Recognizing the symptoms of Cannabis Use Disorder is the first step toward understanding its impact and seeking help. While cannabis is often perceived as less risky than other substances, its potential for dependence and withdrawal is real and well-documented. (A) There are two known endocannabinoids, called anandamide (AEA) and 2-arachidonoylglycerol (2-AG). Cannabis contains exogenous cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). (B) Endogenous cannabinoid release prevents overstimulation of neurons, modulates the release of various neurotransmitters such as GABA and glutamate, and has downstream effects, notably on dopaminergic transmission. Compared with signaling by endogenous cannabinoids (normal state), chronic cannabis use likely results in changes in various components of the endocannabinoid system (e.g., CB1 and FAAH).
Treatment for cannabis use disorder
Our goal is to support individuals on their path to recovery, helping them achieve a healthier, substance-free lifestyle through a comprehensive approach to treatment. A healthcare professional will begin the diagnosis of cannabis use disorder by examining the individual’s personal and family history of substance use and mental health, as well as their medical background and any exposure to environmental stresses. Approximately 10% of individuals who start using cannabis eventually become addicted, with around 30% of current users fulfilling the criteria for addiction.
Better characterization of the factors that influence treatment effectiveness and engagement will be important in future studies as they could help to personalize and optimize treatments. Cannabis use contributes to a global health burden, although notably less than other psychoactive substances such as alcohol, tobacco, opioids, and stimulants. According to the Global Burden of Disease project, in 2016 CUDs resulted in an approximate 646,500 years of life lost to disability, with an age-standardized rate of 8.5 years per 100,000 persons (33). Despite an increase in cardiovascular disease mortality among US adults (34), the association between cannabis use and increased all-cause mortality remains uncertain (35). In Canada, the cannabis-attributable burden of disease in 2012 included 55,813 years of life lost due to disability, 10,533 years of life lost due to premature mortality, and 66,346 disability-adjusted life years overall. Those cannabis use guidelines aimed at lowering risk have been endorsed by some public agencies and widely disseminated in Canada to reduce the impact of cannabis legalization using a public health framework (see Table 1) (37).
Symptoms and Causes
Cannabis use disorder is a real and treatable condition affecting millions of Americans. As cannabis becomes more alcohol rehab widely available, understanding its potential for addiction becomes increasingly important for public health. It’s important to understand that cannabis use disorder is not simply a matter of choice or willpower.
- Telemedicine offers a convenient way to access care from the comfort of your home.
- These occur because the brain and body have become dependent on regular cannabis intake, and when it is no longer available, the body reacts negatively.
- A cannabis use disorder can arise from genetic, psychological, social, biological, and environmental factors working together.
- The squirrel monkey is so far the only tested animal species that reliably self-administers THC85.
Treatments
- It’s important to understand that cannabis use disorder is not simply a matter of choice or willpower.
- Researchers emphasize open, honest conversations about cannabis, combined with clear boundaries, can mitigate its appeal to teens.
- The American Society of Addiction Medicine (ASAM) developed guidelines for opioid and stimulant use disorders, but comprehensive guidelines for cannabis use disorder are unavailable.
- Mirtazapine is often prescribed to patients experiencing significant anxiety, depression, or sleep disturbances related to cannabis withdrawal.
- This distinction becomes particularly important as today’s cannabis products contain higher THC concentrations than ever before.
Reinforcement can be positive (such as physical satisfaction) or negative (such as relief of discomfort)133. Punishment decreases the likelihood of the behaviour (for example, through aversive consequences such as pain or loss of positive consequences). The frequency and regularity of the consequences affects learning143,144; for example, a cannabis user who smokes 5 joints and has 10 puffs per cigarette receives 50 reinforcements per day145.
Of note, the SDS and TLFB may not be reliable if the patient has reasons to understate their use, such as in assessing their fitness for work, forensic matters, disability support or welfare. In these cases, more weight may be given to corroborating data from family, work, medical records and to biological markers of cannabis use. Social and cognitive learning processes can explain the onset, course and maintenance of addictive behaviour133. Balanced placebo studies can isolate the pharmacological effects of a substance from expected (learnt) cognitive changes134. These designs typically lead participants to expect that they are consuming alcohol or drugs when some participants are given a placebo (non-active substance).
Box 3 . Cannabis use disorder assessment.
A pregnenolone derivative drug called AEF0117, a more promising CB1-SSi (51), reduces THC taking and THC seeking as well as THC-induced elevation of dopamine and various measures of impairment induced by THC (51). Negative allosteric modulators (NAMs) for CB1 may have some therapeutic utility by blocking some effects of THC (but not all; for instance, there was no induction of withdrawal) (52). Cannabidiol is the major nonpsychomimetic compound derived from cannabis that has some potential for a range of neuropsychiatric disorders, including addictive disorders (53). The latest edition, published in 2022 (DSM-5-TR), includes items related to impaired control over cannabis use, social impairments due to cannabis use, risky use of cannabis, and pharmacological cannabis use disorder indicators (13).
Trials that included a CM-only condition showed a reduction in self-reported and objectively measured abstinence in comparison to other active treatment and control conditions among individuals with CUD (109, 126, 127). A recent, small observational study suggested that remote delivery of a CM intervention may be a feasible and effective treatment approach (128). Several studies have used CM in combination with other active treatments (such as CBT and MET) to investigate possible cumulative treatment gains. However, consistent with findings in other substance use disorders (125), the improvements observed during individual or adjunct CM treatment tend to diminish relatively rapidly after the cessation of treatment.
Cannabidiol (CBD) products that contain no or very small amounts of THC are not reviewed. CBD has generated a great deal of interest in its potential therapeutic use22,23 because it does not produce euphoria24 and it has low abuse or dependence potential25. While no specific medications treat cannabis addiction directly, various medications can help manage withdrawal symptoms and co-occurring conditions. While cannabis does not cause the same level of physical dependence as substances like alcohol or opioids, psychological dependence can develop, resulting in withdrawal symptoms upon dose reduction or discontinuation.
Learning mechanisms (such as cue reactivity and operant learning) further explain long-lasting behavioural changes. Cannabis use and CUD have similar risk factors to other substance use and SUDs157. Other factors that increase risk of SUDs are parental use of drugs, permissive attitudes towards drug use, mental disorders, poor relationships and unfavourable child-rearing161,162. Peer substance https://bccl.work/2023/01/20/alcoholism-denial-recognizing-signs-causes-and/ use, attitudes and behaviours have an important role in adolescents162. Psychosocial risk factors include social disadvantage, early onset behavioural difficulties and adverse peer affiliations, moving away from home, dropping out of education, behavioural deviance and acts of violence163.
Its excessive use can lead to dire health complications in almost every single body system. Unlike casual smokers, heavy marijuana users are especially prone to respiratory complications such as dry coughs, lung inflammation, and bronchitis, which are only exacerbated by traditional smoking. The gastrointestinal system of an avid user can also fail to function optimally, giving rise to persistent nausea and severe abdominal pain that will greatly suppress one’s normal eating habits.
The reasons stated for use were to manage depression, anxiety, and stress, pain, nausea, and for recreation. Wanting to manage depression and lower stress are major factors contributing to cannabis use amongst users. 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. Over time, with skyrocketing THC concentrations in cannabis products, the possibility of addiction has become even greater. For those with a genetic predisposition, cannabis use may trigger psychotic disorders like schizophrenia earlier than expected, making it fundamental to recognize and address early patterns of use 6.