What is Cannabis Use Disorder?

Cannabis can help us, but can it also hinder our lifestyle? Is there a point when the benefits of cannabis stop?

We note that the subject contained in this article represents illegal activity in certain jurisdictions. Whilst we do not condone any acts which are contrary to any such laws, we understand that readers in those jurisdictions which have decriminalised cannabis may find this article of interest.

Cannabis can be a God-send for pain relief, insomnia, and stress; yet for some, it can make things worse, a lot worse. Cannabis Use Disorder (CUD) occurs when a person suffers from withdrawal symptoms when cannabis use ceases. Not everyone is at risk of becoming addicted, but it can happen. With legalisation gaining traction and more potent strains emerging, cannabis use might be the cause of addiction levels rising.

Cannabis remains illegal under federal law as a Schedule I drug, meaning that it does not classify to have any medicinal benefits. Opiates, on the other hand, are the leading cause of prescription addiction and classify as being less harmful under the same federal law as a Schedule II drug. 

This fact seems ludicrous at face value. Research and development investigating cannabis benefits are now in demand and medicinal marijuana restrictions in the U.S. are loosening on a state-by-state level. Meanwhile, CBD-based products are now available for purchase in the U.S., Canada, and the U.K. 

In Australia, medicinal cannabis is federally legal in all states. According to a report by Prohibition Partners, the Oceania legal cannabis market will reach an estimated USD 1.55b by 2024. This is due to a rise in investments in domestic cultivation, and clinical research into understanding the plant. From this, Australia is likely to account for 79% of the Oceania market by 2024.

Despite a relatively slow start, the global cannabis market is on the rise and the public demand for it is showing now more than ever. Nine out of eleven recreationally legal U.S. states categorise cannabis use as an 'essential' service during the current COVID-19 pandemic, and sales are spiking as a result.

However, even though there is public demand for the plant, cannabis use can, at times, have more negative effects than positive ones. Cannabis can make us feel good, help us sleep, and was one of the first natural substances to relieve pain. But we also know that too much of a good thing can do more damage than we intend it to. 

There is an ongoing debate on whether or not cannabis is addictive or not. The simple answer is: yes, it can be addictive; but not for everyone. Cannabis use affects different people in different ways. There are people who are frequent users of cannabis for years and won't be at risk of addiction and there are others who will be.

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What is Cannabis Use Disorder? 

CUD (also known as marijuana use disorder) is a substance abuse disorder classified in the Diagnostic Statistics Manual, 5th Edition (DSM-V). It classifies CUD based on the identification of 11 behavioural symptoms: 

  • Cannabis is often taken in larger amounts over a longer period of time than intended.
  • A persistent desire or unsuccessful efforts to cut down or control cannabis use.
  • A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.
  • Craving, or a strong desire to use cannabis.
  • Recurrent cannabis use resulting in a failure to fulfil major role obligations at work, school, or home.
  • Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of cannabis.
  • Important social, occupational, or recreational activities are given up or are reduced because of cannabis use.
  • Recurrent cannabis use in situations in which it is physically hazardous.
  • Cannabis use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are likely to have been caused or exacerbated by cannabis use.
  • Tolerance, as defined by either: 1) markedly increased to achieve intoxication or desired effect or 2) markedly diminished effect with continued use of the same amount of the substance.
  • Withdrawal, as manifested by either: 1) the characteristic withdrawal syndrome for cannabis or 2) cannabis is taken to relieve or avoid withdrawal symptoms.

 Depending on how many symptoms a person can identify with, the severity of the disorder can fluctuate from person to person. For example, a person that only identifies with two symptoms has a mild case of CUD, while a severe case consists of having six or more symptoms. 

There are different categories of CUD that affect users. This can include cannabis-induced insomnia, cannabis-induced anxiety, and cannabis intoxication delirium among others. It's an extensive disorder.

The key to treating CUD lies within several behavioural therapies that can help rephrase thoughts and motivation. Cognitive behavioural therapy, contingent management, and motivational enhancement therapies are all effective in transitioning negative thought patterns and behaviours. 

Evidence also shows that gradually cutting down the dosage of cannabis is more effective in quitting the plant than going cold turkey. In cases of substance abuse, if users are receiving treatment for CUD, then the goal is to cease cannabis use altogether.

I Feel the Need, the Need for Weed 

As cannabis legalization spreads globally, the reasons behind its use are increasing too. Overall, cannabis and CBD use is escalating in almost all demographics, including pregnant women and the elderly. 

People use cannabis for different reasons, sometimes its as simple as experimentation or stress relief; other times it's medicinal. In pregnant women, for example, a cohort study found that cannabis use tripled between 1999-2003. Most likely for prenatal nausea and perinatal pain relief.

When legalisation is loosening, and investment is increasing, there's no surprise that cannabis use will increase with it. However, this can also be at a detriment. The more cannabis we consume, the more the risk of developing dependence increases. 

CUD revolves around dependence. Cannabis can make you feel better and give you a good night's rest. For some, however, there's a point when cannabis can start becoming counterproductive. 

In some cases, when long-term users stop, they can lose sleep, feel irritated, apathetic, and depressed. The longer chronic use occurs, the more users will feel like cannabis is the answer.

Is Cannabis Use Disorder on the Rise? 

There have been studies that suggest that around 9% of cannabis users end up developing CUD; however, other studies state that low levels of dependence can occur in as high as 30% of users. This rate can increase in teenagers due to the effect cannabis can have on developing minds.

A 2019 study shows that addiction to cannabis has increased in U.S. states that have legalised recreational cannabis use. People over the age of 26 use cannabis at a 26% higher rate than those in states where recreational weed remains illegal. Similarly, there has been a 37% increase in CUD cases in recreationally legal states in the same age group. 

With legalisation rising, the demand for more potent weed has increased as well. The average THC content in cannabis has risen from 3.8% to around 12% within the past two decades. Some cannabis strains can contain up to 40% THC. Prolonged use of potent cannabis can have detrimental effects on brain function.

Addiction appears to be common in people that use weed both recreationally as well as medically. However, it's important to understand that most people who use cannabis will not develop an addiction. 

Is it Addictive or Not? 

Cannabis interacts with our brain function through our endocannabinoid system. When our brain functioning is already impaired, cannabis can exacerbate unwanted symptoms.

Two categories of people seem to have more of a risk of CUD than most: heavy, chronic users (especially is cannabis use began at an early age) and people with a history or a predisposition to psychotic disorders.

People who inherit the psychosis gene are psychologically vulnerable, meaning that their cognitive regulation and awareness are disrupted. Just because you inherit the gene, doesn't mean that you'll develop psychosis, it simply places you at a higher risk. Cannabis use can enhance symptoms of psychosis, especially when use begins early in life. 

On the other hand, chronic, heavy cannabis use can cause anxiety, depression, and cognitive impairment. Similarly, higher levels of THC found within chronic users are indicative of brain dysfunction, hallucinations, and delusions. In adolescence, heavy use can cause lower academic achievement and lower IQ

Evidence shows that the reason for use can be as important in developing a risk of addiction. While heavy use in people who use cannabis to enhance activities, enjoyment, and habit may cause dependence; this risk increases in people who use cannabis as an avoidant. People who use cannabis as a way to escape reality, avoid unpleasant feelings, and out of boredom are at the most risk of developing an addiction. 

Cannabis is a great resource for some, however, its implications on our brain function are not something that should be taken for granted. If you are aware of a genetic predisposition to any form of psychosis then perhaps rethink your reasoning for using cannabis. 

Ultimately, one's mental health is a valuable asset. So, if you find yourself depending too much on weed to make you feel better, speak to your health-care professional. 

CUD is as complicated as the plant itself. Its awareness is important in making sure that cannabis is available for people in a safe, healthy way.

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Taylor Ridewood
Taylor Ridewood

Taylor is a Sydney-based writer with a background in psychology and professional writing. She has a keen interest in the benefits of medicinal cannabis and enjoys researching the multi-faceted effects of cannabis on the body and mind.

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