The dried leaves, stems, and flowers from the plant Cannabis sativa are more commonly known as marijuana. Marijuana, while it is legal in some states, is still classified as a Schedule I controlled substance by the United States Drug Enforcement Administration. As such, it is the most commonly used illicit drug in the United States. The major active ingredient in cannabis is delta-9-tetrahydrocannabinol (THC), although there other related compounds.
In 2014, the Substance Abuse and Mental Health Services Administration issued a report on a national survey on drug abuse and use that indicated the following:
- Slightly over 80 percent of all people who used illicit drugs used marijuana at one time, and 65 percent of these individuals reported that marijuana was the only illicit drug they used.
- More than 22 million people reported being marijuana users.
- For young people between the ages of 18 and 25, marijuana was the most common drug of abuse.
- Adults over the age of 26 who reported using marijuana before the age of 15 also reported high instances of using other substances, such as cocaine (62 percent of that group), prescription drugs (54 percent of that group), and heroin (9 percent of this group reported using heroin at least once).
While there are a number of potential medical uses for marijuana, this does not make its recreational use legitimate. In this country, there is currently quite a bit of controversy over the legalization of marijuana, especially in the light of the legal status of drugs that may be physically more addictive and dangerous, such as alcohol. There are questions regarding marijuana’s potential to result in the development of physical dependence, abuse, and potential addiction. These questions have been addressed by the development of a formal clinical diagnosis.
Cannabis Use Disorder
The notion of a substance use disorder is the new clinical terminology for the former terms substance abuse and substance dependence (addiction). The notions of abuse and addiction are combined into one singular disorder. Individuals displaying fewer symptoms of the substance use disorder are considered to be more in the abuse end of the spectrum, whereas individuals displaying more symptoms are located on the dependence or addiction end of the spectrum. The term for both marijuana abuse and addiction is now cannabis use disorder.
The National Institute of Drug Abuse and the American Psychiatric Association both consider marijuana to be a psychoactive substance that can be abused and lead to addiction. The American Psychiatric Association clearly lays out the symptoms for a cannabis use disorder, which have been developed based on the research associated with individuals who have serious issues related to abusing marijuana.
The National Institute on Drug Abuse similarly reports that marijuana is addictive due to both to the physiological changes that occur in the brain as a result of chronic marijuana usage and psychological changes that also occur due to chronic use. Individuals who begin smoking marijuana at younger ages or who use marijuana daily are at increased risk to develop the symptoms.
The symptoms of a cannabis use disorder include the clinical diagnostic symptoms reported by the American Psychiatric Association that can only be professionally applied by licensed mental health care workers. In addition, symptoms of a cannabis use disorder include:
- Using marijuana more often, in larger amounts, or for longer periods of time than originally intended
- Having cravings to use marijuana
- Failing to fulfill important aspects of one’s job, family responsibilities, and educational responsibilities as a result of marijuana use or due to recovering from marijuana use
- Continuing to use marijuana despite knowing that such use is causing functional issues or resulting in negative consequences
- Using marijuana in inappropriate situations or in situations where marijuana use could be dangerous
- Spending more time using marijuana, developing financial issues as a result of marijuana use, spending significant amounts of time trying to obtain marijuana, or using marijuana instead of engaging in formally satisfying and pleasurable activities
- A change in one’s appearance, such as seeming less concerned with one’s appearance
- Changes in friends or associates who spend significant amounts of time using or trying to get marijuana
- Financial issues as a result of using marijuana
In addition, individuals who begin to use more and more marijuana to achieve the same effects that they achieved at lower doses previously, and who develop mild withdrawal symptoms when they stop using marijuana, are displaying signs of physical dependence on marijuana. Withdrawal symptoms from cannabis typically include severe irritability, restlessness, decreased appetite, mood swings, difficulty sleeping, and strong cravings to use marijuana. Thus, the physical dependence that develops on marijuana is relatively mild. The National Institute of Drug Abuse estimates that about 9 percent of heavy users develop symptoms of physical dependence.
Who Abuses Marijuana?
Marijuana is a widely abused the drug. As mentioned above, the age group most significantly affected by cannabis abuse are individuals between the ages of 18 and 26; however, individuals over all ages abuse marijuana.
Risk factors for developing a cannabis use disorder include:
- A family history of a substance use disorder: The risk is higher if one has a first-degree relative, such as a brother, sister, or parent, with any kind of substance use disorder. Having a first-degree relative with a marijuana use disorder increases the risk even more.
- Peer pressure/peer relations: For most individuals, marijuana is a social drug. Individuals tend to begin using the drug with peers.
- The age at which one begins using marijuana: Typically, the younger people are when they begin using marijuana, the higher the risk of developing a marijuana use disorder.
- Potency: Individuals who smoke or ingest high-potency strains of marijuana are more likely to develop marijuana use disorders.
- The presence of other psychological disorders: Any co-occurring mental health issues can increase the likelihood of developing a substance use disorder.
Those attempting to recover from a substance use disorder of any type will benefit from the assistance of a professional treatment program. These programs address the substance use disorder from a number of different perspectives and help clients to learn structured approaches to relapse prevention.
While marijuana abuse or a cannabis use disorder is not associated with the potential to develop significant physical dependence and potentially dangerous physical withdrawal symptoms, many individuals will experience some level of withdrawal symptoms, and about 10 percent will experience fairly significant withdrawal symptoms. Most of the symptoms are emotional and psychological, but some minor physical symptoms may also occur.
A formal medically assisted detox program may be useful for individuals who have long histories of chronic marijuana usage. While some type of residential or inpatient treatment program is not necessary for most individuals, it might be advisable under certain conditions.
Individuals looking to recover from a cannabis use disorder should consider the following:
- All forms of effective treatment for substance use disorders include some type of individual therapy, group therapy, or a combination of individual and group therapy or counseling. The approach to therapy for substance use disorders should be based on empirically validated treatment approaches (treatment approaches that have been demonstrated in the research literature to be successful). These approaches can all be slightly tailored to meet the specific needs of the individual case, but should follow the general blueprint designed to ensure success in recovery.
- Substance use disorder treatment/therapy typically uses some type of cognitive-behavioral approach to assist the individual in recognizing the issues that drive their substance use, changing irrational and dysfunctional methods of thinking, and developing new coping skills that are more in line with recovery.
- Family support, peer support, and other forms of social support are necessary to ensure recovery. For some individuals, this may include some type of family therapy in order to identify aspects of the family environment that contribute to substance abuse. For some individuals, this may require actually developing an entire new peer support group and letting go of old friends who helped to foster the substance use disorder. One potentially important resource is getting involved in some type of 12-Step group, such as Narcotics Anonymous or Marijuana Anonymous.
- The use of medically assisted treatment options when needed. Many individuals with substance use disorders, including cannabis use disorders, may also suffer from co-occurring psychological disorders, other medical issues, and so forth. These issues will require the consultation of a psychiatrist or other physician to medically treat them. Co-occurring psychological disorders can also be treated in therapy along with marijuana use disorder.
- Treatment should focus on helping the individual develop a new set of skills, coping strategies, stress management techniques, and other approaches to allow for long-term recovery. In addition, long-term aftercare, such as continued participation in 12-Step groups or other activities focused on maintaining recovery, will ensure that the individual continues to engage in proactive behaviors designed to ensure wellness and manage the substance use disorder.