IS CANNABIS ADDICTIVE?

Every day we are learning more and more about cannabis thanks to research taking place at centers like CUChange. However, despite our growing knowledge of cannabis, there are still several misconceptions about this increasingly available product. One such misconception is that it is not possible to become addicted to cannabis after periods of prolonged use.

In fact, cannabis CAN be addictive. Cannabis use disorder (CUD) has been a clinically recognized substance use disorder for many years. CUD has been recognized by the American Psychiatric Association since 2013 (APA, 2013) and was also recognized by the World Health Organization starting in 2019 (WHO, 2019).

You may now be wondering what does CUD mean and how is it diagnosed? Well, the Centers for Disease Control and Prevention (CDC) defines CUD as an individual being unable to willingly stop the use of cannabis products despite it causing potential health issues and social problems. The diagnosis of CUD involves eleven different criteria including social/interpersonal problems, craving, and withdrawal. Meeting any two of these eleven criteria within the past 12 months constitutes a diagnosis of CUD (APA, 2013; Patel & Marwaha, 2020).

The eleven criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Version 5 (APA, 2013) can be found listed below. *

1.     Cannabis is often taken in larger amounts or over a longer period than was intended.

2.     There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.    

3.     A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.  

4.     Craving, or a strong desire or urge to use cannabis.  

5.     Recurrent cannabis use results in failure to fulfill role obligations at work, school, or home. 

6.     Continued cannabis use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.  

7.     Important social, occupational, or recreational activities are given up or reduced because of cannabis use.

8.     Recurrent cannabis use in situations in which it is physically hazardous.  

9.     Cannabis use continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.

10.  Tolerance, as defined by either: (1) a need for markedly increased cannabis to achieve intoxication or desired effect or (2) a markedly diminished effect with continued use of the same amount of the substance. 

11.  Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms.

*If you are a cannabis user or you start using cannabis and believe you are suffering from any of the symptoms listed above, please contact your primary care physician to discuss these concerns further.

It is currently estimated that 3 out of 10 individuals that use cannabis have at least some degree of CUD (Hasin et al., 2015). The age demographic that is most affected is 18 to 25-year-olds, with 13.5% of this age group experiencing some symptoms of CUD within the past year (HHS, 2021). In comparison, 15.6% of individuals 18-25 are diagnosed with an alcohol use disorder, according to the 2020 National Survey on Drug Use and Health (HHS, 2021). Figure 27 below shows how CUD compares with rates of other substance use disorders for all people over 12.

Why does cannabis use disorder occur?

Cannabinoids like delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are just two of the many active compounds found within cannabis products, and it is THC that is commonly associated with producing the intoxicating effects associated with cannabis.

One prevailing theory of how cannabis use disorder develops is attributed to THC’s interaction with dopaminergic and serotonin receptors within the brain. Both receptors play a role in the body’s intrinsic reward system and prolonged use of cannabis products high in THC may disrupt how this system functions and produce some of the symptoms of CUD (NIDA, 2016).

Treatment for cannabis use disorder

An important component of many of the diagnostic criteria for cannabis use disorder is that cannabis use persists despite the individual’s desire to stop using and despite consequences that may occur with prolonged use. These features are common with other substance use disorders, including alcohol use disorder, stimulant abuse, and opiate abuse.

There are currently no approved pharmacotherapies (i.e., medications) for the treatment of cannabis use disorder although some medications may be prescribed to lessen the symptoms of withdrawal (Connor et al., 2021). There are multiple clinical trials currently underway to develop new medications targeted at treating cannabis use disorder (Connor et al., 2021; Sherman & McRae-Clark, 2016). Because we don’t have effective medications yet, treatment relies heavily on talk therapies like cognitive behavioral therapy (CBT), motivational enhancement therapy, and contingency management (Connor et al., 2021).

Interestingly, another cannabinoid that we have already mentioned is currently being explored as one of these potential therapy options. Cannabidiol (CBD), unlike THC, is not intoxicating and can antagonize or oppose the effects of THC. This may provide a natural remedy to assist with the treatment of cannabis use disorder, though further research is necessary (Freeman et al., 2020).

For those who frequently use high doses of cannabis, withdrawal symptoms may occur when use is stopped or reduced, and these symptoms can include trouble falling asleep, changes in appetite, feelings of aggression or irritability, depressed mood, and headaches (Levin et al., 2010). These symptoms can last 1-4 weeks and be quite distressing to individuals attempting to abstain from cannabis (Budney & Hughes, 2006). Individuals who think they may have CUD should speak to their doctor.

In Conclusion

As you have learned, it is indeed a myth that cannabis is not addictive. Cannabis use disorder is recognized by many health organizations as a substance use disorder and appears to be most prevalent in individuals aged 18 to 25 years old but can afflict people of all ages. Treatment options are available and should be discussed with your primary care physician. Individuals with cannabis use disorder find symptom relief with cessation of cannabis use and supervised medical treatment.

*The above information is for educational purposes only and should not be considered medical advice.

Contributing Authors: Carillon Skrzynski, Austin Drake, Josh Elmore, & Jonathan Lisano

Check out the studies below for more information:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Connor, J. P., Stjepanović, D., Le Foll, B., Hoch, E., Budney, A. J., & Hall, W. D. (2021). Cannabis use and cannabis use disorder. Nature Reviews Disease Primers, 7(1), 1-24. (link: https://www.nature.com/articles/s41572-021-00247-4)

Freeman, T. P., Hindocha, C., Baio, G., Shaban, N. D., Thomas, E. M., Astbury, D., ... & Curran, H. V. (2020). Cannabidiol for the treatment of cannabis use disorder: a phase 2a, double-blind, placebo-controlled, randomized, adaptive Bayesian trial. The Lancet Psychiatry, 7(10), 865-874.

Levin, K. H., Copersino, M. L., Heishman, S. J., Liu, F., Kelly, D. L., Boggs, D. L., & Gorelick, D. A. (2010). Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers. Drug and alcohol dependence, 111(1-2), 120–127. https://doi.org/10.1016/j.drugalcdep.2010.04.010

Patel, J., & Marwaha, R. (2020). Cannabis Use Disorder, StatPearls. Treasure Island (FL). (link: https://www.ncbi.nlm.nih.gov/books/NBK538131/?report=reader)

National Institute on Drug Abuse. (2016, March 10). The reward circuit: How the brain responds to marijuana. National Institutes of Health. (link: https://nida.nih.gov/videos/reward-circuit-how-brain-responds-to-marijuana)

Sherman, B. J., & McRae-Clark, A. L. (2016). Treatment of Cannabis Use Disorder: Current Science and Future Outlook. Pharmacotherapy, 36(5), 511–535. https://doi.org/10.1002/phar.1747

World Health Organization (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed.).

Hasin D.S., Saha T.D., Kerridge B.T. (2015). Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry, 72(12), 1235-1242.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2021). National Survey on Drug Use and Health 2020 (PEP21-07-01-003).

Budney A.J., Hughes J.R. (2006). The cannabis withdrawal syndrome. Curr Opin Psychiatry, 19(3), 233-238. doi:10.1097/01.yco.0000218592.00689.e5