3=Bernard |last4=Hoch |first4=Eva |last5=Budney |first5=Alan J. |last6=Hall |first6=Wayne D. |title=Cannabis use and cannabis use disorder |journal=Nature Reviews Disease Primers |date=25 February 2021 |volume=7 |issue=1 |page=3 |doi=10.1038/s41572-021-00247-4 |pmid=33627670 |url=https://doi.org/10.1038/s41572-021-00247-4 |language=en |issn=2056-676X|pmc=8655458 }} Susceptibility to cannabis addiction can also stem from genetic predispositions or environmental influences that make certain individuals inherently more vulnerable to substance dependence. Moreover, prenatal exposure to cannabis—where the mother uses cannabis during pregnancy—can predispose offspring to an increased risk of developing cannabis use disorder later in life, highlighting a possible transgenerational transmission of vulnerability.{{Cite web |title=Maternal Cannabis Use During Pregnancy and Neuropsychiatric Adverse Outcomes During Childhood and Early Adult Life |url=https://www.psychiatrist.com/jcp/maternal-cannabis-use-pregnancy-neuropsychiatric-adverse-outcomes-children-young-adults/ |access-date=2025-03-06 |website=Psychiatrist.com |language=en-US}}

Certain factors are considered to heighten the risk of developing cannabis dependence. Longitudinal studies over a number of years have enabled researchers to track aspects of social and psychological development concurrently with cannabis use. Increasing evidence is being shown for the elevation of associated problems by the frequency and age at which cannabis is used, with young and frequent users being at most risk.{{cite web | url=http://www.drugabuse.gov/publications/drugfacts/marijuana | title=DrugFacts: Marijuana | publisher=National Institute on Drug Abuse | access-date=20 July 2015}} The frequency of cannabis use and duration of use are considered to be major risk factors for development of cannabis use disorder. The strength of cannabis used, with higher THC content conferring a heightened risk, is also thought to be a risk factor. Concomitant alcohol or tobacco use, a history of adverse childhood experiences, depression or other psychiatric disorders, stressful life events and parental cannabis use may also increase the risk of developing cannabis use disorder.

The main factors in Australia, for example, related to a heightened risk for developing problems with cannabis use include frequent use at a young age; personal maladjustment; emotional distress; poor parenting; school drop-out; affiliation with drug-using peers; moving away from home at an early age; daily cigarette smoking; and ready access to cannabis. The researchers concluded there is emerging evidence that positive experiences to early cannabis use are a significant predictor of late dependence and that genetic predisposition plays a role in the development of problematic use.

A number of groups have been identified as being at greater risk of developing cannabis dependence and, in Australia have been found to include adolescent populations, Aboriginal and Torres Strait Islanders and people with mental health conditions.McLaren, J, Mattick, R P., Cannabis in Australia Use, supply, harms, and responses Monograph series No. 57 Report prepared for: Drug Strategy Branch Australian Government Department of Health and Ageing. National Drug and Alcohol Research Centre University of New South Wales, Australia.

The endocannabinoid system is directly involved in adolescent brain development. Adolescent cannabis users are therefore particularly vulnerable to the potential adverse effects of cannabis use.{{Cite journal|last1=Volkow|first1=Nora D.|last2=Swanson|first2=James M.|last3=Evins|first3=A. Eden|last4=DeLisi|first4=Lynn E.|last5=Meier|first5=Madeline H.|last6=Gonzalez|first6=Raul|last7=Bloomfield|first7=Michael A. P.|last8=Curran|first8=H. Valerie|last9=Baler|first9=Ruben|date=2016-03-01|title=Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review|journal=JAMA Psychiatry|volume=73|issue=3|pages=292–7|doi=10.1001/jamapsychiatry.2015.3278|pmid=26842658|issn=2168-622X|url=https://discovery.ucl.ac.uk/id/eprint/1481951/1/Curran_Volkow%20et%20al%202016.pdf}} Adolescent cannabis use is associated with increased cannabis misuse as an adult, issues with memory and concentration, long-term cognitive complications, and poor psychiatric outcomes including social anxiety, suicidality, and addiction.{{Cite journal|last1=Levine|first1=Amir|last2=Clemenza|first2=Kelly|last3=Rynn|first3=Moira|last4=Lieberman|first4=Jeffrey|date=2017-03-01|title=Evidence for the Risks and Consequences of Adolescent Cannabis Exposure|url=https://jaacap.org/article/S0890-8567(16)32000-7/abstract|journal=Journal of the American Academy of Child & Adolescent Psychiatry|language=en|volume=56|issue=3|pages=214–225|doi=10.1016/j.jaac.2016.12.014|issn=0890-8567|pmid=28219487}}{{Cite book|title=The health effects of cannabis and cannabinoids : the current state of evidence and recommendations for research|last=National Academies of Sciences, Engineering, and Medicine (U.S.). Committee on the Health Effects of Marijuana: an Evidence Review and Research Agenda.|date=2017|publisher=The National Academies Press|isbn=978-0-309-45304-2|oclc=1021254335}}{{Cite book |last1=Montoya |first1=Ivan D. |title=Cannabis use disorders |last2=Weiss |first2=Susan R. B. |date=2018 |publisher=Springer Berlin Heidelberg |isbn=978-3-319-90364-4 |edition=1 |location=New York, NY |oclc=1029794724}}

There are several reasons why adolescents start a smoking habit. According to a study completed by Bill Sanders, influence from friends, difficult household problems, and experimentation are some of the reasons why this population starts to smoke cannabis.SANDERS, Bill (2005). Youth Crime and Youth Culture in the Inner City. Taylor and Francis Group. This segment of population seems to be one of the most influenceable group there is.LEMIRE, L. (2014). Enquête québécoise sur la santé des jeunes du secondaire 2010-2011. Santé publique. Récupéré de http://www.cisss-lanaudiere.gouv.qc.ca/fileadmin/internet/cisss_lanaudiere/Documentation/Sante_publique/Themes/Sante_mentale_et_psychosociale/EQSJS-Envir_social-Amis-VF.pdf They want to follow the group and look "cool", "hip", and accepted by their friends. This fear of rejection plays a big role in their decision to use cannabis. However it does not seem to be the most important factor. According to a study from Canada, the lack of knowledge about cannabis seems to be the main reason why adolescents start to smoke.LEOS-TORO, C., FONG, G. T., MEYER, S. B. et HAMMOND, D. (2020). Cannabis health knowledge and risk perceptions among Canadian youth and young adults. Harm Reduction Journal. London. Vol. 17. (p.1-13). The authors observed a high correlation between adolescents that knew about the mental and physical harms of cannabis and their consumption. Of the 1045 young participants in the study, those who could name the least number of negative effects about this drug were usually the ones who were consuming it. They were not isolated cases either. Actually, the study showed that the proportion of teenagers who saw cannabis as a high-risk drug and the ones who thought the contrary was about the same.LEOS-TORO, C., FONG, G. T., MEYER, S. B. et HAMMOND, D. (2020). Cannabis health knowledge and risk perceptions among Canadian youth and young adults. Harm Reduction Journal. London. Vol. 17. (p.1-13)

In a 2023 national inpatient study, researchers found that adolescents with Cannabis Use Disorder (CUD) were at a significantly higher risk for suicide attempts and self-harm tendencies. They observed 807,105 adolescents who were hospitalized from January 1, 2016 to December 31, 2019, of which 6.9% had CUD. The study showed the majority of adolescents with CUD that were hospitalized were more likely to be older and have depression, emphasizing the association between CUD and suicide attempts/self-harm. Adolescents who were diagnosed with CUD had 2.4 times the odds of suicide attempt/self-harm.{{Cite journal |last1=Oladunjoye |first1=Adeolu Funso |last2=Li |first2=Elijah |last3=Aneni |first3=Kammarauche |last4=Onigu-Otite |first4=Edore |date=2023 |title=Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States |journal=PLOS ONE |volume=18 |issue=10 |pages=e0292922 |doi=10.1371/journal.pone.0292922 |doi-access=free |issn=1932-6203 |pmc=10581466 |pmid=37847698|bibcode=2023PLoSO..1892922O }} Interventions should occur early on to attempt to prevent the development of CUD and any related actions.

The American College of Obstetricians and Gynecologists advise against cannabis use during pregnancy or lactation.{{cite journal |title=Committee Opinion No. 722: Marijuana Use During Pregnancy and Lactation |journal=Obstetrics & Gynecology |date=October 2017 |volume=130 |issue=4 |pages=e205–e209 |doi=10.1097/AOG.0000000000002354|pmid=28937574}} There is an association between smoking cannabis during pregnancy and low birth weight.{{Cite journal|last1=Gunn|first1=J K L|last2=Rosales|first2=C B|last3=Center|first3=K E|last4=Nuñez|first4=A|last5=Gibson|first5=S J|last6=Christ|first6=C|last7=Ehiri|first7=J E|date=2016|title=Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis|journal=BMJ Open|volume=6|issue=4|pages=e009986|doi=10.1136/bmjopen-2015-009986|pmid=27048634|pmc=4823436|issn=2044-6055}} Smoking cannabis during pregnancy can lower the amount of oxygen delivered to the developing fetus, which can restrict fetal growth. The active ingredient in cannabis (Δ⁹-tetrahydrocannabinol, THC) is fat soluble and can enter into breastmilk during lactation. THC in breastmilk can then subsequently be taken up by a breastfeeding infant, as shown by the presence of THC in the infant's feces. However, the evidence for long-term effects of exposure to THC through breastmilk is unclear.{{Cite journal|last1=Metz|first1=Torri D.|last2=Stickrath|first2=Elaine H.|date=December 2015|title=Marijuana use in pregnancy and lactation: a review of the evidence|journal=American Journal of Obstetrics and Gynecology|volume=213|issue=6|pages=761–778|doi=10.1016/j.ajog.2015.05.025|pmid=25986032|issn=0002-9378}}{{Cite journal|last1=Brown|first1=R.A.|last2=Dakkak|first2=H.|last3=Seabrook|first3=J.A.|date=2018-12-21|title=Is Breast Best? Examining the effects of alcohol and cannabis use during lactation|journal=Journal of Neonatal-Perinatal Medicine|volume=11|issue=4|pages=345–356|doi=10.3233/npm-17125|pmid=29843260|s2cid=44153511|issn=1934-5798}}{{Cite journal|last1=Seabrook|first1=J.A.|last2=Biden|first2=C.|last3=Campbell|first3=E.|date=2017|title=Does the risk of exposure to marijuana outweigh the benefits of breastfeeding? A systematic review.|journal=Canadian Journal of Midwifery Research and Practice|volume=16|issue=2|pages=8–16|doi=10.22374/cjmrp.v16i2.67 }} In a study conducted by Reproductive Health, the use of cannabis during pregnancy may also alter the neurotransmission system of the infant. Prenatal exposure to cannabis could harm their brain areas such as the "prefrontal cortex, the mesolimbic system, the striatum and the hypothalamic-pituitary axis."{{Cite journal |last1=Roncero |first1=Carlos |last2=Valriberas-Herrero |first2=Isabel |last3=Mezzatesta-Gava |first3=Marcela |last4=Villegas |first4=José L. |last5=Aguilar |first5=Lourdes |last6=Grau-López |first6=Lara |date=2020-02-17 |title=Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders. A systematic review |journal=Reproductive Health |language=en |volume=17 |issue=1 |pages=25 |doi=10.1186/s12978-020-0880-9 |doi-access=free |issn=1742-4755 |pmc=7027300 |pmid=32066469}} These areas are involved in executive functions such as the reinforcement and regulation of emotions. Thus, consequences of exposure to maternal cannabis use could cause executive dysfunction to the emotional system that will remain present even in early adulthood.

Cannabis use disorder is recognized in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),{{cite web|url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=39 |title=Proposed Revision | APA DSM-5 |publisher=Dsm5.org |access-date=2011-04-20}} which also added cannabis withdrawal as a new condition.{{cite web|url=https://rogershospital.org/blog/dsm-5-now-categorizes-substance-use-disorders-single-continuum|title=DSM-5 Now Categorizes Substance Use Disorder in a Single Continuum |date=17 May 2013|publisher=American Psychiatric Association|access-date=12 December 2013|archive-url=https://web.archive.org/web/20150207071529/https://rogershospital.org/blog/dsm-5-now-categorizes-substance-use-disorders-single-continuum|archive-date=7 February 2015|url-status=dead}} In the 2013 revision for the DSM-5, DSM-IV abuse and dependence were combined into cannabis use disorder. The legal problems criterion (from cannabis abuse) has been removed, and the craving criterion was newly added, resulting in a total of eleven criteria: hazardous use, social/interpersonal problems, neglected major roles, withdrawal, tolerance, used larger amounts/longer, repeated attempts to quit/control use, much time spent using, physical/psychological problems related to use, activities given up and craving. For a diagnosis of DSM-5 cannabis use disorder, at least two of these criteria need to be present in the last twelve-month period. Additionally, three severity levels have been defined: mild (two or three criteria), moderate (four or five criteria) and severe (six or more criteria) cannabis use disorder.{{cite journal | vauthors = Hasin DS, O'Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM, Crowley T, Ling W, Petry NM, Schuckit M, Grant BF | display-authors = 6 | title = DSM-5 criteria for substance use disorders: recommendations and rationale | journal = The American Journal of Psychiatry | volume = 170 | issue = 8 | pages = 834–51 | date = August 2013 | pmid = 23903334 | pmc = 3767415 | doi = 10.1176/appi.ajp.2013.12060782 }}

Cannabis use disorder is also recognized in the eleventh revision of the International Classification of Diseases (ICD-11),{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1913137404|title=ICD-11 – Mortality and Morbidity Statistics|website=icd.who.int|access-date=2019-11-17}} adding more subdivisions including time intervals of pattern of use (episodic, continuous, or unspecified) and dependence (current, early full remission, sustained partial remission, sustained full remission, or unspecified) compared to the 10th revision.{{Cite web|url=https://icd.who.int/browse10/2016/en#/F12|title=ICD-10 Version:2016|website=icd.who.int|access-date=2019-11-17}}

A 2019 meta-analysis found that 34% of people with cannabis-induced psychosis transitioned to schizophrenia. This was found to be comparatively higher than hallucinogens (26%) and amphetamines (22%).{{cite journal |last1=Murrie |first1=Benjamin |last2=Lappin |first2=Julia |last3=Large |first3=Matthew |last4=Sara |first4=Grant |title=Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis |journal=Schizophrenia Bulletin |date=16 October 2019 |volume=46 |issue=3 |pages=505–516 |doi=10.1093/schbul/sbz102 |pmid=31618428 |pmc=7147575 |doi-access=free}}

To screen for cannabis-related problems, several methods are used. Scales specific to cannabis, which provides the benefit of being cost efficient compared to extensive diagnostic interviews, include the Cannabis Abuse Screening Test (CAST), Cannabis Use Identification Test (CUDIT), and Cannabis Use Problems Identification Test (CUPIT).{{Cite journal|last1=Casajuana|first1=Cristina|last2=López-Pelayo|first2=Hugo|last3=Balcells|first3=María Mercedes|last4=Miquel|first4=Laia|last5=Colom|first5=Joan|last6=Gual|first6=Antoni|title=Definitions of Risky and Problematic Cannabis Use: A Systematic Review|journal=Substance Use & Misuse|volume=51|issue=13|pages=1760–1770|doi=10.1080/10826084.2016.1197266|issn=1532-2491|pmid=27556867|year=2016|s2cid=32299878}} Scales for general drug use disorders are also used, including the Severity Dependence Scale (SDS), Drug Use Disorder Identification Test (DUDIT), and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). However, there are no gold standard and both older and newer scales are still in use. To quantify cannabis use, methods such as Timeline Follow-Back (TLFB) and Cannabis Use Daily (CUD) are used. These methods measure general consumption and not grams of psychoactive substance as the concentration of THC may vary among drug users.{{Cite journal|last1=López-Pelayo|first1=H.|last2=Batalla|first2=A.|last3=Balcells|first3=M. M.|last4=Colom|first4=J.|last5=Gual|first5=A.|title=Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments|journal=Psychological Medicine|volume=45|issue=6|pages=1121–1133|doi=10.1017/S0033291714002463|issn=1469-8978|pmid=25366671|year=2015|s2cid=206254638}}

Clinicians differentiate between casual users who have difficulty with drug screens, and daily heavy users, to a chronic user who uses multiple times a day.[https://books.google.com/books?id=JJk52UeE6hYC& Clinical Textbook of Addictive Disorders], Marijuana, David McDowell, page 169, Published by Guilford Press, 2005 {{ISBN|1-59385-174-X}}. In the US, {{as of|2013|lc=yes}}, cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities.{{cite journal |vauthors=Borgelt LM, Franson KL, Nussbaum AM, Wang GS |title=The pharmacologic and clinical effects of medical cannabis |journal=Pharmacotherapy |volume=33 |issue=2 |pages=195–209 |date=February 2013 |pmid=23386598 |doi=10.1002/phar.1187 |s2cid=8503107 |type=Review |doi-access=free}} Demand for treatment for cannabis use disorder increased internationally between 1995 and 2002.Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2003). Emergency department trends from the drug abuse warning network, final estimates 1995–2002, DAWN Series: D-24, DHHS Publication No. (SMA) 03-3780. In the United States, the average adult who seeks treatment has consumed cannabis for over 10 years almost daily and has attempted to quit six or more times.

Treatment options for cannabis dependence are far fewer than for opioid or alcohol dependence. Most treatment falls into the categories of psychological or psychotherapeutic, intervention, pharmacological intervention or treatment through peer support and environmental approaches.{{cite book | vauthors = Copeland J, Gerber S, Swift W | title = Evidence-based answers to cannabis questions a review of the literature | publisher = National Drug and Alcohol Research Centre University of New South Wales, A report prepared for the Australian National Council on Drugs | date = December 2004 }} No medications have been found effective for cannabis dependence,{{cite journal|vauthors=Nielsen S, Gowing L, Sabioni P, Le Foll B|date=January 2019|title=Pharmacotherapies for cannabis dependence|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=3|pages=CD008940|doi=10.1002/14651858.CD008940.pub3|pmc=6360924|pmid=30687936}} but psychotherapeutic models hold promise. Screening and brief intervention sessions can be given in a variety of settings, particularly at doctor's offices, which is of importance as most cannabis users seeking help will do so from their general practitioner rather than a drug treatment service agency.{{cite book | vauthors = Degenhardt L, Hall W, Lynskey M | date = 2000 | title = Cannabis use and mental health among Australian adults: Findings from the National Survey of Mental Health and Well-being, NDARC Technical Report No. 98 | location = Sydney | publisher = National Drug and Alcohol Research Centre, University of New South Wales }}

The most commonly accessed forms of treatment in Australia are 12-step programmes, physicians, rehabilitation programmes, and detox services, with inpatient and outpatient services equally accessed.{{cite journal |vauthors = Copeland J, Swift W |title = Cannabis use disorder: epidemiology and management |journal = International Review of Psychiatry |volume = 21 |issue = 2 |pages = 96–103 |date = April 2009 |pmid = 19367503 |doi = 10.1080/09540260902782745 |s2cid = 10881676 |type = Review}} In the EU approximately 20% of all primary admissions and 29% of all new drug clients in 2005, had primary cannabis problems. And in all countries that reported data between 1999 and 2005 the number of people seeking treatment for cannabis use increased.{{cite book |author = EMCDDA |year = 2007 |title = Annual report 2007: The state of the drugs problem in Europe | location = Luxembourg | publisher = Office for Official Publications of the European Communities}}

Psychological intervention includes cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), contingency management (CM), supportive-expressive psychotherapy (SEP), family and systems interventions, and twelve-step programs.{{Cite journal|last1=Gates|first1=Peter J.|last2=Sabioni|first2=Pamela|last3=Copeland|first3=Jan|last4=Le Foll|first4=Bernard|last5=Gowing|first5=Linda|date=2016-05-05|title=Psychosocial interventions for cannabis use disorder|journal=The Cochrane Database of Systematic Reviews|volume=2016 |issue=5|pages=CD005336|doi=10.1002/14651858.CD005336.pub4|issn=1469-493X|pmc=4914383|pmid=27149547}}

Evaluations of Marijuana Anonymous programs, modelled on the 12-step lines of Alcoholics Anonymous and Narcotics Anonymous, have shown small beneficial effects for general drug use reduction.{{cite journal |last1=Sussman |first1= Steve |date= 1010 |title= A Review of Alcoholics Anonymous/Narcotics Anonymous Programs for Teens|journal= Evaluation & the Health Professions|volume= 33 |issue= 1 |pages= 26–55 |doi= 10.1177/0163278709356186 |pmid= 20164105 |pmc= 4181564 }} In 2006, the Wisconsin Initiative to Promote Healthy Lifestyles implemented a program that helps primary care physicians identify and address marijuana use problems in patients.{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/profiles/support-collaborative-primary-care-practices-identify-and-address-behavioral-health-issues |title=With Support From Collaborative, Primary Care Practices Identify and Address Behavioral Health Issues, Reducing Binge Drinking, Marijuana Use, and Depression Symptoms |date=2013-05-08 |access-date=2013-05-10}}

As of 2023, there is no medication that has been proven effective for treating cannabis use disorder, research is focused on three treatment approaches: agonist substitution, antagonist, and modulation of other neurotransmitter systems.{{cite journal |last1=Gorelick |first1=David A. |title=Cannabis-Related Disorders and Toxic Effects |journal=New England Journal of Medicine |date=14 December 2023 |volume=389 |issue=24 |pages=2267–2275 |doi=10.1056/NEJMra2212152|pmid=38091532 }} More broadly, the goal of medication therapy for cannabis use disorder centers around targeting the stages of the addiction: acute intoxication/binge, withdrawal/negative affect, and preoccupation/anticipation.{{cite journal | vauthors = Zehra A, Burns J, Liu CK, Manza P, Wiers CE, Volkow ND, Wang GJ | title = Cannabis Addiction and the Brain: a Review | journal = Journal of Neuroimmune Pharmacology | volume = 13 | issue = 4 | pages = 438–452 | date = December 2018 | pmid = 29556883 | pmc = 6223748 | doi = 10.1007/s11481-018-9782-9 }}

For the treatment of the withdrawal/negative affect symptom domain of cannabis use disorder, medications may work by alleviating restlessness, irritable or depressed mood, anxiety, and insomnia.{{cite journal | vauthors = Brezing CA, Levin FR | title = The Current State of Pharmacological Treatments for Cannabis Use Disorder and Withdrawal | journal = Neuropsychopharmacology | volume = 43 | issue = 1 | pages = 173–194 | date = January 2018 | pmid = 28875989 | pmc = 5719115 | doi = 10.1038/npp.2017.212 }} Bupropion, which is a norepinephrine–dopamine reuptake inhibitor, has been studied for the treatment of withdrawal with largely poor results. Atomoxetine has also shown poor results, and is as a norepinephrine reuptake inhibitor, though it does increase the release of dopamine through downstream effects in the prefrontal cortex (an area of the brain responsible for planning complex tasks and behavior). Venlafaxine, a serotonin–norepinephrine reuptake inhibitor, has also been studied for cannabis use disorder, with the thought that the serotonergic component may be useful for the depressed mood or anxious dimensions of the withdrawal symptom domain. While venlafaxine has been shown to improve mood for people with cannabis use disorder, a clinical trial in this population actually found worse cannabis abstinence rates compared to placebo. It is worth noting that venlafaxine is sometimes poorly tolerated, and infrequent use or abrupt discontinuation of its use can lead to withdrawal symptoms from the medication itself, including irritability, dysphoria, and insomnia.{{cite journal | vauthors = Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J | title = Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review | journal = Psychotherapy and Psychosomatics | volume = 87 | issue = 4 | pages = 195–203 | date = 2018 | pmid = 30016772 | doi = 10.1159/000491524 | s2cid = 51677365 | url = https://flore.unifi.it/bitstream/2158/1132671/1/Fava%2c%20Benasi%2c%20Lucente%2c%20Offidani%2c%20Cosci%2c%20Guidi_Withdrawal%20symptoms%20after%20SNRI%20discontinuation.pdf | doi-access = free }} It is possible that venlafaxine use actually exacerbated cannabis withdrawal symptoms, leading people to use more cannabis than placebo to alleviate their discomfort. Mirtazapine, which increases serotonin and norepinephrine, has also failed to improve abstinence rates in people with cannabis use disorder.

People sometimes use cannabis to cope with their anxiety, and cannabis withdrawal can lead to symptoms of anxiety. Buspirone, a serotonin 5-HT_1A receptor partial agonist, has shown limited efficacy for treating anxiety in people with cannabis use disorder, though there may be better efficacy in males than in females. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), has failed to show efficacy in adolescents with both cannabis use disorder and depression. SSRIs are a class of antidepressants that are also used for the treatment of anxiety disorders, such as generalized anxiety disorder.{{cite web |title=Generalised anxiety disorder – NICE Pathways |url=https://pathways.nice.org.uk/pathways/generalised-anxiety-disorder#path=view%3A/pathways/generalised-anxiety-disorder/step-3-gad-with-marked-functional-impairment-or-that-has-not-improved-after-step-2-interventions.xml&content=view-node%3Anodes-drug-treatment |website=pathways.nice.org.uk |publisher=NICE |access-date=13 April 2019 |archive-date=29 March 2019 |archive-url=https://web.archive.org/web/20190329183739/https://pathways.nice.org.uk/pathways/generalised-anxiety-disorder#path=view%3A/pathways/generalised-anxiety-disorder/step-3-gad-with-marked-functional-impairment-or-that-has-not-improved-after-step-2-interventions.xml&content=view-node%3Anodes-drug-treatment |url-status=dead}} Vilazodone, which has both SRI and 5-HT_1A receptor agonism properties, also failed to increase abstinence rates in people with cannabis use disorder.

Studies of valproate have found no significant benefit, though some studies have found mixed results. Baclofen, a GABA_B receptor agonist and antispasmodic medication, has been found to reduce cravings but without a significant benefit towards preventing relapse or improving sleep. Zolpidem, a GABA_A receptor positive allosteric modulator and "z-drug" medication, has shown some efficacy in treating insomnia due to cannabis withdrawal, though there is a potential for misuse. Entacapone was well tolerated and decreased cannabis cravings in a trial on a small number of patients. Topiramate, an antiepileptic drug, has shown mixed results in adolescents, reducing the volume of cannabis consumption without significantly increasing abstinence, with somewhat poor tolerability. Gabapentin, an indirect GABA modulator, has shown some preliminary benefit for reducing cravings and cannabis use.

The agonist substitution approach is one that draws upon the analogy of the success of nicotine replacement therapy for nicotine addiction. Dronabinol, which is synthetic THC, has shown benefit in reducing cravings and other symptoms of withdrawal, though without preventing relapse or promoting abstinence. Combination therapy with dronabinol and the α₂-adrenergic receptor agonist lofexidine have shown mixed results, with possible benefits towards reducing withdrawal symptoms. However, overall, the combination of dronabinol and lofexidine is likely not effective for the treatment of cannabis use disorder. Nabilone, a synthetic THC analogue, has shown benefits in reducing symptoms of withdrawal such as difficulty sleeping, and decreased overall cannabis use. Despite its psychoactive effects, the slower onset of action and longer duration of action of nabilone make it less likely to be abused than cannabis itself, which makes nabilone a promising harm reduction strategy for the treatment of cannabis use disorder. The combination of nabilone and zolpidem has been shown to decrease sleep-related and mood-related symptoms of cannabis withdrawal, in addition to decreasing cannabis use. Nabiximols, a combined THC and cannabidiol (CBD) product that is formulated as an oromucosal spray, has been shown to improve withdrawal symptoms without improving abstinence rates. Oral CBD has not shown efficacy in reducing the signs or symptoms of cannabis use, and likely has no benefit in cannabis use withdrawal symptoms. The CB₁ receptor antagonist rimonabant has shown efficacy in reducing the effects of cannabis in users, but with a risk for serious psychiatric side effects.

Naltrexone, a μ-opioid receptor antagonist, has shown mixed results for cannabis use disorder—both increasing the subjective effects of cannabis when given acutely, but potentially decreasing the overall use of cannabis with chronic administration. N-acetylcysteine (NAC) has shown some limited benefit in decreasing cannabis use in adolescents, though not with adults. Lithium, a mood stabilizer, has shown mixed results for treating symptoms of cannabis withdrawal, but is likely ineffective. Quetiapine, an atypical antipsychotic, has been shown to treat cannabis withdrawal related insomnia and decreased appetite at the expense of exacerbating cravings. Oxytocin, a neuropeptide that the body produces, has shown some benefit in reducing the use of cannabis when administered intranasally in combination with motivational enhancement therapy sessions, though the treatment effect did not persist between sessions.

CB₁ receptor antagonists such as rimonabant have been tested for utility in CUD.{{Cite journal|last1=Sabioni|first1=Pamela|last2=Le Foll|first2=Bernard|date=2018|title=Psychosocial and pharmacological interventions for the treatment of cannabis use disorder|journal=F1000Research|volume=7|page=173|doi=10.12688/f1000research.11191.1|issn=2046-1402|pmc=5811668|pmid=29497498 |doi-access=free}}

Research that looks at barriers to cannabis treatment frequently cites a lack of interest in treatment, lack of motivation and knowledge of treatment facilities, an overall lack of facilities, costs associated with treatment, difficulty meeting program eligibility criteria and transport difficulties.{{dubious|date=March 2019}}{{cite journal | doi = 10.1080/09687630600761444 | vauthors = Treloar C, Holt M | year = 2006 | title = Deficit models and divergent philosophies: Service providers' perspectives on barriers and incentives to drug treatment | journal = Drugs: Education Prevention and Policy | volume = 13 | issue = 4| pages = 367–382 | s2cid = 73095850}}{{cite book | vauthors = Treloar C, Abelson J, Cao W, Brener L, Kippax S, Schultz L, Schultz M, Bath N | date = 2004 | title = Barriers and incentives to treatment for illicit drug users | series = Monograph Series 53 | location = Canberra | publisher = Department of Health and Ageing, National Drug Strategy}}{{cite journal | vauthors = Gates P, Taplin S, Copeland J, Swift W, Martin G | date = 2008 | title = Barriers and Facilitators to Cannabis Treatment | journal = Drug and Alcohol Review | volume = 31 | issue = 3 | pages = 311–9 | publisher = National Cannabis Prevention and Information Centre, University of New South Wales, Sydney | pmid = 21521384 | doi = 10.1111/j.1465-3362.2011.00313.x}}

Recommendations by the Lower-Risk Cannabis Use Guidelines (LRCUG) for strategies to reduce the risks associated with cannabis use include:

- Delaying use until after adolescence to lower the risk of cognitive impairment and dependence

- Avoiding high-potency cannabis to reduce the likelihood of Cannabis Use Disorder

- Limiting frequency of use

- Avoiding high-risk methods of consumption such as deep inhalation and combusted cannabis

- Avoid simultaneous substance use such as tobacco and alcohol to prevent compounding effects on health and dependence{{Cite journal |last1=Fischer |first1=Benedikt |last2=Russell |first2=Cayley |last3=Sabioni |first3=Pamela |last4=van den Brink |first4=Wim |last5=Le Foll |first5=Bernard |last6=Hall |first6=Wayne |last7=Rehm |first7=Jürgen |last8=Room |first8=Robin |date=August 2017 |title=Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations |journal=American Journal of Public Health |volume=107 |issue=8 |pages=e1–e12 |doi=10.2105/AJPH.2017.303818 |issn=0090-0036 |pmc=5508136 |pmid=28644037}}

According to the 2022 National Survey on Drug Use and Health, cannabis is one of the most widely used drugs in the world.{{Cite web |title=WDR 2022_Booklet 2 |url=https://www.unodc.org/unodc/en/data-and-analysis/wdr-2022_booklet-2.html |access-date=2022-11-07 |website=United Nations : Office on Drugs and Crime |language=en}} Research by the Pew Research Center from 2012 claims 42% of the US population have claimed to use cannabis at some point. According to the 2019 National Survey on Drug Use and Health, 46% of U.S. adults say they have ever used cannabis.{{Cite web |url=http://www.pewresearch.org/fact-tank/2015/04/14/6-facts-about-marijuana/ |title=6 facts about marijuana |date=10 April 2024}} An estimated 9% of those who use cannabis develop dependence.{{cite journal |vauthors = Budney AJ, Roffman R, Stephens RS, Walker D |title = Marijuana dependence and its treatment |journal = Addiction Science & Clinical Practice | volume = 4 |issue = 1 |pages = 4–16 |date = December 2007 |pmid = 18292704 |pmc = 2797098 |doi = 10.1151/ascp07414|doi-broken-date = 15 April 2025 }}{{cite journal |vauthors = Marshall K, Gowing L, Ali R, Le Foll B | title = Pharmacotherapies for cannabis dependence |journal = The Cochrane Database of Systematic Reviews |volume = 12 |issue = 12 |pages = CD008940 |date = 17 December 2014 |pmid = 25515775 |pmc = 4297244 |doi = 10.1002/14651858.CD008940.pub2}}{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/30687936 |date = May 2019}}

In the United States, cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities. Most of these people were referred there by the criminal justice system. Of admittees, 16% either went on their own, or were referred by family or friends.{{cite web|title=Treatment Episode Data Set (TEDS)2001 – 2011. National Admissions to Substance Abuse Treatment Services|url=http://archive.samhsa.gov/data/2k13/TEDS2011/TEDS2011N.pdf|website=samhsa.gov|publisher=Substance Abuse and Mental Health Services Administration|access-date=17 April 2015|archive-url=https://web.archive.org/web/20170801113557/http://archive.samhsa.gov/data/2k13/TEDS2011/TEDS2011N.pdf|archive-date=1 August 2017|url-status=dead}}

Of Australians aged 14 years and over, 34.8% have used cannabis one or more times in their life.{{Cite web|url = http://www.druginfo.adf.org.au/topics/quick-statistics#cannabis|title = Drug Info|website = Australian Drug Foundation|archive-url = https://web.archive.org/web/20110425032922/http://www.druginfo.adf.org.au/topics/quick-statistics#cannabis#cannabis|archive-date = 25 April 2011|url-status = dead}}

In the European Union (data as available in 2018, information for individual countries was collected between 2012 and 2017), 26.3% of adults aged 15–64 used cannabis at least once in their lives, and 7.2% used cannabis in the last year. The highest prevalence of cannabis use among 15 to 64 years old in the EU was reported in France, with 41.4% having used cannabis at least once in their life, and 2.17% used cannabis daily or almost daily. Among young adults (15–34 years old), 14.1% used cannabis in the last year.{{Cite web|url=http://www.emcdda.europa.eu/data/stats2018/gps_en|title=Statistical Bulletin 2018 — prevalence of drug use {{!}} www.emcdda.europa.eu|website=emcdda.europa.eu|access-date=2019-02-05}}

Among adolescents (15–16 years old) in a European school based study (ESPAD), 16% of students have used cannabis at least once in their life, and 7% (boys: 8%, girls: 5%) of students had used cannabis in the last 30 days.{{Cite web|url=http://www.espad.org/report/summary|title=Summary {{!}} www.espad.org|website=espad.org|access-date=2019-02-05}}

Globally, 22.1 million people (0.3% of the worlds population) were estimated to have cannabis dependence.{{cite journal | vauthors = Degenhardt L, Charlson F, Ferrari A, Santomauro D, Erskine H, Mantilla-Herrara A, etal | collaboration = GBD 2016 Alcohol and Drug Use Collaborators | title = The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 | language = en | journal = The Lancet. Psychiatry | volume = 5 | issue = 12 | pages = 987–1012 | date = December 2018 | pmid = 30392731 | pmc = 6251968 | doi = 10.1016/S2215-0366(18)30337-7 }}

Medications such as SSRI antidepressants, mixed-action antidepressants, bupropion, buspirone, and atomoxetine may not be helpful to treat cannabis use disorder, but the evidence is very weak and further research is required. THC preparations, gabapentin, oxytocin, and N-acetylcysteine also require more research to determine if they are effective as the evidence base is weak.

Heavy cannabis use has been associated with impaired cognitive functioning; however, its specific details are difficult to elucidate due to the potential use of additional substances of users, and lack of longitudinal studies.{{cite journal |last1=Scott |first1=JC |last2=Slomiak |first2=ST |last3=Jones |first3=JD |last4=Rosen |first4=AFG |last5=Moore |first5=TM |last6=Gur |first6=RC |title=Association of Cannabis With Cognitive Functioning in Adolescents and Young Adults: A Systematic Review and Meta-analysis. |journal=JAMA Psychiatry |date=1 June 2018 |volume=75 |issue=6 |pages=585–595 |doi=10.1001/jamapsychiatry.2018.0335 |pmid=29710074|pmc=6137521 }}

• La Guardia Committee, the first in-depth study into the effects of cannabis.
• Medical cannabis
• Quitting smoking

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{{Addiction|state=expanded}}

{{Cannabis|state=expanded}}

{{Psychoactive substance use}}

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Category:Cannabis smoking

Category:Substance dependence