What Is Cannabis Use Disorder?

Cannabis use disorder (CUD) is a diagnosis given for problematic marijuana (cannabis) use. This condition 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. The diagnosis 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.

Keep reading to learn more about the symptoms of cannabis use disorder and how the condition is diagnosed. It also covers what causes cannabis use disorder and the treatment that can help.

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 use
• 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

Diagnosis of Cannabis Use Disorder

To diagnose cannabis use disorder, a healthcare provider assesses the person's history. This includes 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 it 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
  

CUD and Other Mental Health Conditions

A cannabis use disorder 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 marijuana use disorder in people with post-traumatic stress disorder.

Research has reported connections between CUD and other specific substance use disorders as well, including:

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

Causes of Cannabis Use Disorder

THC, which stands for delta-9-tetrahydrocannabinol, is the compound in cannabis that produces psychoactive effects. It attaches to cannabinoid receptors in the body and causes the release of dopamine. This activates the brain's reward system, which plays a part in the onset of addiction.

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

The age at which a person begins using cannabis is another factor linked to the risk for addiction. People who start using cannabis before the age of 18 have a higher risk of becoming addicted. Using cannabis frequently also increases this risk.

Cannabis potency is also believed to play a role. Evidence suggests that the higher-potency cannabis products that are available today are associated with an increased risk for 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.

Approximately 10% of people who use cannabis daily seek treatment. People who don't seek treatment cite poor motivation, fear of change, stigma, other mental health problems, and lack of access as barriers to treatment.

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 uses a formal contract between the therapist and client to help the client change behavior by 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 use outpatient treatment options.

Research has also found that developing a strong sense of self-efficacy, or a belief that a person can resist using cannabis, is an important predictor of long-term abstinence.

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.