Marijuana/Cannabis Addiction: Understanding Cannabis Use Disorder (CUD)

What is Marijuana and How Does it Work in the Body?

Marijuana is a substance derived from the cannabis plant. It goes by other names like cannabis, weed, pot, grass, joint, and more.

When consumed (typically smoked), cannabis’ active compounds, primary tetrahydrocannabinol (THC), bind with the cannabinoid receptors in the brain and give rise to a “high”; a kind of euphoric feeling. It is because of this “high” that cannabis has become a widely used recreational drug. It also produces other psychoactive effects, like enhancing mood, reducing anxiety, providing pain relief, and so on. On the other hand, cannabis also has a wide range of negative effects like dry mouth, dizziness, decreased attention and memory, hallucinations, and paranoia, among others.

While THC is the most well-known cannabinoid, there are other cannabinoids as well. Cannabidiol (CBD), cannabigerol (CBG), and cannabinol (CBN) are among them. CBD is touted for its medical uses, while CBN is known to be psychoactive. Albeit only minimally. 

Is Marijuana Addictive?

Yes, cannabis can be addictive. Whenever the subject of legalizing marijuana or cannabis comes up, the debate on whether or not it is addictive has received considerable attention. Both sides have their arguments, but the central question remains – is cannabis addictive?

The simple answer to that is, cannabis has the potential to be addictive. To understand this in better detail, it is also crucial to understand the difference between use, dependence, and addiction. Not everyone who uses cannabis will become addicted to the substance. However, frequent and extended cannabis can lead to dependence and a more severe condition known as Cannabis Use Disorder (CUD). It is typically when the line between use and addiction gets blurred. Cannabis addiction is when a compulsive, persistent need for the substance is present, driving all else from the mind.

First things first, CUD is not the same as cannabis addiction. It affects 10% of cannabis users, and it recognizes how cannabis can negatively impact lives even if not necessarily addicted to it. CUD can drastically impact a person, leading to cannabis tolerance and dependence.

How Do You Know If You Have Cannabis Use Disorder?

The American Psychiatric Association introduced cannabis use disorder nearly a decade ago, in 2013. While it does not explicitly mean cannabis addiction, there is potential to recognize addiction if and when it happens.. For a person to be diagnosed with CUD, they must meet at least 2 of the following criteria:

• Craving for cannabis.
• Cutting down other activities in life to dedicate time for cannabis use.
• Problems in interpersonal, social, academic, or professional life because of cannabis use.
• Difficulty in controlling or reducing cannabis use.
• Extended cannabis use despite physical, psychological, and social issues.
• Consuming larger amounts of cannabis than intended.
• Using cannabis over and over again, even if it jeopardizes general safety and well-being.
• Tolerance to cannabis – needing more cannabis to achieve the desired effect.
• Experiencing withdrawal symptoms, which subside only when cannabis is consumed.

The criteria for CUD does not use the word “addiction” anywhere, it does not mean that addiction cannot happen. CUD can be mainly characterized by severe dependence on the substance, however, dependence can just as easily turn into addiction if care is not taken.  

Dependence refers to when the body physically relies on a substance, like cannabis. The body becomes accustomed to cannabis and is unable to adapt when its usage is reduced or stopped abruptly. This is when a person also begins to experience withdrawal symptoms, which are these negative, unpleasant symptoms that can only be reduced by consuming the substance.

Addiction, meanwhile, is a chronic health condition. It modifies the brain’s biochemistry and a person’s priorities completely change. Everything else takes a backseat, as they begin to prioritize cannabis use over all else; even when the substance is endangering their safety, well-being, and day-to-day functioning. It brings about a change in the person’s behavior, wherein they begin to act irrationally if they are unable to get hold of the substance.  

If you or your loved one is experiencing any of the above, know that there is a road to recovery. At Sober Living, we provide safe and comfortable spaces to recover from cannabis addiction. We also seek to rebuild lives by providing help to develop new skills and in seeking employment. For individuals exploring alternative recovery paths, understanding the Cali Sober approach to sobriety can shed light on how some integrate moderation strategies into their journey.

Risk Factors for Cannabis Use Disorder

The primary risk factor for cannabis use disorder is cannabis use. 3 in 10 people who use cannabis can develop cannabis use disorder.

Factors like younger age, personality traits, impulsivity, and enjoyment experienced when using, among others are certain factors that can lead to the development of CUD, as per the study, “A preliminary risk prediction model for cannabis use disorder.”

The study, “Multi-ancestry Genome-wide Association Study of Cannabis Use Disorder Yields Insight Into Disease Biology and Public Health Implications,” conducted by Yale SCHOOL OF MEDICINE suggests there is a genetic predisposition to developing CUD. However, it is too early to confirm one way or the other. More research is needed to establish that CUD is hereditary.

Moreover, there are certain social factors to consider as well. Peers, availability of cannabis, and social acceptance of cannabis use can also increase the likelihood of CUD. With the push toward the legalization of cannabis, there has been a seismic shift in how the society views cannabis use as well. This has led to widespread availability and use, increasing the risk of CUD. With changing times, the potency of the substance has increased as well. For instance, synthetic cannabinoids have become quite famous in recent times. While not legal, these synthetics are sprayed on dried plants so that they can be smoked. They are sold as “Spice” or “K2” and are far stronger than cannabis.

Negative Consequences of Cannabis Use Disorder

The diagnostic criteria for cannabis use disorder may often replace more severe terms like addiction with use or dependence. However, its negative consequences can be no less devastating.

Cannabis use typically begins during adolescence. As the adolescent brain is still in the developing stage, this is especially serious and must not be neglected. CUD can also increase the risk for schizophrenia among adolescents, as per the study, “The Developmental Trajectory to Cannabis Use Disorder.” It is a severe psychiatric disorder characterized by psychosis. 

Among adults, cannabis use disorder can lead to lung problems as it is typically smoked. It can also lead to deficits in attention and memory, interpersonal and occupational difficulties, and an increased risk of addiction not just to cannabis but also to other substances.

Marijuana Use and Special Populations

Marijuana or cannabis use among special populations is concerning. Especially when they can experience the effects of the substance more severely. The review article, “Cannabis Use in Pregnant and Breastfeeding Women: Behavioral and Neurobiological Consequences,” links cannabis use during pregnancy to several birth issues in babies, like low birth weight, reduced head circumference, cognitive deficits, impulsivity, aggression, and a greater risk of developing substance use disorders.

Similarly, among adolescents or teenagers, cannabis use raises several red flags as their brains are still developing. Regular cannabis use during this formative time frame can lead to impairments in attention, learning, and memory as well as a greater risk of developing addiction.

Moreover, cannabis use has wide-ranging effects on other aspects of life as well, especially where sleep is concerned, thereby impacting the overall health of a person. It is often said that cannabis helps people sleep, however, the reality is that insomnia is two times more likely with regular cannabis users, whether used daily or weekly, as per the study, “Study of the association between cannabis use and sleep disturbances in a large sample of University students,” conducted by  French universities in Bordeaux, Versailles, and Nice.

How is Cannabis Use Disorder Diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is the standard manual used to diagnose cannabis use disorder. It suggests 12 criteria, and for a person to be diagnosed with CUD, they need to be diagnosed with at least 2 of the 12 criteria. Additionally, these symptoms need to be present within a 12-month period to indicate CUD.

Clinicians also rely on validated, self-report measures specifically designed for cannabis use. Cannabis Abuse Screening Test (for adolescents) and Cannabis Use Disorders Identification Test – Revised are some of the tools used to identify the persons at risk and also to inform treatment.

With that being said, there is no one universally applicable instrument for use. Clinicians, more often than not, have to rely on their clinical judgment to identify the tool that may be most suitable in a given context.

Treatment Options for Cannabis Use Disorder

Many treatment options are available for CUD, and the best among them are psychotherapies. Cognitive Behavioral Therapy (CBT), in particular, has produced excellent results and is the go-to choice for the treatment of CUD. It identifies and modifies damaging thinking patterns and behaviors associated with CUD, thereby facilitating recovery.

Motivational Interviewing (MI), a counseling technique, helps change a person’s behavior toward cannabis use and recovery by building motivation, is also something worth considering.

On the flip side, there are no Food and Drug Administration (FDA)-approved medications for CUD. There are many voices calling for this to change, for as has often been noted with psychological disorders, a combination of psychotherapeutic and pharmacological treatments is the best way forward.

Special considerations for teenagers are important while looking at treatments for CUD, especially as adolescents are most at risk of developing the disorder. The strongest evidence for treatment among teens has also been for CBT. However, treatment programs for teens also need to consider co-occurring mental health issues, integrate family counseling, and create tailored interventions for their age and specific needs.

Cannabis use disorder can change a person’s life, but not for the better. It might seem like there is no light at the end of the tunnel, however, it is not true. Early attention and the right approach to treatment can lead to recovery and sober living.

Can Medical Marijuana Lead to Addiction?

Yes, medical marijuana can lead to addiction. Some doctors prescribe marijuana for medical reasons, especially to deal with the side effects after chemotherapy. While this has often been used as an argument for pushing for legalizing marijuana, the main question here is – can medical marijuana lead to addiction?

There has been evidence that medical marijuana can have negative consequences, especially among those suffering from anxiety and depression. What is worth noting here is that people with anxiety or depression are most vulnerable to developing cannabis use disorder or even cannabis addiction.

While there is no doubt that medical marijuana has its benefits, the key is to balance its therapeutic effects and the risk of addiction it carries. Healthcare providers can play a very crucial role in this. By educating patients about the risks that marijuana carries and about the potential signs of dependency, the risk of addiction can be mitigated to a great extent. Moreover, establishing clear guidelines for medical marijuana use, like only sticking to the prescribed amounts, avoiding recreational use, and emphasizing consistent follow-ups allow patients to adjust to the treatment plan. This also ensures that marijuana only remains beneficial as part of the treatment without veering toward dependency.

An additional concern with medical marijuana is also whether it can be prescribed during pregnancy. The answer to that is quite straightforward. Similar to recreational marijuana, medical marijuana does carry significant risks to the baby. These include premature birth, low birth weight, and restricted fetal development.

How to Prevent Cannabis Use Disorder?

Cannabis use disorder can very much be prevented, however, proactive steps must be taken toward the same.

To prevent CUD, it is crucial to establish clear boundaries and limits. So, if new to cannabis, take lower doses and only consume it in controlled and safe environments. Understanding personal tolerance levels so as to not sail perilously close to dependence is also very important. Regularly assess the need for cannabis in life, and be acutely aware of any changes in the dose or frequency to maintain a healthy relationship with the substance.

Moreover, if simple steps are taken by the person, family, community, and society, the prevalence of CUD can also be reduced:

• Education is the first step. By extending outreach programs and increasing community understanding of cannabis use and its negative effects.
• When it comes to youth, educating parents and community members regarding the devastating impacts of CUD on developing brains and restricting access to it.
• Offering education and free support services for special populations like expectant mothers regarding cannabis use and its effects on babies.
• Supporting media campaigns like Substance Abuse Prevention and Control (SAPC) media campaigns that expose communities to messages that bring about positive change and reduce risks.

Where to Get Help for Cannabis Use Disorder

If you or a loved one may be suffering from cannabis use disorder, the first step to recovery is identifying it and seeking help for it. There are many paths you can choose for your journey toward sobriety.

Rehabilitation centers are structured environments where medical supervision, therapy sessions, and peer support are certain facilities provided. Both, inpatient, and outpatient programs are available and they cater to different levels of treatment depending on the severity of the disorder.

If structured environments are not suitable or needed, then informal support groups are something to consider. Narcotics Anonymous (NA) and Marijuana Anonymous (MA) are peer-led support groups that provide a respectful and safe space to share experiences, find encouragement, and take responsibility. They follow the Twelve Traditions and practice the Twelve Steps toward recovery, both of which have been central to the success of the more well-known Alcoholics Anonymous (AA).

Moreover, individual therapies like CBT and counseling services are worth considering as well, as they can be tailored to substance use disorders and can offer personalized approaches for treating CUD. This goes for both adolescents and adults.

If seeking a program designed for lasting recovery and sober living in Los Angeles, then Bridges Sober Living Apartments offers a unique program wherein clients can get one-on-one mentoring with our experienced healthcare specialists and enjoy semi-private rooms designed to balance solitude as well as social support.

Medication monitoring, community-building meals, and money management are all part of the comprehensive care system, where a drug-free environment ensures regular testing and instills responsibility. Family services are also available, which are geared toward repairing broken relationships and guiding clients as well as their loved ones toward healing.