Cannabis Use Disorder

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Cannabis Use Disorder

Cannabinoids, especially cannabis, are the most widely used illicit psychoactive substances in the United States. The high prevalence of cannabis use disorder likely reflects the much more widespread use of cannabis relative to other to other illicit drugs rather than greater addictive potential. Cannabis use disorder is most commonly observed in males, although the magnitude of this difference is less among adolescents. Individuals with cannabis use disorder may use cannabis throughout the day over a period of months or years, and thus may spend many hours a day under the influence. Even though medical uses of cannabis remain controversial, use for medical circumstances should be considered when a diagnosis is being made.

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Cannabis Use Disorder Defined

Cannabis use disorder is a condition characterized by the harmful consequences of repeated cannabis use, a pattern of compulsive cannabis use, and (sometimes) physiological dependence on cannabis (i.e., tolerance and/or symptoms of withdrawal). Over time, this plant material has accumulated many names (e.g., weed, mary jane, pot, grass, herb, dope, bhang, skunk, boom, gangster, kif, dagga, and ganja). A concentrated extraction of the cannabis plant that is also commonly used is hashish. Cannabis is most commonly smoked via a variety of methods: pipes, water pipes (hookahs or bongs), cigarettes (joints or reefers), or, most recently, in the paper from hollowed out cigar (blunts). Cannabis is sometimes also ingested orally, typically by being mixed into food. Recently, devices have been developed in which cannabis can be vaporized. Cannabis users can develop tolerance to this drug so that it can be difficult to detect when they are intoxicated. Signs of cannabis use include red eyes, chronic cough, cannabis odor on clothing, yellowing of fingertips (from smoking joints), burning of incense (to hide odor), and exaggerated craving and impulse for specific foods. This disorder is only diagnosed when cannabis use becomes persistent and causes significant academic, occupational or social impairment.

Different Types:

There are not separate types of cannabis use disorders, but there are levels of severity. These levels are based on which criteria is met, which is listed under symptoms.

Mild: Presence of 2-3 symptoms.
Moderate: Presence of 4-5 symptoms.
Severe: Presence of 6 or more symptoms.

Cannabis Use Disorder Causes:

The onset of cannabis use disorder can occur at any time during or following adolescence, but onset is most commonly during adolescence or young adulthood. Individuals are not all automatically or equally vulnerable to developing cannabis use disorder or other substance-related disorders. Some individuals have lower levels of self-control that predispose them to develop problems if they're exposed to drugs.

Cannabis Use Disorder Symptoms:

To be diagnosed with cannabis use related disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.

    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 the cannabis, use the cannabis, or recover from its effects.
    4. Craving, or a strong desire or urge to use cannabis.
    5. Recurrent cannabis use, resulting in a failure to fulfill major role obligations at work, school, or home.
    6. Continued cannabis use despite having 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. Continued cannabis use 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 of the following:
      • A. A need for markedly increased amounts of cannabis to achieve intoxication or desired effect.
      • B. Markedly diminished effect with continued use of the same amount of the cannabis.
    11. Withdrawal, as manifested by either of the following:
      • A. The characteristic withdrawal syndrome for cannabis.
      • B. The cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

If you are taking cannabinoids, under appropriate medical supervision, an individual does not meet this criteria. Cannabis use disorder can include periods of cannabis intoxication and symptoms of withdrawal.

Cannabis Intoxication:

Cannabis Intoxication causes significant psychological and social impairment. To be diagnosed with cannabis intoxication, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. Recent use of cannabis.
B.Clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, social withdrawal) that developed during, or shortly after, cannabis use.
C. Two (or more) of the following signs or symptoms developing within 2 hours of cannabis use:

      1. Conjunctival injection.
      2. Increased appetite.
      3. Dry mouth.
      4. Tachycardia.

D. The signs or symptoms are not attributable to another medical conditioning are not better explained by another mental disorder, including intoxication with another substance.

Cannabis withdrawal:

Cannabis withdrawal occurs after the cessation of (or reduction in) heavy and prolonged cannabis use.To be diagnosed with cannabis withdrawal, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. Cessation of cannabis use that has been heavy and prolonged (i.e. usually daily or almost daily use over a period of at least a few months).

B. Three (or more) of the following signs and symptoms develop within approximately 1 week after Criterion A:

      1. Irritability, anger, or aggression.
      2. Nervousness or anxiety.
      3. Sleep difficulty (e.g., insomnia, disturbing dreams).
      4. Decreased appetite or weight loss.
      5. Restlessness.
      6. Depressed mood.
      7. At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache.

C. The signs of symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

How to Approach a Loved One:

There is not a perfect way to approach a loved one that you assume or know is struggling with a cannabis use disorder. Many people with cannabis use disorder do not seek treatment, mainly because they don’t think it is a problem. Approaching loved ones to tell them that they do have a problem can be difficult. An intervention from loved ones can help some people recognize and accept that they need help. If you're concerned about someone who may have an cannabis use disorder, ask a professional experienced in drug addiction treatment for advice on how to approach that person. You can not force someone to seek professional care, but you can always offer your support and encouragement.

Types of Cannabis Use Disorder Treatment:

There is no FDA-approved pharmacological treatment for cannabis dependence. Lifestyle changes are important in deciding to stop using cannabis. Reflecting on why you choose to use cannabis and the affects you seek from cannabis may help in your decision to stop using cannabis. Ensuring that your family and friends are aware that you no longer want to use cannabis and develop a support system of friends and family who can support your decision is important. If you have people in your life that continue to take cannabis that do not support your choice to stop using, it may impact your decision and ability to stop. Engaging in other healthy habits like good sleep habits, regular physical activity, meditation, and yoga can be used to replace your cannabis use.

Differences Between Common Disorders:

There are other possible causes of that resemble cannabis use disorder but would not meet criteria for this disorder. These are common disorders but the differences between them and cannabis use disorder.

  • Other mental disorders- Cannabis-induced disorders symptoms may resemble primary mental disorders, like generalized anxiety disorder. Chronic intake of cannabis can produce a lack of motivation that resembles persistent depressive disorder (dysthymia). Acute adverse reactions to cannabis should be differentiated from the symptoms of panic disorder, major depressive disorder, delusional disorder, bipolar disorder, or schizophrenia, paranoid type. Physical examination will usually show an increased pulse and conjunctival injection. Urine toxicological testing can be helpful in making a diagnosis.
  • Non Problematic use of cannabis- The distinction between non problematic use of cannabis and cannabis use disorder can be difficult to make because social, behavioral, or psychological problems may be difficult to attribute to the substance, especially in the context of use of other substances. Also, denial of heavy cannabis use and the attribution that cannabis is related to or causing substantial problems are common among individuals who are referred to treatment by others (i.e., school, employer, family, criminal justice system).

Resources:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.

Cannabis Use Disorder. (2018.). Retrieved from:
https://www.mentalhealth.com/home/dx/cannabisdependence.html

Hartney, E., & Gans, S. (n.d.). What Are Some Criteria for Substance Use Disorders? Retrieved from:
https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926

National Institute on Drug Abuse. (2018). Marijuana as Medicine. Retrieved from:
https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

National Institute on Drug Abuse. (2016). Marijuana as Medicine: Marijuana use disorder is common and often untreated. Retrieved from:
https://www.drugabuse.gov/publica tions/drugfacts/marijuana-medicine

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