Cannabis Use Disorder or Problematic Marijuana Use

Model poses as a marijuana smoker
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Cannabis use disorder is a diagnosis that is given for problematic marijuana use. The diagnosis was introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM-5. In the previous edition, the DSM-IV-TR, problematic use of cannabis or marijuana was separated into two different disorders, cannabis abuse, and cannabis dependence.

Does This Mean Cannabis Is Not Addictive?

With the disappearance of cannabis dependence, some people might interpret the change of disorder name to a single disorder to imply that cannabis is not addictive, and cannabis does not lead to drug dependence. After all, it has long had a reputation as a soft drug.

A lot of consideration went into deciding how cannabis use disorder should be described in DSM-5. Many cannabis users deny any addictive aspects of the drug, yet many do appear to become addicted.

Cannabis use disorder captures the possibility that people can be negatively impacted by their marijuana use, without necessarily being addicted. However, it also has room to recognize addiction if it happens.

Just because the name has changed, and the term "use" has replaced "abuse" or "dependence," doesn't mean that cannabis is not addictive. In fact, the research shows conclusively that cannabis is addictive.

Cannabis dependence expert Dr. Alan Budney reviewed studies of cannabis withdrawal and found that both lab studies of inpatients and studies of outpatients consistently showed a physical withdrawal syndrome pattern in cannabis users who were discontinuing the drug that paralleled that of other drugs which are well recognized to be addictive, such as cocaine and heroin. Withdrawal symptoms begin within 24 to 48 hours of not using cannabis, peak within four to six days, and last for one to three weeks.

Why One Disorder to Replace Two?

Having established the addictive basis of cannabis use disorder, the DSM-5 task force also focused on deciding whether substance use disorders in general and cannabis use disorder in particular, should be grouped into one disorder or two.

In previous editions of the DSM, cannabis abuse was considered the less serious disorder, with problems arising from cannabis use, but no indication of dependence. In contrast, cannabis dependence focused on the signs and symptoms of addiction, specifically, tolerance and withdrawal.

Various experts used different methods of analysis to determine whether the problems people experience as a result of drug use are best explained using a single dimension of substance use disorder, or two separate categories of substance abuse and substance dependence. Based on the results of the analyses, they determined that a dimensional view made the most sense.

Instead of using the separate categories of cannabis abuse and cannabis dependence, with different kinds of problems in each category, one dimension is used which includes all of the problems that previously appeared in the two categories.

The severity of the person's problems can be captured by including an additional indicator:

  • Mild: two to three symptoms
  • Moderate: four to five symptoms
  • Severe: six or more symptoms

Symptoms of Cannabis Use Disorder

At least two of the following symptoms within a 12-month period indicates cannabis use disorder:

  • Taking more cannabis than was intended
  • Difficulty controlling or cutting down cannabis use
  • Spending a lot of time on cannabis use
  • Craving cannabis
  • Problems at work, school, and home as a result of cannabis use
  • Continuing to use cannabis despite social or relationship problems
  • Giving up or reducing other activities in favor of cannabis
  • Taking cannabis in high-risk situations
  • Continuing to use cannabis despite physical or psychological problems
  • Tolerance to cannabis
  • Withdrawal when discontinuing cannabis.

Remember, the new way of describing cannabis use disorder means that the severity of the person's physical addiction is unrelated to the severity of their disorder. With a list of 11 symptoms to choose from, someone can have cannabis use disorder, severe, without having any tolerance or withdrawal, the hallmarks of addiction. By the same token, they can meet the criteria for mild cannabis use disorder, despite experiencing severe physical tolerance and withdrawal.

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Article Sources

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  1. Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007;4(1):4-16.

  2. 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

  3. Dawson DA, Saha TD, Grant BF. A multidimensional assessment of the validity and utility of alcohol use disorder severity as determined by item response theory models. Drug Alcohol Depend. 2010;107(1):31-38. doi:10.1016/j.drugalcdep.2009.08.019

Additional Reading

  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, fifth edition DSM-5 American Psychiatric Association, 2013.
  • Helzer, J., Van Den Brink, W., & Guth, S. "Should There Be Both Categorical and Dimensional Criteria for the Substance Use Disorders in DSM-V?" Addiction 101,s1:17-22. 2006.
  • Muthén, B. "Should Substance Use Disorders Be Considered as Categorical or Dimensional?" Addiction 101,s1:6–16. 2006.