Cannabis Dependence

Cannabis Dependence

Cannabis Dependence

Cannabis Use Disorder (CUD) is the dependence on marijuana / cannabis to feel good regardless of its mental and physical damage. THC is the main psychoactive element of marijuana / cannabis, with mind-altering and health-damaging abilities such as permanent loss of IQ (if started young), significant driving and athletic impairment, growth and brain development damage in utero, low motivation—which damages relationships, schooling outcomes, and job performance—and possible depression, psychotic and suicidal thoughts, and anxiety.

Marijuana can be smoked, vaporized, cooked into food, or diffused in drinks or other liquids. Smoking THC resins in the form of hash oil, wax, budder, or shatter delivers dangerously higher amounts of THC. Vaping THC is causing hundreds of severe lung diseases and several deaths. The onset of the effects of cannabis is usually felt within minutes when smoked and can last for two to six hours, depending on the amount used.

Prevalence

In the United States, approximately 50% of the population has used marijuana / cannabis, with numbers rising; and approximately 9 to 30% of users develop cannabis dependence. The largest group of marijuana users are those in the 18 to 25 age group, with almost 4% of 18-year-olds vaping THC daily.

Recreational use of marijuana has been legalized in some countries and US states.

Medical use of marijuana, requiring the approval of a physician, has been legalized in a greater number of countries.

Symptoms of Cannabis Dependence or Abuse:

Marijuana has multiple mental and physical effects.

  • Mental effects – include euphoria, disinhibition, impaired judgment, altered states of mind, altered sense of time, mood changes, difficulty thinking or concentrating, tiredness, relaxation, confusion, anxiety, paranoia, and defective short-term memory. Hallucinations, delusions, and psychosis can be experienced with higher doses.
  • Physical effects – include a faster heart rate, decreased blood pressure, difficulty breathing, dizziness, nausea, dry mouth, red eyes, poor coordination, distorted perception, awkward or impaired body movements, sedation, and an increase in appetite.

Diagnosis of Cannabis Dependence or Abuse:

For a diagnosis of CUD to be made, the cannabis must have been used for at least a year, and no fewer than two of the following eleven criteria must be present over a 12-month period:

  1. Hazardous use
  2. Social and interpersonal problems
  3. Neglected major roles
  4. Withdrawal
  5. Tolerance – consuming higher doses of the drug to achieve the desired effect or “hit”
  6. Used larger amounts and/or for longer periods of time
  7. Repeated attempts to quit or control use
  8. A great deal of time spent using
  9. Physical or psychological problems related to use
  10. Activities given up
  11. Craving

CUD can be classified as:

  • Mild: 2 – 3 criteria
  • Moderate: 4 – 5 criteria
  • Severe: 6 or more criteria

Causes of Cannabis dependence:

The exact cause of cannabis dependency remains unknown; however, genetic and environmental factors have both been implicated.

Young age and frequency of use are the main factors that increase the risk of developing CUD. Other risk factors include:

  • Emotional distress
  • Poor parenting
  • School drop-out
  • Affiliation with drug-using peers
  • Daily cigarette smoking
  • Ready access to cannabis

Risk factors for Cannabis dependence:

Short-term risks include a reduction in athletic abilities, increased heart rate, and a higher chance of driving accidents due to the slowing effect of marijuana on the mind’s senses and reaction times. Smoking weed while pregnant can slow down a baby’s growth and brain development and may cause premature or stillbirths. Marijuana is also ingested through a mother’s breast milk.

Long-term detrimental outcomes may include decreased IQ of up to 8 points in those who started using it regularly as teenagers, chronic coughing, anxiety, depression, suicide planning, and a predisposition to respiratory infections. Compared to those who don’t use marijuana, long-term users have reported deficiencies in every aspect of life — less general happiness, worse mental and physical health, and more relationship problems. They are also more likely to regularly withdraw from daily life by dropping out of school and taking more sick days from work.

People who use high doses of marijuana / weed are at increased risk of developing psychotic symptoms such as delusions and hallucinations. People who experience psychosis as a result of marijuana use are at increased risk of developing schizophrenia.

Increasing the strength of the marijuana taken and an increasing use of more effective methods of delivery often increase the progression of CUD.

Treatment for, and recovery from, Cannabis dependance:

Treatment options for CUD include:

  • Talking therapies – cognitive behavioral therapy and motivational enhancement therapy (MET)
  • Medication – no medications have been found effective for CUD. Rather, the goal of medication therapy for CUD revolves around targeting the stages of the addiction:

    • Acute intoxication / binge,
    • Withdrawal / negative affect, and
    • Preoccupation / anticipation.
  • Peer support programmes
  • Adjustments to a person’s environment – such as the removal of any paraphernalia

Marijuana withdrawal symptoms occur in one-half of people in treatment for CUD. Symptoms may include anxiety, irritability, depression, restlessness, disturbed sleep, excessive sweating, and decreased appetite. Most symptoms begin during the first week of abstinence and resolve after a few weeks. About 12% of heavy marijuana users show marijuana withdrawal.

Symptoms of Cannabis Dependence or Abuse:

Marijuana has multiple mental and physical effects.

  • Mental effects – include euphoria, disinhibition, impaired judgment, altered states of mind, altered sense of time, mood changes, difficulty thinking or concentrating, tiredness, relaxation, confusion, anxiety, paranoia, and defective short-term memory. Hallucinations, delusions, and psychosis can be experienced with higher doses.
  • Physical effects – include a faster heart rate, decreased blood pressure, difficulty breathing, dizziness, nausea, dry mouth, red eyes, poor coordination, distorted perception, awkward or impaired body movements, sedation, and an increase in appetite.

Diagnosis of Cannabis Dependence or Abuse:

For a diagnosis of CUD to be made, the cannabis must have been used for at least a year, and no fewer than two of the following eleven criteria must be present over a 12-month period:

  1. Hazardous use
  2. Social and interpersonal problems
  3. Neglected major roles
  4. Withdrawal
  5. Tolerance – consuming higher doses of the drug to achieve the desired effect or “hit”
  6. Used larger amounts and/or for longer periods of time
  7. Repeated attempts to quit or control use
  8. A great deal of time spent using
  9. Physical or psychological problems related to use
  10. Activities given up
  11. Craving

CUD can be classified as:

  • Mild: 2 – 3 criteria
  • Moderate: 4 – 5 criteria
  • Severe: 6 or more criteria

Causes of Cannabis dependence:

The exact cause of cannabis dependency remains unknown; however, genetic and environmental factors have both been implicated.

Young age and frequency of use are the main factors that increase the risk of developing CUD. Other risk factors include:

  • Emotional distress
  • Poor parenting
  • School drop-out
  • Affiliation with drug-using peers
  • Daily cigarette smoking
  • Ready access to cannabis

Risk factors for Cannabis dependence:

Short-term risks include a reduction in athletic abilities, increased heart rate, and a higher chance of driving accidents due to the slowing effect of marijuana on the mind’s senses and reaction times. Smoking weed while pregnant can slow down a baby’s growth and brain development and may cause premature or stillbirths. Marijuana is also ingested through a mother’s breast milk.

Long-term detrimental outcomes may include decreased IQ of up to 8 points in those who started using it regularly as teenagers, chronic coughing, anxiety, depression, suicide planning, and a predisposition to respiratory infections. Compared to those who don’t use marijuana, long-term users have reported deficiencies in every aspect of life — less general happiness, worse mental and physical health, and more relationship problems. They are also more likely to regularly withdraw from daily life by dropping out of school and taking more sick days from work.

People who use high doses of marijuana / weed are at increased risk of developing psychotic symptoms such as delusions and hallucinations. People who experience psychosis as a result of marijuana use are at increased risk of developing schizophrenia.

Increasing the strength of the marijuana taken and an increasing use of more effective methods of delivery often increase the progression of CUD.

Treatment for, and recovery from, Cannabis dependence:

Treatment options for CUD include:

  • Talking therapies – cognitive behavioral therapy and motivational enhancement therapy (MET)
  • Medication – no medications have been found effective for CUD. Rather, the goal of medication therapy for CUD revolves around targeting the stages of the addiction:

    • Acute intoxication / binge,
    • Withdrawal / negative affect, and
    • Preoccupation / anticipation.
  • Peer support programmes
  • Adjustments to a person’s environment – such as the removal of any paraphernalia

Marijuana withdrawal symptoms occur in one-half of people in treatment for CUD. Symptoms may include anxiety, irritability, depression, restlessness, disturbed sleep, excessive sweating, and decreased appetite. Most symptoms begin during the first week of abstinence and resolve after a few weeks. About 12% of heavy marijuana users show marijuana withdrawal.

Sources SAMHSA – Marijuana | CDC – Lung Disease | SAMHSA – National Survey on Drug Use and Health | DEA – Marijuana | QUIZLET – Substance Use flash cards | ADAI.UW.EDU. – Appetite | MEDLINE – Marijuana Intoxication | DRUGABUSE.gov – Commonly Abused Drug Charts | DRUGABUSE.gov – National Institute of Drug Abuse. (2014). Drugfacts: Marijuana. | ALBERTELLIS – The Albert Ellis Institute, | 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. | American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC. | McCaffrey DF, Pacula RL, Han B, Ellickson P. Marijuana Use and High School Dropout: The Influence of Unobservables. Health Econ. 2010;19(11):1281-1299. doi:10.1002/hec.1561. | Zwerling C, Ryan J, Orav EJ. The efficacy of preemployment drug screening for marijuana and cocaine in predicting employment outcome. JAMA. 1990;264(20):2639-2643.