What Is Cannabis Use Disorder?

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What Is Cannabis Use Disorder?

Cannabis use disorder (CUD) is a diagnosis given for problematic marijuana use. CUD was introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM 5. (The previous DSM edition separated problematic use into two different disorders: cannabis abuse and cannabis dependence.)

Cannabis use disorder affects roughly 10% of the 193 million cannabis users in the world, and it captures the possibility that people can be negatively impacted by marijuana use without necessarily being addicted. However, it also has room to recognize cannabis addiction if it occurs.

Signs and Symptoms of Cannabis Use Disorder

One of the key things to remember with cannabis use disorder is that it involves cannabis use that creates issues or problems for the user. With that in mind, at least two of the following official criteria or symptoms occurring within a 12-month period indicate cannabis use disorder:

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

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

Diagnosis of Cannabis Use Disorder

To diagnose cannabis use disorder, the person's history is assessed. This includes investigating whether they or their immediate family members have a history of substance abuse or mental health issues and also includes their medical history and exposure to environmental stress.

Laboratory testing can be used to help identify cannabis use. However, a positive drug test does not necessarily mean the person has cannabis use disorder and a negative drug test does not rule this out. Instead, it is more important to look at reported cannabis intake compared to the amount that is in the blood.

A cannabis use disorder diagnosis can depend, in part, on its effects—such as the 11 criteria or symptoms outlined above. 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

The new cannabis use disorder classification (which separates problematic use from cannabis dependence or cannabis abuse) means that someone can have severe cannabis use disorder 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 high physical tolerance and withdrawal.

CUD and Other Mental Health Conditions

A CUD diagnosis can be complicated by comorbid or co-occurring mental health conditions. For instance, cannabis use disorder is strongly associated with both major depression and generalized anxiety disorder. Some studies have also found higher rates of cannabis use disorder in people with post-traumatic stress disorder.

Research has reported connections between this disorder and other specific substance use disorders as well, some of which include:

  • Sedative use disorder
  • Cocaine use disorder
  • Stimulant use disorder
  • Club drug use disorder
  • Alcohol use disorder

Causes of Cannabis Use Disorder

Substance use disorders don't have one specific cause that fits all people diagnosed with this condition. Stress, emotional distress, and other mental health conditions (such as anxiety and depression) can each contribute to the development of cannabis use disorder.

Yale Medicine adds that there may be a genetic or hereditary component as well, with one of its studies identifying several gene variants that can increase one's risk of developing cannabis dependence or cannabis addiction.

Treatment for Cannabis Use Disorder

There are a couple of different treatment options for people with cannabis use disorder. It's important to note that if there is a co-occurring condition, treating both conditions at the same time can provide the most favorable treatment outcome.

Counseling and Therapy

Several types of counseling or therapy have been found beneficial for reducing cannabis use and the subsequent problems this drug creates. They are:

  • Cognitive Behavioral Therapy: a form of psychotherapy that helps people identify destructive thought patterns, then change those patterns to positively influence their behaviors
  • Motivational Enhancement Therapy: a short-term therapy designed to help motivate the person to change harmful behaviors
  • Contingency Management: a behavioral therapy technique that utilizes a formal contract between the therapist and client to help the client change behavior through establishing goals while also setting rewards and penalties

One study involving 308 subjects also found that online interventions that include chat counseling can also be helpful for people with cannabis use disorder, especially when used by those who don't traditionally utilize outpatient treatment options.

Medication

At this time, there is no medication approved by the Food and Drug Administration (FDA) to treat cannabis use disorder, though some medicines are currently under investigation. Until such options exist, cannabis use disorder is best treated through counseling and therapy.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Frequently Asked Questions

  • How is cannabis use disorder treated?

    Cannabis use disorder is currently treated with counseling and therapy, though some medications are being investigated as potential treatment options. Some health experts suggest that, should a medicine be found, combining it with therapy may offer people with cannabis use disorder the best prognosis.

  • Who is most affected by cannabis use disorder?

    Roughly 1.4% of American adults have cannabis use disorder, while this condition affects 9.3% of cannabis users. Individuals most at risk of developing CUD include those who are younger, male, unmarried, in a lower income bracket, and reside in a state that has medical marijuana laws. People with psychiatric disorders also have a higher risk.

  • What are the physical effects of cannabis use disorder?

    The answer to the question can vary based on the individual person's response to the drug, the form of cannabis used, and the level of cannabis use. The physical effects of using marijuana, in general, include daily cough, more frequent lung illnesses and infections, increased heart rate, and—in some cases—intense nausea and vomiting. If cannabis use is heavy and prolonged, it can even change the brain's networks.

  • How is cannabis use disorder diagnosed?

    If cannabis use disorder is suspected, the person's individual and familial history is assessed, both in terms of substance use and mental health issues. Medical history and environmental stressors are also taken into consideration. To be diagnosed with CUD, at least two of the 11 criteria as outlined by the DSM 5 must be met. While drug tests can determine cannabis use, they are not necessarily good for diagnosing cannabis use disorder as a positive test doesn't mean a disorder exists and a negative test doesn't preclude this diagnosis either.

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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.