In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) replaced the diagnostic terms substance abuse and substance dependence with the term substance use disorders, categorized as mild, moderate, or severe to indicate the level of severity as determined by the number of diagnostic criteria met by an individual. (3)
Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.
According to the DSM-5, a diagnosis of substance use disorder, including cannabis use disorder, is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.
What is the risk of developing cannabis use disorder?
Cannabis is the most-used drug after alcohol and tobacco in the United States.
- In 2015, about 4 million people in the United States met diagnostic criteria for a substance use disorder based on cannabis use (4), and 138,000 voluntarily sought treatment for their cannabis use. (5)
- Greater frequency of cannabis use increases the likelihood of developing problem cannabis use. Recent data suggest that 30 percent of heavy cannabis users may have some degree of cannabis use disorder. (6)
- People who begin using cannabis before the age of 18 are four to seven times more likely to develop a cannabis use disorder than adults. (7)
- In Washington state, 7,427 people who were admitted to treatment in 2013 reported cannabis as their primary drug of abuse. (8)
Estimates of the number of people addicted to cannabis are controversial, in part because epidemiological studies of substance use often use dependence as a proxy for addiction even though it is possible to be dependent without being addicted. Those studies suggest that 9 percent of people who use cannabis will become dependent on it, (9,10) rising to about 17 percent in those who start using in their teens. (11, 12)
What are the effects of cannabis use?
Cannabis’s immediate effects include:
- distorted perception,
- difficulty with thinking and problem solving, and
- loss of motor coordination.
Long-term use of the drug can contribute to respiratory infection, impaired memory, and exposure to cancer-causing compounds. Heavy cannabis use in youth has also been linked to increased risk for developing mental illness and poorer cognitive functioning. (13)
What are the symptoms of cannabis use disorder?
Some symptoms of cannabis use disorder include:
- disruptions in functioning due to cannabis use,
- the development of tolerance,
- cravings for cannabis, and
- development of withdrawal symptoms, such as the inability to sleep, restlessness, nervousness, anger, or depression within a week of ceasing heavy use.
Are there treatments for cannabis use disorder?
Treatment of cannabis use disorder usually involves behavioral therapies, such as cognitive behavioral therapy, contingency management, and motivational enhancement therapy. Self-help groups like Marijuana Anonymous can be a useful adjunct to other treatment approaches. There are no FDA-approved drugs for cannabis use disorder, but research is underway in this area. A few medications such as N-acetylcysteine and gabapentin have shown promise in clinical trials.
- General information: SAMHSA’s page on Marijuana. NIDA’s Research Report on Marijuana, and the National Academies’ Health Effects of Cannabis and Cannabinoids.
- Assessment: see ADAI brief reports on Screening & Assessment of Cannabis Use Disorders
- Treatment: see ADAI’s Treating Youth Substance Use: Evidence Based Practices and their Clinical Significance, and NIDA’s Treatments for Marijuana Use Disorders.
- Substance Abuse and Mental Health Administration (SAMHSA) Substance Use Disorders (https://www.samhsa.gov/disorders/substance-use) Accessed 5/25/2017
- National Institute on Drug Abuse (NIDA) Research Report on Marijuana (https://www.drugabuse.gov/publications/research-reports/marijuana/) Accessed 5/25/2017
- Hasin DS, O’Brien CP, Auriacombe M, et al. DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. Am J Psychiatry 2013;170(8):834-851. doi:10.1176/appi.ajp.2013.12060782. PMCID: PMC3767415
- Center for Behavioral Health Statistics and Quality (CBHSQ). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.htm. Accessed 10/11/2016.
- Center for Behavioral Health Statistics and Quality (CBHSQ). Treatment Episode Data Set (TEDS): 2003-2013. National Admissions to Substance Abuse Treatment Services. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015. BHSIS Series S-75, HHS Publication No. (SMA) 15-4934. https://wwwdasis.samhsa.gov/dasis2/teds_pubs/2013_teds_rpt_natl.pdf
- Hasin DS, Saha TD, Kerridge BT, et al. Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72(12):1235-1242. doi:10.1001/jamapsychiatry.2015.1858.|
- Winters KC, Lee C-YS. Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age. Drug Alcohol Depend. 2008;92(1-3):239-247. PMCID: PMC2219953.
- Center for Behavioral Health Statistics and Quality (CBHSQ). Treatment Episode Data Set (TEDS): 2003-2013. State Admissions to Substance Abuse Treatment Services. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015. BHSIS Series S-80, HHS Publication No. (SMA) 16-4964. https://wwwdasis.samhsa.gov/dasis2/teds_pubs/2013_teds_rpt_st.pdf
- Anthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol. 1994;2(3):244-268.
- Lopez-Quintero C, Pérez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2011;115(1-2):120-130. PMCID: PMC3069146.
- Anthony JC. The epidemiology of cannabis dependence. In: Roffman RA, Stephens RS, eds. Cannabis Dependence: Its Nature, Consequences and Treatment. Cambridge, UK: Cambridge University Press; 2006:58-105
- Hall WD, Pacula RL. Cannabis Use and Dependence: Public Health and Public Policy. Cambridge, UK: Cambridge University Press; 2003.
- Shrivastava A, Johnston, M, Tsuang M. Cannabis use and cognitive dysfunction. Indian J Psychiatry 2011; 53(3): 187–191. PMCID: PMC3221171
Updated 2017. Adapted from the public domain resources SAMHSA’s “Substance Use Disorders” (1) and NIDA’s “Research Report on Marijuana.” (2)